Infertility: when nature doesn't take its course

Most couples assume that when the time is right, they will be able to start a family. However, in 10 to 15 per cent of couples, no pregnancy occurs after a year of unprotected sexual intercourse. When this happens, infertility is suspected and testing can begin.

Infertility is usually defined as an inability to conceive after a year of unprotected intercourse in women under the age of 35, and after six months of unprotected intercourse in women over the age of 35.

There are several reasons for this inability to conceive, many of them treatable. Around one-third of the cases of infertility are related to factors in the male’s body, one-third related to the female body and the remaining third can be attributed to a combination of factors in both partners, or to factors that cannot be explained.

Couples are generally advised to seek medical help if they are unable to achieve pregnancy after a year of unprotected intercourse. Both partners should be examined to determine their overall state of health and to check for common problems preventing conception. X-rays may be done of the woman’s fallopian tubes, (the tubes through which eggs pass from the ovaries to the uterus) and uterus (womb), and semen analysis is also likely to be carried out. If obvious problems are discovered, surgery or drug therapy will be done to correct the problem.

The most common male infertility factors include azoospermia (no sperm cells are produced) and oligospermia (few sperm cells are produced). Sperm cells may also be malformed or die before they reach the egg.

In women, the most common factor in infertility is a disorder related to ovulation. This could include blocked fallopian tubes, which can occur as a result of pelvic inflammatory disease or endometriosis.

Factors linked to female infertility include:

  • Irregular ovulation (release of eggs from the ovaries) or lack of ovulation
  • Poor egg quality
  • Polycystic ovarian syndrome a condition in which sacs of fluid grow on the ovaries, sometimes interfering with the production of sex hormones by the ovary
  • Pelvic inflammatory disease – infection and inflammation of the uterus, fallopian tubes and surrounding tissues
  • Endometriosis – a condition in which the tissue that normally lines the uterus begins to develop in other areas outside the uterus
  • Female reproductive system structural problems, such as a blockage in the fallopian tubes, fibroids (non-cancerous growths) in the uterus or scar tissue
  • Problems with the cervical mucous which lines the cervix. High acidity levels or levels of toxins (such as those from cigarettes) may be present in the mucous and may damage the sperm
  • Immune system dysfunctions such as lupus
  • Untreated chronic illness, such as diabetes, thyroid problems or kidney disease
  • Chronic or recurrent bladder infections
  • Exposure to environmental toxins
  • Heavy drug, alcohol or tobacco use
  • Advanced maternal age – the chances of a woman’s conceiving drop from the age of 35
  • Untreated sexually transmitted diseases such as chlamydia or gonorrhoea
  • Extreme underweight, or obesity, in the mother

Factors linked to male infertility include:

  • Sexually transmitted diseases such as chlamydia or gonorrhoea
  • Infection with the mumps virus after puberty
  • Undescended testicles, in which the testes have failed to descend through the abdominal wall into the scrotum
  • Tumours, cysts or cancer in the testicles
  • Chronic illness such as diabetes or thyroid disease
  • Exposure to environmental toxins
  • Heavy alcohol, tobacco or drug consumption
  • Steroid or antidepressant use
  • Frequent motorcycle or bicycle riding
  • Overheating of the testicles or constricting underwear
  • Recent, severe feverish illness

In many cases, treatment of the underlying reason for failure to conceive will result in conception. Where it does not, or where the underlying problem cannot be treated, there are other options open. These include treatment with drugs to stimulate the production of ova (eggs) and in vitro fertilisation. While these procedures may be costly, they have a relatively high success rate.

IVF

In vitro fertilisation (IVF) offers help to infertile couples where women have blocked or absent fallopian tubes, or where men have low sperm counts. IVF involves surgically removing eggs from the ovary and mixing them with the sperm in a laboratory. After 40 hours, eggs that have been successfully fertilised are placed in the woman’s uterus.
 
In cases where the woman’s eggs are of a poor quality, a donor’s eggs may be harvested, fertilised and implanted into the woman’s uterus. Women with hormonal problems often manage to conceive after treatment with fertility drugs.
 
In cases where a man has low sperm count or poor sperm motility, artificial insemination (in which the man’s sperm or donor sperm is injected directly into the egg) is relatively successful.
 
In some cases, failure to conceive is the result of immune reactions by the woman’s body to the sperm. Sperm washing (in which the sperm is separated from possible allergenic - immune triggering - proteins in the semen) or the use of immunosuppressive drugs, can improve a couple’s chances of conceiving a baby.
 
In couples where no physical problems are present, a doctor may advise using natural rhythm methods to determine which are the woman’s most fertile days. This may be done using saliva testing kits available through pharmacies.
 
If you are beginning to doubt your ability to conceive, consult your doctor for testing and advice about treatment options.