INFERTILITY
Infertility is usually defined as the inability to conceive after 1 year of regular, unprotected sexual intercourse. The World Health Organization (WHO) recognizes infertility as a medical condition. When couples engage in regular unprotected intercourse, approximately half of them achieve conception within three months, 75% within six months, and 90% within one year.
Various factors can contribute to infertility
- Sperm abnormalities (affecting around 35% of couples)
- Irregular ovulation or diminished ovarian reserve (occurs in about 20%)
- Tubal and pelvic issues (accounting for roughly 30%)
- Unusual cervical mucus (affecting fewer than 5%)
- Unexplained causes (around 10%)
Experiencing difficulty in conceiving often triggers emotions such as anxiety, sadness, frustration, anger, guilt, resentment, and feelings of inadequacy.
For couples aiming to conceive, it is advised to have frequent intercourse during the six days leading up to ovulation, especially the three days prior. Ovulation usually occurs around 14 days before the next menstrual cycle begins.
In women with consistent menstrual cycles, monitoring daily morning basal body temperature (BBT) can help pinpoint ovulation. A temperature drop suggests impending ovulation, while a rise of ≥ 0.5°C indicates recent ovulation. However, for a more convenient option, commercial luteinizing hormone (LH) prediction test kits are recommended. These kits detect the LH surge during the middle of the menstrual cycle and are less time-intensive than BBT measurement. BBT tracking can be valuable for women who lack access to or affordability for LH prediction kits. It’s important to note that there is no evidence that any ovulation detection method enhances the likelihood of pregnancy in couples who are consistently sexually active.
Reducing the consumption of caffeine, tobacco, and alcohol is advised, as excessive use of these substances can negatively impact fertility.
Research is indicating that men over the age of 45 might have reduced fertility compared to younger men, regardless of their female partner’s age.
While infertility does not encompass recurrent miscarriages (spontaneous abortions), the emotional impact can be similar.
Evaluation of Infertility
Evaluating Infertility involves tests based on the suspected cause. Partners undergo assessment after one year of unsuccessful pregnancy attempts. This evaluation begins with a comprehensive medical history, physical examination, and counseling. Men are screened for sperm-related issues, while women are assessed for ovulatory dysfunction, tubal problems, and pelvic disorders.
An expedited evaluation is recommended if:
- The woman is over 35 years old.
- The woman’s ovarian reserve is compromised (e.g., due to having one ovary).
- The woman experiences irregular menstrual cycles.
- The woman has a known abnormality of the uterus, fallopian tubes, or ovaries.
- The man is known to have suboptimal fertility or is at risk.
Appropriate tests are conducted based on the suspected causes, such as measuring follicle-stimulating hormone and antimüllerian hormone levels and determining antral follicle count through transvaginal ultrasonography for decreased ovarian reserve. Semen analysis is performed for sperm disorders.
Treatment of Infertility
The primary cause of male or female infertility is addressed whenever possible. For instance, structural irregularities in the reproductive tract (like testicular varicocele or uterine leiomyomas) or endocrine anomalies (such as pituitary adenoma or thyroid disorders) can be treated. Patients should be encouraged to adopt changes that mitigate modifiable risk factors.
For instance, quitting smoking for individuals who smoke, weight reduction for overweight patients, consuming alcohol in moderation or abstaining entirely, and maintaining a balanced diet (with potential vitamin supplementation) are recommended.
In broad terms, treatment aims to enhance the chances of conception. This involves increasing the availability of high-quality oocytes (for example, through ovulation induction or egg donation) or improving sperm count and quality (using gonadotropin medications to stimulate spermatogenesis or sperm donation). Procedures that facilitate the interaction between oocytes and sperm to achieve fertilization, like intrauterine insemination and in vitro fertilization, are also utilized.
Individuals dealing with infertility might encounter emotions such as sadness, anxiety, frustration, emotional stress, feelings of inadequacy, guilt, or anger. These emotions could lead to disruptions in sleep or eating patterns, or even clinical anxiety or depression. If necessary, counseling and behavioral health support should be made available.
Providing both partners with information about the treatment process proves valuable. This information encompasses:
- The likelihood of success
- Details of the process, including timeframes and costs
- When it might be appropriate to conclude treatment
- When adoption could be considered