What to do when you can’t get pregnant?

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. Many people are struggling to have a baby, around 10 to 15% of couples.

Fortunately, 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 some signs of hormonal problems, such as changes in hair growth or sexual function. You probably don’t need to see a doctor about infertility unless you have been trying regularly to conceive for at least one year.

Causes of male infertility

In most cases a cause cannot be identified. To increase the chance of falling pregnant, it is advisable for couples to have regular intercourse several times around the time of ovulation for the highest pregnancy rate. Having intercourse beginning at least five days before and until a day after ovulation improves your chances of getting pregnant. Ovulation usually occurs at the middle of the cycle – halfway between menstrual periods – for most women with menstrual cycles about 28 days apart.

Causes of male infertility

Abnormal sperm production or function 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 the delivery of sperm due to sexual problems, such as premature ejaculation; certain genetic diseases, such as cystic fibrosis; structural problems, such as a blockage in the testicle; or damage or injury to the reproductive organs.

Overexposure to certain environmental factors, such as pesticides and other chemicals, and radiation.

Cigarette smoking, alcohol, marijuana or taking certain medications, such as select antibiotics, antihypertensives, anabolic steroids or others, can also affect fertility. Frequent exposure to heat can raise the core body temperature and may affect sperm production.

Damage related to cancer and its treatment, including radiation or chemotherapy. Causes of female infertility

Causes of female infertility

Ovulation disorders. These include hormonal disorders such as polycystic ovary syndrome.

Hyperprolactinaemia, a condition in which you have too much prolactin – the hormone that stimulates breast milk production – may also interfere with ovulation. Either too much thyroid hormone (hyperthyroidism) or too little (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 with the opening of the cervix, polyps in the uterus or the shape of the uterus. v Noncancerous (benign) 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, which occurs when endometrial tissue grows outside of the uterus, may affect the function of the ovaries, uterus and fallopian tubes. v Primary ovarian insufficiency (early menopause), when the ovaries stop working and menstruation ends before age 40. Certain factors are associated with early menopause, including immune system diseases, radiation or chemotherapy treatment, and smoking. v Pelvic adhesions, bands of scar tissue that bind organs after pelvic infection, appendicitis, or abdominal or pelvic surgery

Risk factors

These apply to both males and females:

Age. A woman’s fertility gradually declines with age, especially in her mid-30s, and it drops rapidly after age 37. Men over 40 may be less fertile than younger men.

Tobacco use. Smoking by either partner reduces the likelihood of pregnancy. v Alcohol use. This increases the risk of birth defects, and may contribute to infertility. For men, heavy alcohol use can decrease sperm count and motility.

Being overweight. Among women, an inactive lifestyle and being overweight may increase the risk of infertility. A man’s sperm count may also be affected if he is overweight.

Being underweight. Women at risk of fertility problems include those with eating disorders, such as anorexia or bulimia, and women who follow a very low calorie or restrictive diet.

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Dr Dulcy who holds an MBBCH degree from Wits University, a diploma in occupational health, a diploma in HIV management, travel medicine diploma, masters of science in sports medicine, and a masters in business administration degree from GIBS is here to help!

Dr Dulcy is a social entrepreneur with a passion for providing healthcare and wellness solutions for low and middle-income communities in South Africa. As the 2016 Social Entrepreneurship Regional Business Achiever award winner for Business Women’s Association, she started Accessible Quality Healthservices (AQH) in 2013 after being a general practitioner in Vryburg then Carletonville for 11 years.

In 2015, she partnered with Pascal Frohlicher and we founded U-Care Medical Centres which focused on building private medical centres and providing world-class health services at an affordable cost. This company evolved in 2019 to become quadcare, which is a network of medical centres in areas where they are needed the most providing access to affordable healthcare. Currently, the centres are in Edenvale, Fox Street Johannesburg, Meadowlands, Carletonville, University of Johannesburg, and Park Station.

Dr Dulcy said her life’s purpose was to make an impact on how healthcare was delivered in this country, especially to the poor.

*Always consult your GP paediatrician, gynaecologist or health-care provider for all health matters