Infertility

The term infertility is defined as the inability to conceive despite regular and unprotected intercourse for 2 years. However, risk factors such as the woman's age, abnormal menstrual periods, history of pelvic inflammatory disease and whether there has been previous abdominal or pelvic surgery, history of undescended testicles may warrant earlier investigations and treatment of infertility. Couples should be aware that 80% will conceive within a year and 90% within two years if they don't use contraception and have regular intercourse. Although, infertility by itself may not threaten physical health, it does have a serious impact on the mental and social well being of affected couples.

Infertility is classified into two types:

• Primary infertility if there was no previous pregnancy (approximately 40% of infertile couples).
• Secondary infertility if there was a previous pregnancy whatever the outcome (approximately 60% of infertile couples).

Incidence of infertility

Natural conception depends on satisfactory ovulation, transport of viable sperm and egg into the female reproductive system. Natural conception is influenced by hormonal control, timing and frequency of intercourse as well as the general health status of the couple. Infertility affects one in seven couples and affects both men and women. The most important factor affecting a couple’s fertility is the woman ‘s age. For women aged 25 or under, 60% achieve conception within 6 months and 85% at one year. However, if the woman is aged 35 years or older, the conception rates are less than half. Male fertility also declines with age.

It is important to remember that the majority of infertile couples can achieve a pregnancy and livebirth with treatment,  they are subfertile. Only a minority of patients are sterile, i.e. even with treatment they would be unable to conceive. This could be due to no sperm, absent or non-functioning ovaries or an absent uterus (womb).

To help you understand what causes infertility, what investigations are needed and why, and the proposed treatment, a review of how to achieve a natural pregnancy is summarized in the following four topics.

Is the incidence of infertility rising and why?

It appears that the incidence of infertility is rising. This is probably due to factors such as:

• Increasing tendancy to postpone childbearing until women establish a career and achieve financial security
• Rising incidence of sexually transmitted diseases resulting in damage to reproductive organs
• Increasing obesity
• Declining sperm count as a result of environmental pollution, possibly arising from estrogenic industrial waste

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