Dr. Theo’s Desk

I think it’s in bad taste to ask a couple who have been married for a certain length of time when they will be getting their first born. Or when they expect to get a second child. The reasoning behind this is that the cases of both primary and secondary infertility have continued to rise even among very young men and women.

What is infertility?

Dr Theo describes infertility as not being able to get pregnant after one year of trying (regular, unprotected sex, without the use of contraceptives) or six months of trying if a woman is 35 or older. “About 90 percent of couples will become pregnant after 12 months of trying. Women who can get pregnant but are unable to carry a pregnancy to full term may also be infertile,” explains Dr Theo. 

Infertility issues

About a third of the issues involved with infertility are due to the man, another third due to the woman, and the remaining third result from complications with both partners. Some couples have been pregnant at least once in the past, but are not able to get pregnant now. 

For a woman to get pregnant, her body must release an egg from one of her ovaries (ovulation). The released egg must go through the fallopian tube toward her uterus whereby a man’s sperm must fertilize the egg along the way and the fertilized egg must attach to the inside of the uterus (implantation). Infertility can happen if there are problems with any of these steps. 

What Causes Fertility Problems in Women?

Blocked fallopian tubes

Blocking of the fallopian tubes is a major cause of infertility. The blocking could be due to previous infection of the tubes (pelvic inflammatory disease or PID), which is commonly caused by sexually transmitted diseases such as chlamydia and gonorrhea. 

The Infection of the fallopian tubes can also be due to 

• abortion
•  miscarriage
• traumatic child birth. 
• PID can cause scar tissue which may block the egg from travelling down the fallopian tubes.

Endometriosis 

Another cause of blocked tubes is endometriosis which is growth of endometrial tissue in the tubes and/or around the ovaries. Pelvic adhesions, bands of scar tissue that bind organs after pelvic infection, appendicitis, or abdominal or pelvic surgery, can also cause infertility.

Lack of ovulation

Another common reason for infertility in women is lack of ovulation. Polycystic ovary syndrome (PCOS) is a leading cause of lack of ovulation. In PCOS, the eggs don’t develop well and there is an excess of male hormones. 

Other causes

Growth (such as fibroids or polyps) in the uterus, certain drugs, including cancer treatment, thyroid disease, hormone imbalance and early menopause. 

What Causes Fertility Problems in Men?

Problems with Sperm

In men, the most common reasons for infertility are problems with sperm. These include low sperm count (too few or no sperm in the semen), sperm that don’t move as well as they should, abnormally shaped sperm, blocked sperm ducts. Frequent exposure to heat, such as in saunas or hot tubs, and varicoceles (when the veins on a man’s testicles are too large) can affect sperm production. 

Sexual problems

These include premature ejaculation and retrograde ejaculation.

Other causes include:

Hormone problems

Heavy use of alcohol, smoking, 

Undescended testes 

Cancer and its treatment.

Risk factors for both male and female infertility include:

Age

A woman’s peak fertility occurs in the 20s. The fertility gradually declines with age, especially after the age of 35. Getting pregnant after age 45 is rare.

 Alcohol and tobacco use

 Miscarriages are more frequent in women who smoke. For women, there’s no safe level of alcohol use during conception or pregnancy. For men, heavy alcohol use can decrease sperm count and motility. 

Being overweight or underweight

A man’s sperm count may be affected if he is overweight. One should aim for an ideal BMI: Women with a BMI of <19 and who have irregular menstruation or are not menstruating should be advised that increasing body weight is likely to improve their fertility. Women with a BMI of ≥30 are likely to take longer to conceive and those who are not ovulating should be informed that losing weight is likely to increase their chance of conception.

Too much exercise or the lack of it

Too much exercise (such as regular long-distance running) or no exercise at all can contribute to infertility.

When to see the doctor 

• If you have been trying to conceive for at least one year without success
•  if you’re a woman and you’re aged above 35 years and have been trying for more than six months
• If you have irregular periods or no periods
• If your periods are very painful
• If you’ve been diagnosed with endometriosis or pelvic inflammatory disease
• If you’ve had more than one miscarriage or you’ve had prior cancer treatment. 

Testing for infertility in women

It is important to disclose the following details to your doctor:

• How regular the periods are
• Abnormal bleeding
• Age
• Length of time you have been trying
• History of previous STDs, infections, miscarriages is important. 

The doctor will look out for signs of excessive hair growth (hirsutism), male pattern hair distribution (pubic hairline that extends up towards the navel), acne, weight and BMI are assessed. Pelvic exam may identify swellings such as fibroids. 

Specific fertility tests in women may include: 

• Hormone profile tests checks if the female hormones are balanced or not. They include prolactin, Progesterone, Estrogen, FSH and LH. 

• A blood test to check if ovulation occurs measures the hormone progesterone which is high just after ovulation. 
• Other hormone tests include testosterone, thyroid and pituitary hormones 
• Blood sugar and insulin tests to rule out diabetes 
• Laparoscopy, a minimally invasive surgery to check the pelvic organs 
• Hysterosalpingography (HSG), it confirms if the tubes are patent or blocked 
• Ovarian reserve testing, which checks if there are enough eggs available for ovulation. 
• Pelvic ultrasound looks for problems like fibroids and Polycystic Ovaries 
• STD tests such as HIV, hepatitis B and hepatitis C, especially for those seeking IVF treatment. 

Fertility tests for men may include:

• The man may have a general physical exam, checking the genitals for any varicoceles. 

Specific tests may include: 

• Examination of semen (semenalysis) looking for the quantity (sperm numbers, or sperm count) and quality (shape and movement) of sperms. 

• Others are Hormone tests for testosterone, scrotal ultrasound etc 

Treatment for infertility in women

• Clomiphene citrate (Clomid) is used to stimulate ovulation. 

• Metformin (glucophage), which is used to treat some people with diabetes, is also used in women with PCOS. 

• Other medicines are: Human menopausal gonadotropin (hMG), Gonadotropin-releasing hormone (Gn-RH) analogs and Bromocriptine. These medicines are only prescribed by a trained fertility expert. 

• Surgery may be an option in blocked tubes, endometriosis, PCOS, fibroids or pelvic adhesions. 

Treatment for infertility in men 

• Treatment for infertility in men includes treatment for general sexual problems such as impotence or premature ejaculation. 

• Hormonal treatment or assisted reproductive technology for instance, sperm retrieval may be done for those who lack healthy sperm. 

• Surgery may be done for blocked sperm ducts and varicoceles. 

Types of assisted reproductive technology (ART)

• In vitro fertilization (IVF) 

IVF means fertilization outside of the body. It is often used when a woman’s fallopian tubes are blocked or when a man produces too few sperm. Egg and sperm are brought together in a test-tube. Embryo is put back inside the woman’s body. 

• Other types are, Intrauterine insemination (IUI), Gamete intrafallopian transfer (GIFT), and Intracytoplasmic sperm injection (ICSI). 

Complications of infertility treatment may include: 

• Multiple pregnancy (twins, triplets or more)
• Premature delivery
• Low birth weight 
• Birth defects (especially with IVF). 

Planning to Become Pregnant

Ovulation occurs about two weeks before the next period starts. If you get your period every 28 days, you should have intercourse at least every 3 days between the 10th and 18th day after the period starts. This can increase your chances of becoming pregnant. Semen quality is optimized by waiting two to three days between ejaculations. 

Preparing the body for pregnancy

Before becoming pregnant it is advisable to do the following: 

• Take folic acid supplements 
• Have a blood test to screen for hepatitis B, syphilis and HIV 
• Work on having an optimal weight 
• Eat a healthy diet that include foods rich in iron and calcium 
• Eat some oily fish, 
• Wash your hands after handling raw meat
• Handling cats and kittens
• Before you prepare food
• Stop drinking 
• Stop smoking 
• Reduce caffeine intake