Infertility is defined as not being able to get pregnant despite having frequent, unprotected sex for at least a year for most couples. It may result from an issue with either you or your partner, or a combination of factors that interfere with pregnancy.
About 10 to 15% of couples struggle to conceive. But there are many safe and effective therapies that significantly improve your chances of getting pregnant.
Sometimes an infertile woman may have irregular or absent menstrual periods. Rarely, an infertile man may have signs of hormonal problems, such as changes in hair growth or sexual function.
With the right advice most couples will eventually conceive. You probably don’t need to see a doctor about infertility unless you have been trying regularly to conceive for at least one year. To increase the chance of falling pregnant, it is advisable for couples to have regular intercourse several times around the time of ovulation.
Having intercourse beginning at least five days before and until a day after ovulation improves your chances. Ovulation usually occurs at the middle of the cycle for most women with menstrual cycles about 28 days apart.
You definitely need to see a doctor, if you’re a woman and:
- You’re over 40 and want a child
- You menstruate irregularly or not at all
- Your periods are very painful
- You have known fertility problems
- You’ve been diagnosed with endometriosis or pelvic inflammatory disease
- You’ve had many miscarriages
- You’ve had treatment for cancer
Talk to your doctor if you’re a man and:
- You have a low sperm count or other problems with sperm
- You have a history of testicular, prostate or sexual problems
- You’ve had treatment for cancer
- You have small testicles or swelling in the scrotum
- You have family members with infertility problems
All of the steps during ovulation and fertilisation need to happen correctly to get pregnant.
Causes of male infertility
• Abnormal sperm production due to undescended testicles, genetic defects, health problems such as diabetes or infections such as chlamydia, gonorrhoea, mumps or HIV. Enlarged veins in the testes (varicocele) can also affect the quality of sperm.
• Problems with sperm delivery due to premature ejaculation; certain genetic diseases, such as cystic fibrosis; a blockage in the testicle or injury to the reproductive organs.
• Overexposure to pesticides and other chemicals and radiation. Cigarette smoking, alcohol, marijuana or certain antibiotics, antihypertensives and anabolic steroids can also affect fertility. Frequent exposure to heat may affect sperm production.
• Treatment for cancer can impair sperm production, sometimes severely.
Causes of female infertility
• Ovulation disorders: These include polycystic ovary syndrome. Hyperprolactinaemia, a condition in which you have too much prolactin may also interfere with ovulation. Hyperthyroidism or hypothyroidism can affect the menstrual cycle or cause infertility. Other underlying causes may include excessive exercise, eating disorders, injury or tumours.
• Uterine or cervical abnormalities: Abnormalities at the opening of the cervix, polyps in the uterus or the shape of the uterus. Noncancerous tumours in the uterine wall (uterine fibroids) may rarely cause infertility by blocking the fallopian tubes. More often, fibroids interfere with implantation of the fertilised egg.
• Fallopian tube damage or blockage, often caused by inflammation of the fallopian tube (salpingitis): This can result from pelvic inflammatory disease, which is usually caused by a sexually transmitted infection, endometriosis or adhesions.
• Endometriosis: When endometrial tissue grows outside of the uterus it may affect the function of the ovaries, uterus and fallopian tubes.
• Primary ovarian insufficiency (early menopause): When the ovaries stop working and menstruation ends before age 40.
• Pelvic adhesions: Bands of scar tissue that bind organs after pelvic infection, appendicitis or abdominal or pelvic surgery.
Risk factors for males and females:
Age: A woman’s fertility drops rapidly after age 37. Men over age 40 may be less fertile than younger men.
Tobacco use: Smoking of tobacco or marijuana by either partner reduces likelihood of pregnancy.
Alcohol use: Alcohol use may contribute to infertility. For men, heavy use can decrease sperm count.
Overweight: Among women, being overweight may increase the risk of infertility. A man’s sperm count may also be affected.
Underweight: Those with eating disorders, such as anorexia or bulimia or who follow a very low calorie diet are at risk.