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The inability to conceive when desired is one of the most difficult challenges for a couple. It creates stress, distress and can lead to marital strife. The issue is complex and typically there are multiple factors that contribute to the infertility. In most cases, resolution of the problem is straightforward. It is important to seek consultation with an appropriate health care provider for assistance but learning more about the issue can alleviate anxiety and better prepare you for the visit.
Infertility is defined as the failure to conceive after 12 months of regular intercourse in the absence of contraception in a woman less than 35 years of age. The time interval is 6 months in women older than 35. A history of prior pregnancies does not alter the diagnosis. The infertility can be primary or secondary. The term subfertility is sometimes used to describe the situation when an actual cause has yet to be identified.
The term fecundability describes the probability of conception within 1 menstrual cycle. This rate is about 25% in the first 3 months of attempted conception and declines after this. 85% of couples will conceive within the first year and 95% by 2 years. The infertility rate in the U.S. is approximately 12-18% and 10% of women have received some type of fertility services.
There are many potential contributors to the infertility. Evaluations have proven that the issue is due to the couple 35% of the time, 8% it is male only factor and 37% female only. 5% of the time the cause is never identified.
Successful reproduction requires accurate function at every step of the process. It is truly a production line where malfunction at any stage can affect the end product. The male must have sperm that are adequate in function and number. Coitus must occur at the right time in the menstrual cycle since the egg is only around for about 2 days per cycle. The cervix and uterus must allow passage of the sperm and the tube must allow passage of the sperm and egg. Once they meet in the tube fertilization must occur and adequate cell division must commence. The bundle of cells then must travel to the uterus and imbedded successfully in the uterine lining.
Male factor infertility can include many issues: no sperm, low sperm, abnormal sperm or sperm going in the wrong direction. For women, ovulatory dysfunction is usually the problem. Women can have no ovulation, infrequent ovulation or irregular ovulation. There are many factors that contribute to ovulatory problems. Structural abnormalities such as tubal obstruction, uterine polyps, fibroids or adhesions can also prevent the egg and sperm from meeting.
As you can see, the reproductive process is quite complex and the fact that conception occurs in the majority of women is indeed a miracle. If you have a problem, seek the care of an experienced fertility specialist. Be prepared to undergo a comprehensive evaluation and be patient since the suggested test and treatment will be tailored to meet your needs.
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