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INFERTILITY : FAQ

What is infertility?

Infertility is “the inability to conceive after 12 months of unprotected intercourse.” This means that a couple is not able to become pregnant after a year of trying. However, for women aged 35 and older, inability to conceive after 6 months is generally considered infertility.1

How common is it?

Infertility affects 10%-15% of couples. This makes it one of the most common diseases for people between the ages of 20 and 45. In addition, the longer a woman tries to get pregnant without conceiving, the lower are her chances to get pregnant without medical treatment. Most (85%) couples with normal fertility will conceive within a year of trying.

What can cause infertility?

Pregnancy is the result of a process that has many steps. To get pregnant:

  • A woman’s body must release an egg from one of her ovaries (ovulation).
  • The egg must go through a fallopian tube toward the uterus (womb).
  • A man’s sperm must join with (fertilize) the egg along the way.
  • The fertilized egg must attach to the inside of the uterus (implantation).

Infertility can happen if there are problems with any of these steps.

 

Is infertility just a woman’s problem?

No, infertility is not always a woman’s problem. Both women and men can have problems that cause infertility. About one-third of infertility cases are caused by women’s problems. Another one third of fertility problems are due to the man. The other cases are caused by a mixture of male and female problems or by unknown problems.

 

What things increase the risk of infertility?

Woman Man
  • Age
  • Smoking
  • Excess alcohol use
  • Stress
  • Poor diet
  • Athletic training
  • Being overweight or underweight
  • Sexually transmitted infections (STIs)
  • Health problems that cause hormonal changes, such as polycystic ovarian syndrome and primary ovarian insufficiency

 

  • Heavy alcohol use
  • Drugs
  • Smoking cigarettes
  • Age
  • Environmental toxins, including pesticides and lead
  • Health problems such as mumps, serious conditions like kidney disease, or hormone problems
  • Medicines
  • Radiation treatment and chemotherapy for cancer

 

 

How does age affect a woman’s ability to have children?

Many women are waiting until their 30s and 40s to have children. So age is a growing cause of fertility problems. About one-third of couples in which the woman is over 35 have fertility problems.

Aging decreases a woman’s chances of having a baby in the following ways:

  • Her ovaries become less able to release eggs
  • She has a smaller number of eggs left
  • Her eggs are not as healthy
  • She is more likely to have health conditions that can cause fertility problems
  • She is more likely to have a miscarriage

 

How will doctors find out if a woman and her partner have fertility problems?

Doctors will do an infertility checkup. This involves a physical exam. The doctor will also ask for both partners’ health and sexual histories. Sometimes this can find the problem. However, most of the time, the doctor will need to do more tests.

In men, doctors usually begin by testing the semen. They look at the number, shape, and movement of the sperm. Sometimes doctors also suggest testing the level of a man’s hormones.

In women, the first step is to find out if she is ovulating each month. There are a few ways to do this. A woman can track her ovulation at home by:

  • Writing down changes in her morning body temperature for several months
  • Writing down how her cervical mucus looks for several months
  • Using a home ovulation test kit (available at drug stores)
  • Doctors can also check ovulation with blood tests. Or they can do an ultrasound of the ovaries. If ovulation is normal, there are other fertility tests available.

Some common tests of fertility in women include:

Hysterosalpingography

This is an x-ray of the uterus and fallopian tubes. Doctors inject a special dye into the uterus through the vagina. This dye shows up in the x-ray. Doctors can then watch to see if the dye moves freely through the uterus and fallopian tubes. This can help them find physical blocks that may be causing infertility. Blocks in the system can keep the egg from moving from the fallopian tube to the uterus. A block could also keep the sperm from reaching the egg.

Laparoscopy

A minor surgery to see inside the abdomen. The doctor does this with a small tool with a light called a laparoscope (LAP-uh-roh-skohp). She or he makes a small cut in the lower abdomen and inserts the laparoscope. With the laparoscope, the doctor can check the ovaries, fallopian tubes, and uterus for disease and physical problems. Doctors can usually find scarring and endometriosis by laparoscopy.

Finding the cause of infertility can be a long and emotional process. It may take time to complete all the needed tests. So don’t worry if the problem is not found right away.

 

How do doctors treat infertility?

Infertility can be treated with medicine, surgery, artificial insemination, or assisted reproductive technology. Many times these treatments are combined. In most cases infertility is treated with drugs or surgery.

Doctors recommend specific treatments for infertility based on:

  • Test results
  • How long the couple has been trying to get pregnant
  • The age of both the man and woman
  • The overall health of the partners
  • Preference of the partners
courtesy of Freedigitalphotos.net

courtesy of Freedigitalphotos.net

Doctors often treat infertility in men in the following ways:

Sexual problems: Doctors can help men deal with impotence or premature ejaculation. Behavioral therapy and/or medicines can be used in these cases.

Too few sperm: Sometimes surgery can correct the cause of the problem. In other cases, doctors surgically remove sperm directly from the male reproductive tract. Antibiotics can also be used to clear up infections affecting sperm count.

Sperm movement: Sometimes semen has no sperm because of a block in the man’s system. In some cases, surgery can correct the problem.

In women, some physical problems can also be corrected with surgery.

A number of fertility medicines are used to treat women with ovulation problems. It is important to talk with your doctor about the pros and cons of these medicines. You should understand the possible dangers, benefits, and side effects.

 

What can I do about my infertility?

Going to see a fertility specialist may help a couple figure out why they’re not conceiving. Women see a reproductive endocrinologist and men see a urologist who specializes in fertility. In some (10% or more) cases, though, there may not be an obvious reason why a couple can’t conceive. This is known as unexplained infertility. Fertility treatments can often help these couples with unexplained infertility.

 

When should I see a specialist?

Generally, a couple should consult a gynaecologist if they have not been able to conceive within 12 months of trying.

If a woman is 35 or older, she should see a fertility specialist if she hasn’t gotten pregnant after 6 months of trying. If a woman is younger than 35 but has a family history of early menopause, other health problems that can cause early menopause, or has had certain cancer treatments, she might consider seeking fertility advice sooner.

A couple might also seek a fertility consultation sooner if there is a risk for infertility such as irregular menstrual cycles or potential risk for fallopian tube damage. For men who have any prior health problems that can increase the chance of infertility, such as childhood problems with the testicles or prior cancer treatment, the couple can seek evaluation sooner.

MALAY VERSION HERE

References :

  1. ASRM, Defining infertility. Revised 2014
  2. E Eisenberg, K Brumbaugh, Infertility fact sheet, Womenshealth.gov