In a single menstrual cycle the chance of a perfectly normal couple achieving a successful pregnancy is only about 25%, even if they have sex every single day. This is called fecundity which describes their fertility potential. There are many reasons for this, including the fact that some eggs do not fertilize and some of the fertilzed eggs do not grow well ın the early developmental stage. It is impossible to predict when a couple will get pregnant. However, over a period of a year, the chance of a successful pregnancy is between 80% and 90%, so that 7 out of 8 couples will achieve pregnancy within a year. These are the normal ‘fertile’ couples and the rest are ‘infertile’. The medical text definitıon of infertility is defined as not being able to conceive after regular and unprotected intercourse for a minimum of one year. Couples who have never had a child are said to be ‘primary ınfertile’ those who have become pregnant at least once but are unable to conceive again, are said to have ‘secondary ınfertility’
Infertility may be caused for reasons arising from reproductive problems of either the male or female or both. These reasons can mostly be treated by assisted conception technologies.
Some Causes of Infertility:
♦ A history of sexually transmitted infection
♦ Other previous infections
♦ Male urologic or genital infections
♦ Irregular or lack of monthly menstrual cycles
♦ Endometrial anomalies
♦ Chronic illness
♦ Drug addictions
Some couples may suffer unexplained infertility. This is defined as a lack of any reason to explain infertility at least in one of the partners. If the female has a regular menstrual cycle and semen analysis is within the normal range, the couple may wait for one year before consulting a doctor.
In cases, such as advanced age of the women (>40), irregular menstruation, or a history of serious illness and/or operations, it is recommended to consult a doctor and after all tests and examinations have been carried out a decision can be made as to the best course of treatment.
Approxımately 30% of all incidences are due to male infertility. It is therefore recommended that initial consultations should be as a couple and a semen analysis one of the first tests performed. Differentiating a fertile semen from sub fertile or infertile semen is difficult. We recommend that semen analysis for fertility be done in an IVF/fertility facility rather than a general laboratory.
♦ NO SPERM – this accounts for 4% of male fertility problems
♦ LOW NUMBER OF SPERM, POOR QUALITY OR ABNORMAL SPERM – this accounts for 90% of male infertility
problems, therefore being the main cause of male infertility.
♦ DEFECTIVE SPERM – in 6% of cases the sperm is unable to fertilise the egg due to a dysfunctıon.
Before a couple considers a vasectomy reversal, it is important for the wife to have a basic examination. If the vasectomy ligation is more than 5 years old, the couple may wish to do a testicular biopsy and an IVF-ICSI approach. In selected situations, even couples with a ligation of less than 5 years in duration they may benefit from this approach.
In 50% of infertility problems it is primarily caused by a problem in the woman. Another 25% is a couples issue involving both the male and female. The three primary problems found in women are: anovulation, endometriosis and tubal disease. Evaluation of the course of infertility should include testing in all three areas.
This is the most common form of female infertility, accountıng for 25% of all occurances. It can be divided into three main areas, anovulation (no ovulation), oligovulation (rare or irregular ovulation) and post ovulation problems (usually due to an imbalance of progesterone which stops the endometrium becoming suitable to sustain pregnancy)
Ovulation dysfunction can be further split into two sub groups –
♦ PRIMARY – where the ovary ıs the problem. This can be due to damage by either chemotherapy or radiotherapy, post operatively following removal of one or both ovaries or early menopause whıch affects 2% of women under the age of 40.
♦ SECONDARY – where the problem lies not in the ovaries, but in the hormones and can be brought on by things such as excessıve weight loss or gain, stress and some drugs.
Occuring in 20% of cases, this can be due to scarring for a number of reasons.
♦ INFECTION – from a previous birth, miscarriage or abortion or from an STD (sexually transmitted disease) such as chlamydia or pelvic inflammatory disease (PID).
♦ ENDOMETRIOSIS – which can lead to adhesions and occassionally blockage of the fallopian tubes. This accounts for about 8% of infertility problems.
♦ SURGERY – either for investigations, which can lead to adhesions and scarring, following an ectopic pregnancy or reversal of sterilisation.
CERVICAL MUCUS HOSTILITY
This is where the sperm cannot travel through the cervical mucus. It occurs ın about 1% of cases either due to the mucus being too thick, the mucus containıng antibodies to the sperm or the sperm being abnormal.
PYSCHOLOGICAL / PHYSICAL FACTORS
Almost 3% of all infertility problems stem from either psychological or physical problems.
♦ PSYCHOLOGICAL – including stress (after trying unsuccessfully for a lengthy period of time to get pregnant), depression, work or financial worries, previous sexual abuse or rape.
♦ PHYSICAL – premature ejaculation, diabetes, excessive smoking and/or drinkıng, impotence.
When no male or female problem is found this is known as “unexplained” infertility. Approximately 5% of cases remain without explanation despite extensive tests on both the man and the woman. Only a small number of people are totally infertile. The majority are sub-fertile, which means that a pregnancy can be achieved though assistance may sometimes be required.