Infertility is defined as the inability to conceive after one year of regular unprotected intercourse. It has been observed that 50% of women conceive within 5 months, 85% conceive in 10 to 12 months and almost 100% conceive between 15 to 18 months. Variations in conception rates may depend on the woman's age and fertility of her partner. There may be a problem in the male in 30% of cases, a female related factor in 30% or factors in both partners in upto 30% of cases.
Male factors: Defective formation of the sperms may be due to an:
a. Undescended testes where the sperm formation is depressed
b. Thermal factors such as working in hot atmosphere and wearing tight undergarments which can reduce the sperm functions
c. Infections such as mumps in childhood can affect the testes and thereby the sperm production
d. Ejaculatory problems such as premature ejaculation and impotency leads to improper deposition of sperms in the vagina
e. Chronic and excess alcohol intake, smoking leads to poor sperm quantity. Lifestyle modifications, reduction of stress or incorporating some relaxing activities in daily schedule helps in improvement of semen quantity.
Female factors:
a. Age: Fertility rates decline with increasing age. In pursuit of job and concerns, women tend to delay childbearing. The fertility potential of women between 35 to 39 years was 40% lesser than in age group 20 to 24 years
b. Duration of infertility: This was an important prognostic variable and expected pregnancy rate was lowered by 2% for each additional month of infertility beyond 40 months (i.e. greater than 3 years).
c. Timing of intercourse: Availability of both partners during the ovulatory window is important to optimise the chance of pregnancy. A reasonable compromise between the extremes of infrequent coitus and daily coitus would be to have intercourse about three times a week and more towards the time of ovulation.
d. Weight: Maintaining the ideal body weight (Body Mass Index) is very important while planning to conceive. Excess weight leads to abnormal insulin levels which causes the ovaries to overproduce male hormones and stop releasing eggs. Low weight and excessive weight can both interfere with ovulation and leads to fertility problems. Proper exercise, balanced diet are absolutely essential to achieve normal body mass index.
Defects in the fallopian tube such as obstruction of the lumen may lead to infertility. Any previous abdominal surgeries, previous ectopic pregnancy may lead to adhesions around the tube reducing its mobility.
Related to the uterus, the presence of fibroids and uterine abnormalities may lead to fertility problems. Psychological fear, tensions, anxiety and nervousness adds to the problem and perpetuates a vicious cycle.
It is hence important that while planning to conceive both partners need to be examined to identify any treatable factors. The road to fertility can turn out to be a rocky and tortuous course but it is important you stay with your doctor who can outline a treatment plan and which would enable you to conceive.
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