Infertility Q & A
Infertility
Obie Editorial Team
Before worrying, remember that 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 their fecundity which describes their fertility potential. Humans are not very efficient at producing babies!
There are many reasons for this, including the fact that some eggs don't fertilize and that some of the fertilized eggs (embryos) don't grow well in the early developmental stage because of a random genetic error.
Getting pregnant is a game of odds - it's a bit like playing Russian Roulette and it's impossible to predict when an individual 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 be pregnant within a year. These are the normal "fertile" couples - and the rest are "labeled" infertile - the medical text book definition of infertility being the inability to conceive even after trying for a year.
Couples who have never had a child, are said to have "primary infertility", while those who have become pregnant at least once but are unable to conceive again, are said to have "secondary infertility."
The approach to both types of infertility is very similar. However, patients with secondary infertility have a better prognosis, because they have proven their fertility in the past.
The chances of pregnancy for a couple in a given month will depend upon many things, and the most important of these is:
What happens when a couple has a fertility problem? The chances of their getting pregnant depends upon a number of variables multiplied together.
Consider a couple where both partners have a condition that impairs their fertility. For example, the man's fertility, based on a reduced sperm count is 50 percent of normal values. His wife ovulates only in 50 percent of cycles; and one of her fallopian tubes is blocked. With three relative infertility factors, their chance of conception is 0.5 (sperm count) X 0.5 (ovulation factor) X 0.5 (tubal factor) = 0.125, or 12.5 percent of normal.
Since the chance of conception in normal fertile couples is only 25% in any one cycle, the probability of pregnancy in any given month for this couple without treatment is only 3 percent (0.125 X 25 = 0.03125). Even if they kept on trying for 5 years, their chance of conceiving on their own would be only 60%.
Thus, infertility problems multiply together and magnify the odds against a couple achieving a pregnancy. This is why it is important to correct or improve each partner's contributing infertility factors as much as possible in order to maximize the chances of conception.
If infertile couples had 300 years in which to breed, most women would get pregnant without any treatment at all. Of course, time is at a premium, so the odds need to be improved - and this is where medical treatment comes in.
If you have been having sexual intercourse two or three times a week at about the time of ovulation, without any form of birth control for a year or more and are not pregnant, you meet the definition of infertility. Pregnancy may still occur spontaneously, but from a statistical point of view, the chances are decreasing and you may now want to consider seeking medical help. There is no "right" time to do so, and if it is causing you anxiety and worry, then you should consult a doctor. Even though you may be embarrassed and feel that you are the only ones in the world with the problem, you are not alone. Many couples experience infertility and many can be helped.
Unfortunately, while infertility is always an important problem, it is usually never an urgent one. This often means that couples keep on putting off going to the doctor. Unfortunately many find that before they realize it, their chances of getting pregnant have started to decline, even before they have had a chance to consider treatment. Set your priorities, so that you have peace of mind knowing that you tried your best. After all, if you don't take care of your own infertility problem, who will?
Here are some tips for Infertility self-help. Before seeking medical help, remember some of the things you can do to enhance your own fertility potential.
When trying to get pregnant, it's generally recommended to have sex 2-3 times a week every week. In addition, you should have sex tthe 4-5 days before and the day of ovulation. Thus, for couples who have sex only on weekends (often the price they pay for a heavy work schedule) the chance of having sex on the fertile preovulatory day is only one-third that of couples who have sex every other day - which means they may take three times as long to conceive. Many couples complain that they are too stressed out to have frequent sex. Here are some simple measures you can take to increase sexual frequency.
Also remember that you cannot "store up" sperm, which means that there is really no advantage to abstaining from sex if you are trying to conceive. having sex more than once a day is likely to decrease his sperm count. In this case, more is not always better, and in fact studies have shown that fresh sperm have a better chance of achieving a pregnancy than sperm which have been stored up for many days.
Unlike other animals, who know when to have sex in order to conceive (because the female is in "heat" or estrus when she ovulates), most couples have little to no ideas when the woman ovulates. The window of opportunity during which a woman can get pregnant every month is called her "fertile phase" – and is about 4-5 days before ovulation occurs. Timing intercourse during the "fertile period" (before ovulation) is important and can be easy to learn. You can use the free fertility calculator to do so. However, some couples are so anxious about having sex at exactly the right time that they may abstain for a whole week prior to the "ovulatory day " - and often the doctor is the culprit in this over-rigorous scheduling of sex. This over-attention can be counterproductive (because of the anxiety and stress it generates) and is not advisable. As long as the sperm are going in the vagina, it makes no difference which day they go in, so you can have sex as frequently as you like. Just make sure you have sex during the "fertile days" as well!
Sexula position may matter, but not necessarily. Pigs are very efficient at conserving semen - the boar literally screws his penis into the cervix of the vagina, obtaining a tight lock prior to ejaculation, to ensure that no semen leaks out. Humans do not have such well-designed mechanisms of technique - and perhaps this is because they are really not necessary. Leakage of semen after intercourse is completely normal. While many women worry that this means that they are not having sex properly or that their body is rejecting the sperm, actually leakage is a good sign – it means that the semen is being correctly deposited in the vagina. Of course, you can only see what leaks out, and not what goes in. Most doctors advise a male superior position and also advise that the woman remain lying down for at least 5 minutes after sex; she should not wash or douche afterwards. A number of products used for lubrication during intercourse, such as petroleum jelly, K-Y jelly or vaginal cream, have been shown to kill the sperm. Therefore, these products should be avoided if you are trying to get pregnant. A safe "sperm-friendly" lubricant is liquid paraffin, which is easily available at all large chemists. While it is traditionally consumed orally when used as a laxative, when using it to make a baby you need to apply it liberally locally.
FSH level. Women who are more than 30 and who wish to postpone childbearing should get their FSH levels checked on Day 3 of their cycle. This is a simple blood test which allows the doctor to check your ovarian reserve (the quantity and quality of the eggs in your ovaries). A high level suggests poor ovarian reserve and should be a wake-up alarm that your biological clock is ticking away rapidly. It's important that this test should be done in a reliable laboratory.
While there can be no simple answer to this question, remember that a woman’s fertility is maximal between the ages of 20 and 30. Beyond the age of 30, fertility starts to decline; this drop is quite sharp after the age of 35, and precipitate after the age of 38. From a purely biologic point of view, nature has designed women’s bodies so that they have babies between the ages of 20 and 35. However, the right time to have a baby is a very personal and individual decision, which each couple needs to make for themselves. Public anxiety over infertility is fueled by countless magazines articles warning couples not to wait too long to start a family. We now see many patients who are "pre-infertile," who assume they’ll have trouble conceiving even before difficulties actually arise, just because they are more than 30 years old.
Possibly. The reasons for this include:
The good news is that there is definitely an increasing awareness about infertility in society today. It is no longer a taboo issue, and couples are much more willing to seek medical assistance.
The first thing you need to do is become well informed about infertility and your treatment options. BabyMed has over 1000 pages of information to help guide you.
Most couples consult their family physician who will refer them to an obstetrician- gynecologist when infertility is a concern. This first visit should include both partners. The physician will usually outline the possible causes of infertility, and provide an evaluation plan. The first step should be to achieve an accurate diagnosis to try to find out why pregnancy isn't occurring. Once a diagnosis has been determined, the couple and physician should talk again about a treatment plan. For difficult problems, referral to an infertility specialist may be suggested.