Do
you have an infertility problem?
When to start worrying!
from the book How to Have
a Baby: Overcoming Infertility
by Dr. Aniruddha Malpani, MD
and Dr. Anjali Malpani, MD.
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Do
you have an infertility problem? When to start worrying! "So, when
are you planning to have a baby?" This is the commonest question most
newly married couples in India are asked - sometimes even as soon
as they have returned from the honeymoon! There is a lot of pressure
on couples to have a baby, especially in traditional families, where
the wife's role is still seen to be one of perpetuating the family
name by producing heirs.
Many
couples still naively expect they will get pregnant the very first
month they try (the result of watching too many Hindi films, perhaps!)
- and are concerned when a pregnancy does not occur. All of us go
through a brief interlude of doubt and concern when we do not achieve
pregnancy the very first month we try - and we start wondering about
our fertility.
Before
worrying, remember that in a single menstrual cycle, the chance of
a perfectly normal couple achieving a successful pregnancy is only
about 25%, even if they have sex every single day. This is called
their fecundity which describes their fertility potential. Humans
are not very efficient at producing babies! There are many reasons
for this, including the fact that some eggs don't fertilize and some
of the fertilized eggs don't grow well in the early developmental
stage. Getting pregnant is a game of odds - it's a bit like playing
Russian Roulette and it's impossible to predict when an individual
couple will get pregnant! However, over a period of a year, the chance
of a successful pregnancy is between 80 and 90%, so that 7 out of
8 couples will be pregnant within a year. These are the normal "fertile"
couples - and the rest are "labeled" infertile - the medical text
book definition of infertility being the inability to conceive even
after trying for a year. Couples who have never had a child, are said
to have "primary infertility", those who have become pregnant at least
once but are unable to conceive again, are said to have "secondary
infertility."
The
chances of pregnancy for a couple in a given cycle will depend upon
many things, and the most important of these are:
-
The
age of the woman. At the biologic clock ticks on, the number of
eggs and their quality starts decreasing
-
Frequency
of intercourse. While there is no "normal" frequency for sex,
the "optimal" frequency of intercourse if you are trying to get
pregnant is about 3 times a week in the fertile period. Simply
stated, the more sex the better! Couples who have intercourse
less frequently, have a diminished chance of conceiving.
-
"Trying
time" - that is, how long the couple have been trying to get pregnant.
This is an important concept. The longer a couple has been trying
to conceive without success, the lesser their chances of getting
pregnant without medical help.
-
The
presence of fertility problems.
What
happens when a couple has a fertility problem? The chances of their
getting pregnant depends upon a number of variables multiplied together.
Consider a couple where both the husband and wife have a condition
that impairs their fertility. For example, the husband's fertility,
based on a reduced sperm count is 50 percent of normal values. His
wife ovulates only in 50 percent of cycles; and one of her fallopian
tubes is blocked. With three relative infertility factors, their chance
of conception is 0.5 (sperm count) X 0.5 (ovulation factor) X 0.5
(tubal factor) = 0.125, or 12.5 percent of normal. Since the chance
of conception in normal fertile couples is only 25% in any one cycle,
the probability of pregnancy in any given month for this couple without
treatment is only 3 percent (0.125 X 25 = 0.03125)! Even if they kept
on trying for 5 years, their chance of conceiving on their own would
be 60% only. Thus, infertility problems multiply together and magnify
the odds against a couple achieving a pregnancy. This is why it is
important to correct or improve each partner's contributing infertility
factors as much as possible in order to maximize the chances of conception.
If
infertile couples had 300 years in which to breed, most wives would
get pregnant without any treatment at all! Of course, time is at a
premium, so the odds need to be improved - and this is where medical
treatment comes in.
When
should you start worrying and seek medical advice?
If
you have been having sexual intercourse two or three times a week
at about the time of ovulation, without any form of birth control
for a year or more and are not pregnant, you meet the definition of
being infertile. Pregnancy may still occur spontaneously, but from
a statistical point of view, the chances are decreasing and you may
now want to start thinking about seeking medical help. There is no
"right" time to do so - and if it is causing you anxiety and worry,
then you should consult a doctor. Even though you may be embarrassed
and feel that you are the only ones in the world with the problem,
you are not alone. Many couples experience infertility and many can
be helped.
Unfortunately,
while infertility is always an important problem, it is usually never
an urgent one. This often means that couples keep on putting off going
to the doctor. "We'll take care of it next month". Tragically, many
find that time flies, and before they realize it, their chances of
getting pregnant have started to decline, even before they have had
a chance to take treatment properly. Remember that everything in life
comes back, except for time!
A
note of caution.....
There
are certain conditions that warrant seeing a doctor sooner:
Periodsat three-week (or less) intervals
No period for longer than three months
Irregular periods
A history of pelvic infection
Two or more miscarriages
Women over the age of 35 - time is now at a premium !
Men who have had prostate infections
Men whose testes are not felt in the scrotum
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