Infertility is a disease of the reproductive system, in either a male or a
female, that inhibits the ability to conceive and deliver a child, after one
year of trying with unprotected intercourse for couples in which the female is
under 35 and six months of trying for couples in which the female is over 35.
Approximately 8-10% of couples experience some form of infertility problem.
Infertility is exclusively a female problem in 30-40% of the cases and
exclusively a male problem in 10-30% of the cases. Problems common to both
partners are diagnosed in 15-30% of infertile couples. After thorough medical
investigations, the cause of the fertility problem remains unexplained in a
minority of infertile couples (5-10%).
Pregnancy is a complicated process that depends on many factors:
The production of healthy sperm by the man and healthy eggs by the woman
The ability of the sperm to swim through the mouth of the uterus up to the
Unblocked fallopian tubes that allow the sperm to reach the egg
The sperm's ability to fertilise the egg when they meet
A genetically healthy embryo
The ability of the embryo to implant in the uterus.
Encountering difficulty at any of these steps, repeatedly, can lead to
Infertility is a medical problem, just as any other, which needs to be treated
- nobody is at fault.
There may be a variety of problems, in different permutations and combinations
in one or both partners. Both partners need to be investigated simultaneously
Most infertility problems are not hereditary – except for a history of premature
menopause in a mother or sister which could be significant (as it could be a
genetic predisposition), as is a history of chromosomal abnormalities in the
There is no relation between blood groups and infertility.
Delayed child bearing is not advised for several reasons. By age 36 a normal
woman's chances of conceiving per month is decreased by half, and by age 45 the
average natural fertility rate per month is approximately 1%. Most women have
about 300,000 eggs in their ovaries at puberty. By the time a woman
reaches menopause there are only several thousands eggs remaining. The
remaining eggs in her ovaries also age, making them less capable of
fertilization and their embryos less capable of implanting, there
by increasing the risk of miscarriage. Furthermore, advanced maternal
age is associated with an increased risk of genetic abnormalities in the
child e.g. chromosomal abnormalities such as Down syndrome. Gynaecological
problems such as pelvic infection, tubal damage, endometriosis, fibroids,
ovulation problems etc, also tend to increase as she has more time to
develop these conditions.
A man is capable of conceiving a child at any age.
Various clinical studies have calculated the chance of pregnancy among normal
couples who do not use contraception, and indicate that the probability of a
live birth after exposure in any one month averages about 1 in 5, or a 20%
To increase the chance of getting pregnant spontaneously, timed sexual
intercourse is recommended. This means that sexual intercourse, or coitus, has
to take place around the time of ovulation, (release of a mature egg from the
ovary) which is the most fertile period of a woman. This is, in a normal woman,
mostly about 14 days after the first day of the period. The time of ovulation
can sometimes vary a few days each month, even in a regular menstrual cycle. If
the circumstances are right, sperm remain alive and active in woman's cervical
mucus for 48-72 hours following sexual intercourse.
The position of the hips or the coital positions is not important. It is not
necessary for the woman to have an orgasm for conception to take place.
Sperm quality can decrease with high sexual activity. Therefore it is best to
have intercourse 3-4 days before the expected ovulation and every other day
until 2-3 days after the expected ovulation with no necessity for higher
frequency. Although having sexual intercourse near the time of ovulation is
important, no single day is critical.
Semen consists of sperms and seminal fluid secreted by the seminal vesicles and
the prostate. Most women notice some discharge of seminal fluid immediately
after sex. Many infertile couples imagine that this is the cause of their
problem. If your husband ejaculates inside you, then you can be sure that no
matter how much seminal fluid leaks out afterwards, if the semen count is
normal, enough sperm will reach the cervical mucus and swim into the uterus.
This “leakage” is not a cause of infertility.
Fertility potential is dependent on sperm count and not on the volume or
consistency of the semen. Sperm count can only be assessed by microscopic
examination. Men with totally normal sex drives may have no sperm at all.
Masturbation is a normal activity in which most boys and men indulge. This
activity does not affect the sperm count, as sperm are constantly being
produced in the testes.
A normal, fertile man’s sperm count can vary considerably from week to week.
Sperm count and motility can be affected by many factors, including time
between ejaculations, the weather, illness, and medications. There are other
factors which affect the sperm count as well, many of which we do not
Ovulation dysfunction can occur with apparently regular cycles. Tests have to be
done to confirm that ovulation is normal. Irregular cycles indicate a higher
chance of an ovulation problem.
Painful periods do not affect fertility. In fact, for most patients, regular
painful periods usually signal ovulatory cycles. However, progressively
worsening pain during periods (especially when this is accompanied by pain
during sex) may mean you have endometriosis.
About one in five women have a retroverted uterus that is a uterus which has
fallen back. If the uterus is freely mobile, this is normal. This is not a
cause of infertility and certainly not an indication for surgery.
A routine gynaecological examination does not always provide information about
possible problems which can cause infertility. A
systematic infertility workup is a must.
Surgeries on the pelvic structures (including D&C) must be kept to the
minimum and performed only when absolutely necessary as they can damage
their structure and function.
Compared to normal fertility rates, effective treatments can be expected to
have, on average, up to a 25% success rate per cycle of treatment, and may
therefore need to be repeated several times before a pregnancy is achieved.
Fertility drugs do increase the chance of having a multiple pregnancy (as they
stimulate the ovaries to produce several eggs), however, a majority of women,
(about 90%), taking them have a singleton pregnancy - with the remaining
10% being mostly twin.
No epidemiological study has ever established a causal link between ovulation
promoting drugs and ovarian cancer. The chance of a young woman developing an
ovarian malignancy during her lifetime is lower than 1.5%. A number of factors
have been found to increase the risk of ovarian cancer, including genetic
predisposition, dietary habits and infertility itself. Each pregnancy reduces
the risk of a woman contracting ovarian cancer.
The incidence of birth defects in children born following treatment with
ovulation promoting drugs has never been found to be higher than that in the