INFERTILITY PART 1 by Dr. Chin

INFERTILITY PART 1

What does infertility mean? In simple terms infertility is defined as inability to make a baby.

Both a man and woman can be infertile. In a third of the cases of infertility , the problem is from the woman, another third is from the man or both may have a problem or the problem may be unknown.

Infertility is very common and it is seen in about 1 in every 7 couples worldwide.

At the moment let us focus on infertility in women:

A woman under 35 years of age would be said to be infertile if she is unable to conceive even though she is having regular unprotected sex for up to 12 months and has no known problem with her reproductive system .
For women older than 35 years, they will be deemed infertile if they are unable to conceive after 6 months of regular unprotected sex rather than 12 months in younger women.
For women over 35 years, time is of essence so after 6 months she needs to be investigated and treatment started if necessary.
A woman can also be described as being sub fertile if she has tried unsuccessfully to have a child after a period less than the prescribed 12 months in under 35 year olds and less than 6 months in older women. This means that she is less fertile than women of her age.

In the UK infertility is defined as a failure to conceive after regular unprotected sexual intercourse for 2 years in the absence of known reproductive pathology. So a woman will not be entitled to free NHS investigation for infertility unless they have been having regular unprotected sexual intercourse for 2 years or more and yet did not conceive.

What does regular sexual intercourse mean?

It means having sexual intercourse at least every 2-3 days.

Irrespective of how infertility is defined, it is usually grouped into 2 categories as follows:

Primary infertility is when a woman has never conceived ( become pregnant) after at least 1 year of unprotected sex (intercourse). while

Secondary infertility refers to when a woman has been pregnant at least once, but never again.

Some important facts about infertility:

* A woman is at the peak of her fertility in her earlier 20s
* At age 35 ( and especially 40), the chances of getting pregnant drops considerably
* Adequate sexual intercourse is necessary for pregnancy to occur
* For a healthy woman under the age of 30 who has sex regularly, the chance of getting pregnant is about 25 - 30% per month.
* A woman can increase her chances of becoming pregnant each month by having sex at least every 3 days before and during ovulation.
* It is especially important to do so 72 hours before ovulation begins.
* Note that ovulation occurs about 2 weeks before the next menstrual cycle (period) starts.
*If a woman sees her period every 28 days, she should have sex at least every 3 days between the 10th and 18th day after the period starts.
* Also note that sperm can survive in the female reproductive tract for up to 72 hours (3 days) after it was deposited
* An egg (ovum) can survive and be fertilized for up to 24 hours after being released from the ovaries ( ovulation).
* 84% of women who are less than 35 years and have regular unprotected intercourse ( every 2-3 days) will become pregnant within 12 months
* 92% of them will get pregnant within 2 years of having regular unprotected sex
* For women older than 35 years 94% will get pregnant after 3 years of regular unprotected sex while those aged 38, only 77% will do so
*For couples who have been trying to conceive for more than three years without success, the likelihood of pregnancy occurring within the next year is 25% or less.

What is required for a woman to get pregnant

* her ovaries must be able to produce eggs or ova (ovulation)
* After the ovulation, the eggs must be able to move to the tube where they get fertilised by sperm
* When the egg is fertilised to form the embryo, the embryo should be able to move into the womb. If not then the pregnancy becomes ectopic one
* when the embryo ( fertilised egg) gets into the womb, it must be able to attach to the lining of the womb (implantation) *
When it implants, it must be able to survive
Failure of any of these stages will lead to inability of the woman to be pregnant or stay pregnant.