When you can’t fall pregnant

INFERTILITY: ABOUT 15% OF COUPLES ARE STRUGGLING TO HAVE A BABY

There are safe and effective therapies that improve your chances to conceive.

Infertility is defined as not being able to fall 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 – about 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. With the right advice most couples will eventually conceive, with or without treatment. You probably don’t need to see a doctor about infertility, unless you have been trying regularly to conceive for at least one year. 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.

Ovulation usually occurs at the middle of the cycle – halfway between menstrual periods – for most women with menstrual cycles about 28 days apart.

You definitely need to see a doctor, if you’re a woman and:

You’re over age 40 and still want a child;

You menstruate irregularly or not at all;

Your periods are very painful; You have known fertility problems;

You’ve been diagnosed with endometriosis or pelvic inflammatory disease;

You’ve had multiple miscarriages; and

You’ve undergone treatment for cancer.

Talk with your doctor if you’re a man and:

You have a low sperm count or other problems with sperm; You have a history of testicular, prostate or sexual problems; You’ve undergone treatment for cancer;

You have testicles that are small or swelling in the scrotum; and You have others in your family with infertility problems.

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.

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 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. Treatment for cancer can impair sperm production, sometimes severely.

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.

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.

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.

Primary ovarian insufficiency (early menopause), when the ovaries stop working and menstruation ends before age 40. Although the cause is often unknown, certain factors are associated with early menopause, including immune system diseases, radiation or chemotherapy treatment, and smoking.

Pelvic adhesions, bands of scar tissue that bind organs after pelvic infection, appendicitis, or abdominal or pelvic surgery.

Other causes in women include certain cancers and their treatment, poorly controlled diabetes and some autoimmune diseases such as lupus, can affect a woman’s fertility.

Risk factors

These apply to 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. This leads to higher rates of certain medical conditions in offspring, such as psychiatric disorders or certain cancers.

Tobacco use. Smoking by either partner reduces the likelihood of pregnancy.

Alcohol use. For women, there’s no safe level of alcohol use during conception or pregnancy. Avoid alcohol if you’re planning to become pregnant. Alcohol use 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.

Exercise issues. Insufficient exercise contributes to obesity, which increases the risk of infertility. Less often, ovulation problems may be associated with frequent strenuous, intense exercise in women who are not overweight.