Infertility (Subfertility): When A Couple Has Difficulty Conceiving

Infertility is defined as the inability to conceive after a 12-month period of normal unprotected sexual intercourse. In basic terms, this means not getting pregnant after a year of trying for a baby.

In order for a couple to achieve pregnancy, three basic things must happen:

* The right number of healthy sperm have to be placed inside the woman's body in the correct place and at the correct time.

* The woman must be producing healthy ova (eggs) - a process termed "ovulating."

* The tubes inside the woman's body that connect the ovaries to the womb must be patent - and her womb must be healthy enough to allow the fertilised egg to become implanted inside the womb.

Principal Causes for Couple Failing to get Pregnant

Common causes for failure to get pregnant include the following:

* problems with intercourse or the timing of intercourse

* defective production of ova or sperm, which can be caused by previous infections (e.g. mumps in the male) or radiotherapy for cancer treatment or the long term use of steroids

* blockage of the tubes that carry sperm from the testes in the male (called the vasa deferentia) or the tubes that carry ova from the ovaries in the female (called the fallopian tubes). This could be a congenital defect - but more commonly occurs as the result of infections such as chlamydia or tuberculosis.

* psychological factors such as depression, anxiety or stress

How to Treat Infertility?

If a couple has not conceived after 12 months of trying for a baby, they should consult their family doctor together.

The doctor will then ascertain whether intercourse is frequent enough and also whether intercourse takes place at the best time (the fertile period of a woman's menstrual cycle) for conception to take place. The doctor can also tactfully find out whether the couple experiences any sexual difficulties such as erectile dysfunction or premature ejaculation.

Quite often, this preliminary consultation will bring to light a simple correctable problem, and after being given the appropriate advice and health education, the couple can go back to trying. It is often found that the woman gets pregnant within a few months.

If after several months they find themselves still unable to conceive, they should consult their doctor for review so he or she can arrange some tests - principally to find out if the man is producing normal sperm and if the woman is ovulating.

Testing The Male Partner

In order to make sure that the man is producing sperm of normal quality and in normal quantities, he needs to provide a sample of semen. This is usually obtained by masturbation after abstaining from sex for about three to four days. The sample of seminal fluid is then examined under the microscope in the laboratory within an hour of leaving the man's body.

A normal sample of semen (one that is capable of fertilising a woman's ova) should be at least 2 ml in volume, have at least 20 million sperm per millilitre, and have at least half of these sperms being of normal appearance and motility.

Testing the Female Partner

It can be ascertained whether a woman is ovulating by maintaining a chart of her daily body temperature. When her ovary releases an ovum, her body temperature rises slightly - typically less than one degree. A woman is most fertile during the two to three days before this temperature rise - and this period just before the body temperature rises is the best period for the sperm to have a chance of fertilizing the egg.

Another practical test of ovulation is to examine the mucus in the vagina, which changes in nature after ovulation. Measuring the level of female hormone in the urine is another method of testing whether ovulation is occurring.

Special Tests for Subfertility

If the above simple tests do not reveal any abnormality, other special tests may be needed. The family doctor will need to refer the couple for these investigations to hospital or special clinics because these tests need to be done under the guidance of specialists.

Prognosis for Subfertile Couples

Couples who have not been successful in achieving pregnancy after a year of trying can take heart from the fact that current treatment helps about 60% of subfertile couples to become pregnant.