If you or someone you know is trying to get pregnant, you may have heard well-meaning advice like, "Just relax, and it will happen!" But the truth is a bit more complex. Couples today have been postponing family planning to a later date, in hopes of being well settled when they finally decide to have a baby. That has pushed the average conceiving or pregnancy planning age to their late 30â€™s. But when the pressure of extending the family eventually comes from the extended family, the pressure begins to build.
Infertility is often defined as the inability to conceive after 12 months of regular sexual intercourse without the use of birth control. Worldwide, 12-15 % of couples experience fertility problems. Various issues in either of the partners can contribute to infertility. Subfertility may require a doctorâ€™s intervention or help in the form of minimal medication or surgical intervention support.
The first step lies in diagnosing the cause. A doctor can give advice and carry out some preliminary assessments. It is best for a couple to see the doctor together for assessment. There can be various causes of infertility in either of the partners.
Infertility in men can be attributed to:
Low sperm count, low sperm mobility (motility) or abnormal sperm shape, making it harder to move and fertilize an egg. If the sperm does not have the right shape or they cannot travel rapidly and accurately towards the egg, conception may be difficult. Up to 2 % of men are thought to have suboptimal sperm. Low counts can be attributed to various causes such as hormonal imbalance, testicular infections, varicocele, ejaculation disorders, exposure to chemicals, excessive alcohol consumption, smoking, obesity or the use of saunas and hot tubs, wearing tight clothes and working in hot environments. Sometimes, anemia, diabetes and thyroid disease can also be linked to lower fertility.
Infertility in women can also have a range of causes:
- Ages above 34-35 years, alcohol, smoking, obesity and eating disorders
- Medical conditions such as polycystic ovarian disease, in which ovulation/egg release is hampered, appears to be the most common cause of infertility in women
- Premature ovarian failure, poor egg quality, medical problems such as thyroid and diabetes can also have an effect on fertility.
- Diet: A lack of folic acid, iron, zinc and vitamin B12 can affect fertility.
- Exercise: Both too much and too little exercise can lead to fertility problems.
Problems in the uterus or fallopian tubes
Tube blockage: The egg on release travels through the fallopian tubes, which act as bridges to connect the ovaries to the uterus and any defect in their ability to pick up egg or any blockage can prevent natural conception. These blockages can be picked up using hysterosalpingography (HSG) or Sonosalpingography (USG guided tube test).
Submucosal fibroids: Benign or non-cancerous tumors occur in the muscular wall of the uterus. Their location on the uterine cavity side can interfere with implantation or block the fallopian tube.
Endometriosis: Cells that normally occur within the lining of the uterus start growing elsewhere in the body and can result in ovarian cysts, which can decrease fertility and can cause tubo-ovarian anatomical changes.
Stress can also be attributed to cause low fertility in both males and females.
Treatment will depend on many factors, including the age of the person who wishes to conceive, how long the infertility has lasted, personal preferences, and their general state of health.
The couple may be advised to have sexual intercourse more often around the time of ovulation. The four days that are most likely to offer a fertile window are the two days before ovulation, plus the one day of ovulation and post ovulation.
Most women might require only medical treatment for treating infertility or subfertility. The treatment modality is based on an individualized approach depending on the cause .
Various surgical approaches, such as minimal invasive fertility enhancing surgeries, have made diagnosis and treatment possible in the same sitting. Most of these procedures require care for a day or a one-day stay at the medical facility. Fertility enhancing surgeries include hysteroscopic or laparoscopic assisted opening of fallopian tube blockages, removal of fibroids, ovarian cysts, ovarian drilling etc.
As new technology becomes available, fertility treatment is now accessible to more people, and success rates and safety are improving all the time. The need of the hour is to avoid delaying childbirth for too long, having a healthy lifestyle and visiting the doctor for preconceptional counselling.
This article was written by Dr Meenakshi Banerjee, Senior Consultant - Obstetrics and Gynaecology, Madhukar Rainbow Childrenâ€™s Hospital, Malviya Nagar, Delhi and published in partnership with Rainbow Children's Hospital.