Zeroing in on the four main physiological factors of infertility.
Contributed By DR. Fong Chuan Wee
While a child is a blessing from God, couples who long for a child need to do their bit too—and this encompasses finding out the underlying reasons of one’s infertility, adhering to the doctor’s advice and being hopeful. We take a look at the contributing factors that may inhibit conception.
Age Really Matters
Younger couples are more likely to conceive. If possible, try to marry when you are young and do not unduly postpone trying for children once you are married. In studies of couples who encounter difficulty in conceiving, it has been noted that there is an infertility rate of 10 percent in women under the age of 30, 15 percent in women aged 30 to 35, 30 percent in those aged 35 to 40 and 60 percent in women over the age of 40. However, do not give up hope. There is a good chance of spontaneous conception even for women above 40 years of age. Seek out medical help and treatment immediately if you are unable to conceive after one year of regular unprotected intercourse. Undue delay lowers your chance of success.
Sex Does Matter
Many couples experience difficulty in conceiving because they have no time for sexual intimacy. Busy working schedules, deferment in starting a family because of continuing educational pursuit and career development during the early years of marriage are some of the common causes of infertility. “We are so busy that we hardly see each other,” or “by the time we reach home, we are so tired that we have no time or mood for sexual intimacy,” are common confessions of couples in fertility clinics.
When asked how often they have sex, the most likely answers are “once or twice a month” or “we do it only during the fertile periods.” Normal follicular development leading to mature eggs ready for ovulation and fertilization occurs only once a month or 10 to 12 times a year in a fertile couple. It survives only 24 hours after ovulation, so if you want to get pregnant, you need to have more regular sex: alternate days during the fertile period but also every three to four days during the non-menstruating period to share your love for one another and ensure better quality sperms.
Simply put, infrequent sex or sexual problems account for 30 percent of infertility cases. The male factor accounts for the additional 30 percent, the female factor another 30 percent. The remaining 10 percent of infertilities cannot be explained even after thorough medical investigations.
The Male Factor
Age is not as critical for males when it comes to having children. Low sperm count and motility may be due to childhood mumps or viral infection affecting both testes. Varicocele or engorged veins around the testis and the vas deferens are also possible causes. Varicoceles can be surgically treated, leading to 50 percent improvement, but beware of over-diagnosis which may result in surgery that does not bring about the desired result.
Excessive alcohol consumption, smoking, drug abuse, obsessive exercise habits or obesity due to sedentary lifestyles and overeating may also lead to poor sperm count and motility.
Very often, couples are told that they have poor sperm quality because seminal analysis reports show that less than 14 percent of their sperms are normal. However, long term follow-up shows that a sperm morphology (the measure of the percentage of sperm that have a normal shape) between five percent to 14 percent is compatible with fertility. Even with a sperm morphology below five percent, the couple may still conceive, though admittedly the chance of conception is reduced.
Factors that may be detrimental to normal sperm development include exposure to radiation, environmental pollutants, certain groups of drugs, excessive electromagnetic waves and long term exposure to PVC products.
The Female Factor
In women, poor follicular development and ovulation, tubal blockage and pelvic pathologies such as fibroids, endometriosis, pelvic adhesions and uterine abnormalities are the main factors that reduce female fertility.
Poor follicular development and ovulatory failure are often age-related but may be temporarily affected by stress. Obesity or excessive weight loss from obsessive dieting and exercise are not uncommon reasons and can be easily corrected with proper nutritional advice. In fact, both obesity and an overly lean body mass in pregnancy are detrimental to the baby development in the womb.
Clomiphene and gonadotropins injections are effective medication that help to promote follicular development, induce ovulation and improve fertility. Infertile couples should follow their gynecologist’s advice to complete the courses of treatment before deeming them as failed treatments. Early default in ovulation stimulation is a common reason for poor results. Indeed, one of the common faults with couples undergoing infertility treatment is that they expect instant success, switching from one gynecologist to another or giving up hope too soon.
Tubal blockage is another common reason for infertility. Sexually transmitted diseases such as gonorrhea and Chlamydia are classic examples that cause pelvic adhesions and tubal blockage. Pelvic infection may also arise from abortion, abdominal surgery and childbirth. These are treatable with antibiotics and surgery.
Other reasons include large fibroids, which distort the uterine anatomy and disturb uterine function. And while large endometriotic cysts and gross uterine abnormalities should be surgically treated to improve fertility, small fibroids and cysts are common, these do not contribute to infertility and may be left alone.
What’s Next
Even with seemingly insurmountable problems or unexplained infertility, most couples have a good chance of conceiving with modern Assisted Reproductive Treatment procedures such as Intrauterine Insemination, In-Vitro Fertilization and Intracytoplasmic Sperm Injection.
Couples with poor sperm quantity or quality are suitable candidates for IUI. This procedure carries a 20 percent pregnancy rate after six attempts. This should be the first option before consideration of more advanced assisted reproductive procedures. IVF is useful for couples with tubal blockage or for elderly couples (where the wife is above 35 years old) with unexplained infertility. A husband with very few normal sperms is best helped by ICSI. This procedure requires only one healthy sperm each time. Upon embarking on IVF or ICSI, the couple should complete three cycles before giving up. The success rate hovers around 30 to 40 percent. It must be noted, however, that the higher the chances of success, the higher the risk of multiple pregnancies and ovarian hyperstimulation syndrome.
Dr. Fong Chuan Wee is a consultant obstetrician and gynecologist at Fong Clinic For Women
Gleneagles Medical Centre
6 Napier Road #05-18 S (258499)
Tel.: +65 6479 5450
Doing Your Groundwork
• Getting married and starting a family early go a long way in avoiding infertility.
• Keep a healthy lifestyle. Avoid alcohol, smoking, drug abuse, excessive weight gain or loss.
• Early investigation and appropriate treatment should help most couples conceive.
• Do not give up hope easily.
• Prayers and mutual support are important in the often stressful journey towards achieving conception.
