A couple may need to seek help if they fail to achieve pregnancy, having lived together for about one year with adequate and unprotected sexual intercourse. Adequate sexual intercourse means about 2- 3 times of sexual intercourse per week. However, in some cases you may not need to wait until one year before seeking help. For examples, if the woman is already of age (e.g more than 35 years) before marriage, if she has never been pregnant in her life despite regular sexual intercourse or she has some conditions that may delay early consultation especially in cases of no sperm or low sperm count identified earlier in life.
Who is to be blame,The man or the woman?
Evidence has that 30% of cases of infertility are due to the women alone, 30% due to the man while problems in both the man and woman account for another 30%. About 5-10% of causes of infertility are still unknown. Of course the extent of infertility can be unraveled depending on the availability and quality of investigation in a given gynecologic set–up. This may surprise you because most men in our environment believe that the woman is always the culprit. This is one of the reasons why it is good that the woman and the partner see the gynecologist together in order to achieve better outcome. Now let us briefly go through the common causes of infertility.
Causes of infertility
Tubal blockage is about the commonest problem women have in relation to conception, in developing countries largely due to poor health, poor education and poor environment. It is very common in Nigeria, (approximately 30% of cases) due to high incidence of pelvic infections, example of which is Pelvic Inflammatory Disease (PID) which may be contacted through sexually transmitted infection (STI) postnatal (after child birth) and after abortion, when the tubes are blocked and sperm cannot come in contact with female egg thus preventing fertilization and making pregnancy impossible. Sometimes the fertilised egg is prevented from descending into the uterus. This latter condition can result in ectopic pregnancy (conception outside the uterine cavity). In some rare instances tubal blockage may be secondary to an inflammatory condition called endometriosis.
Inability to produce Eggs
Many women are unable to achieve pregnancy because the ovaries do not produce eggs on a monthly basis, even though they menstruate. There are many reasons for this. In our environment, this is about the second most common reason for lack of conception, only second to tubal blockage. A woman may not produce eggs due to imbalance in the hormones that stimulate the ovaries, disease of the ovaries e.g. polycystic ovaries and ovarian failure. This may also be due to natural decline in quantity and quality secondary to old age, genetic factors etc.
Problems with the womb
The inner lining of the womb is where the embryo (early baby) is implanted. If this lining is hostile to implantation, the pregnancy may be aborted very early. Many cases in our environment are due to long standing infection or existing tumors. Also the womb may be wholly or partially divided into two. This may result in inability to achieve pregnancy or abortion.
Some chemicals called hormones are secreted in the body of the woman; some of them are essential production and release of mature eggs, preparation of inner lining of the womb and even facilitation of the entrance and transportation of the sperm to meet the eggs. They are also essential in maintaining the pregnancy even after a woman becomes pregnant.
In approximately one-third (1/3) of people having difficulties in achieving pregnancy, sperm abnormalities may be a contributory factor. Low sperm counts may result from childhood mumps, infections, sexually transmitted disease, previous testicular injury, blocked male tubes (vas deferens) varicocoeles (dilated blood vessels in the scrotum) previous surgery (i.e. hernia operations) or simply due to inheritance. Some have sperm that are sluggish, inactive or structurally defective. Some have many sperm cells that are dead on arrival.
Types of occupation and social habit may affect fertility
The development and sustenance of sperms are hindered by hot environment. Therefore those who wear thick and tight pants (e.g. jeans, nylon pants), oven workers/bakers or long distance drivers are at risk. Men who indulge in chronic alcohol intake or smoke excessively may also have low sperm counts as some of these substances are toxic to the sperms.
Does Fibroid cause Infertility?
About fifty percent (50%) of black women of reproductive age group have fibroids, but most do not complain because the fibroids are not associated with the problem such as pain, excessive bleeding etc. that may take them to hospital. The association of fibroids with infertility has not been scientifically proven. However, big fibroids may compress the fallopian tubes by sitting on either or both. Some fibroids or other tumors are located right inside the womb cavity and hinder implantation early in pregnancy. Sometimes they also can contend for space with the baby; eventually this may result to abortion. Some women who have big fibroids may delay seeking help with health care providers because they enormously believe that the probability of getting pregnant and carrying the pregnancy for the full nine months is improved.
In five to ten percent (5-10%) of cases, no cause is discovered for the infertility, even after a large number of tests have been carried out. However, the good news is that even if you belong to this category, IVF is a good option with good success rate. As fertility declines considerably with age in women, IVF may well be your best option. Taking a decision early is very important.