Infertility or involuntary childlessness is when the man or woman, or both, lack the capability achieving pregnancy with regular intercourse.
For a couple who live together, science speaks of infertility when the couple has actively tried to achieve pregnancy without success for at least a year. So you should not give up hope entirely, if you get impatient after a year and seek help for infertility. A little guidance or help can work wonders.
Worth knowing about infertility
To understand what infertility means, we can start with fertility – the ability to have children. A girl is born with about 400,000 immature eggs, oocytes. These are stored in the ovaries, and the first egg matures when the girl is around 13.
For most women, the fertile age lasts until they are 45‒50 years old, and a woman can become pregnant until her ovulation or menstruation stops. There is a fine balance in the woman’s hormone system that determines when an egg is released, just as it is the hormone system that determines when eggs are not released, e.g. during pregnancy. Around the age of 35, the ovulation begins to decline and it takes longer for a woman to become pregnant. Statistically, this means that while a woman under 35 should expect to need fertility treatment 3‒4 times before becoming pregnant, a woman over 35 should expect to need it 6‒8 times. The fertile age for men is longer than for women, because the testicles can produce new sperm cells almost the whole of a man’s life. The store of sperm cells is renewed about every third month.
Fertilisation can only take place within a relatively short period each month, in fact just a few hours, so the chances of fertilisation occurring in ordinary intercourse are only about 25% each month. With IVF, the chances are somewhat higher, because the egg’s development is followed very precisely and it is removed from the ovary for fertilisation when it has reached exactly the right size and maturity.
Infertility arises if there is imbalance in the production of eggs and sperm cells, or if there are physical reasons for the egg cell and sperm cell not being able to meet. Unfortunately, infertility is quite widespread, since about 15% of all couples with women of childbearing age seek help for infertility (WHO).
Before one can speak of infertility, a couple in their twenties must been trying to achieve pregnancy for at least a year without success. That can be a long time to wait, once you have decided you want to have a child.
In women, the most common cause of infertility is lack of ovulation. The female hormonal cycle is so complex that there can be a lot of disturbances that prevent ovulation. In many cases, this kind of infertility can be relieved with mild hormone stimulation. But infertility in a couple must also be seen in the light of the woman’s age.
Research has shown that about a third of women over 35 are not able to become pregnant within a year. Many women wait with having children until they have finished their education and started a career, but it is important to remember that after the age of 35 the chances of becoming pregnant dramatically decrease. From a scientific point of view, a woman’s 35th year is a dividing line, after which the chances of pregnancy are reduced. Another common cause for infertility in women is polycystic ovary syndrome (PCOS), which is a condition in which the ovaries are enlarged and the surface is covered with small cysts, which are harmless but can prevent ovulation, leading to infertility. A scan can reveal the presence of PCOS, and the woman can usually become pregnant via IVF treatment.
Similarly, endometriosis can prevent ovulation or prevent the fertilised egg attaching itself in the uterus. Infections or inflammation in the abdomen, e.g. after infection with Chlamydia, can lead to the formation of blockages in the Fallopian tubes, so that the egg cell and the sperm cells cannot meet. So we recommend that women who have had inflammation in the abdomen should have an HSE (water scanning) before fertility treatment starts. HSE can show whether there is passage in the Fallopian tubes.
Infertility in men
The most common cause of infertility in men is inability to produce enough healthy sperm cells to make the woman pregnant. Although only one sperm cell is needed for fertilisation itself, many millions of sperm cells need to be present around the egg so that enzymes from the sperm cells can break down the protective tissue around the egg cell, so one sperm cell can penetrate the egg. The sperm-producing tissue in the testicles is very sensitive and infection in the testicles can completely destroy it.
Other causes of infertility in men include genetic defects, physical damage to the testicles, and undescended testicles, and although this latter condition can be rectified surgically, there is very little chance of restoring fertility.
Questions about infertility?
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