Having a baby can be one of life's greatest experiences and joy, this privilege is denied to many couples because of infertility. Roughly 10-15% couples face some fertility problems at some stage of their reproduction carrier. Approximately 13-19 million couples are likely to be infertile in our country at any given time. With increasing awareness among people to have a child from their own egg and sperm, reproductive health is becoming a major health care. Number of patients seeking professional help is sharply expanding. Achievement of pregnancy and development of foetus are extremely complex processes involving hundreds of synchronized and timely occurring events. Any wrong at one or more steps may result in causing delay in achieving pregnancy or infertility. Obviously treatment of infertility is a challenging task. However, current level of diagnoses, understanding and management techniques have made it possible to treat nearly every kind of infertility.
Pregnancy in Natural Cycles
Human reproduction is a relatively slow process. In average fertile couple, the probability of fertilization for any particular exposure of egg to sperm may be approximately 80%, but by the time of the first expected menstrual period after ovulation, approximately half of the early embryos have failed to develop. Many of these lost embryos were fundamentally abnormal and were incapable of survival. The menstrual period may not even be delayed and the couple may not realize that an early pregnancy has been lost. If a menstrual period is missed, approximately one-fourth of the remaining embryos may die later. The probability of a live birth after any one exposure in a normally fertile couple, therefore, is generally no higher than 30%. From a practical point of view, therefore, the expectancy of a continuing pregnancy which will result in birth of a child after any one egg-ovulation is somewhere in the range of 20-25%.
What is Infertility?
Infertility is a disease or condition of the reproductive system often diagnosed after a couple has failed to conceive after one year of unprotected, well timed intercourse, or if the woman has been unable to carry a pregnancy that results in a live birth.
| Primary Infertility | Secondary Infertility |
| Infertility without any previous pregnancy. | When there has been a previous pregnancy. |
Sterility
When there is no chance for a natural pregnancy. This is different from infertility which generally represents a reduced potential for pregnancy. Most childless couples with a female age under 42-44 years that are having problems of getting pregnant are infertile but not sterile.
Probability of Pregnancy Decline with Advancing Age
The effect of age on incidence of infertility and on the results of the therapy cannot be ignored. It is well documented that there is diminished fecundity with increasing age. A woman reaches the maximum fertility potential at the age of 24 years. By the age of 30 her fertility potential begins to decline. However, the decline is not significant, until the age of 35 and it is more marked after 40 years.
Probability of Pregnancy and Age
| Age Group (Yrs) | % Conceiving within 12 Months |
|---|---|
| 20-24 | 85 |
| 25-29 | 78 |
| 30-34 | 63 |
| 35-39 | 52 |
| 40 | 42 |
It has been found that the time required to attain pregnancy increases with the age of a woman. The cumulative pregnancy rate decrease substantially with advancing age.
Age related Infertility
| Age Group (Yrs) | % Conception with Intrauterine Insemination |
|---|---|
| <31 | 15.1 |
| 31-35 | 12.9 |
| 36-40 | 14.6 |
| 41-45 | 6.0 |
| >45 | 0.0 |
When should the Couple seek Medical Assistance for Infertility?
In general, it is appropriate to see a physician for infertility after 12 months of trying to conceive naturally. Depending upon the age of the female partner this time can be longer or shorter. If the woman is young, around 20, 2 years of trying for natural pregnancy can be considered. If the patient has a condition that predisposes to infertility such as irregular menstrual cycles (either early or late), endometriosis, previous tubal pregnancy, polycystic ovarian syndrome, pelvic inflammatory disease, painful menstrual cycles, pelvic pain, repeated abortions etc., immediate medical help is warranted. Similarly men with low sperm count or a history of testicular or prostate cancer or sexual problems must consider seeking help earlier. If the female partner is over 37 years, she may need to seek help sooner than 12 months (e.g. after 6 months of trying). It is appropriate for a woman around 40 and older to see a fertility specialist if not pregnant after 3-6 months of trying. A high percentage of women over 40 years will need medical intervention in order to conceive.
Distribution of Infertility
In both men and women multiple factors can account for difficulty with fertility. According to the current statistics male and female contribute nearly equally(35-40%) to infertility and as such the modern infertility studies should address itself to the couple in a balanced fashion and not confine only to woman as the only control symbol.
Distribution of Infertility
In both men and women multiple factors can account for difficulty with fertility. According to the current statistics male and female contribute nearly equally(35-40%) to infertility and as such the modern infertility studies should address itself to the couple in a balanced fashion and not confine only to woman as the only control symbol.
The Causes
| 1. | Due to Female Factor | 35-40% |
| 2. | Due to Male Factor | 35-40% |
| 3. | Combined Factor | 10-15% |
| 4. | Unexplained Infertility | 10-15% |
Female Factors
| 1. | Irregular ovulation or egg production, hormonal imbalance | 40% |
| 2. | Tubal block | 30% |
| 3. | Uterus problems viz. fibroids adhesions, congenital abnormalities, chocolate cysts of ovaries, endometriosis | 20% |
| 4. | Unexplained causes | 10-15% |
Male Factors
| 1. | Low mobility of sperm with normal and low count, even total absence of sperm in the ejaculate. |
| 2. | Varicocele, absence or blockage of vas deferens, blockage of epididymis, testicular dysfunction and hormonal imbalance. |
| 3. | Infection of male genital tract. |
Improve Your Chance of Getting Pregnant!
Most Fertile Time of Woman
The most fertile time of the month is just before or at ovulation. Ovulation usually occurs two weeks before a period starts. Take the number of days in the usual cycle (from the beginning of one period to beginning to the next) and subtract 14. For example, a woman with a 32 day cycle would likely ovulate around Day18 (32-14=18), while a woman with a 28 day cycle would ovulate around Day14 (28-14). Because sperm live longer than the egg does, it is best to have intercourse before ovulation rather than after it , so a women who ovulates on Day14 would have a good chance of conceiving if she has intercourse on either Day13 or14. The ovulation can be predicted by ultrasound, basal body temperature and ovulation prediction kit available in the market.
Frequency of Intercourse
It is a good idea to have intercourse every other day around the time of ovulation (Day10, 12, 14 and 16). Every woman is different, and may not ovulate exactly on "Day14". To maximize the chance of pregnancy, it is preferable to have intercourse on the alternate day rather than every day so that sufficient sperm will be available in the uterus around the time of ovulation.
Present Status of Infertility Treatment
Human reproduction is a slow process. However, advances in the field of reproductive medicine, new diagnostic tools and various Assisted Reprodution Technology procedures have currently made it possible to treat all kinds of infertility, but the female age is the key issue. As the fertility time in women's life is very limited (ranging from 18-35 years), no time should be wasted. An expert management in the hands of infertility specialist can help achieve pregnancy in more than 60-70% cases.
