INFERTILITY

The term ‘infertility’ is used when a couple fails to conceive after one year of sexual life without contraception. 80% of all women desiring children, conceive within 1 year of marriage and another 10% within the second year.

According to the World Health Organisation, incidence of infertility is about 10 % worldwide. Another 10-12% of all the other couples have only one child and wish to have more. The incidence of infertility is gradually increasing all over the world.

For many people going through infertility treatment, the level of distress and tension can be very high. Mutual trust and faith in the doctor can help the couples to enquire about different modalities of treatment for both the male as well as the female partner, and make informed decisions of their reproductive status.

Infertility investigation requires probing into the minutest physical and psychological details. Management therefore needs sympathy, compassion and a great deal of tact on the part of the doctor.

It is necessary that the couple should be first spoken to together and then again separately. This is so that each is free to reveal anything they should wish to in complete confidentiality.

Knowing the details of the female reproductive organs, and how pregnancy occurs go a long way in understanding the different causes of infertility.

Clinical Assessment of Both the Partners for Infertility

Clinical assessment and a thorough history should be taken before the couple is subjected to investigations, both invasive and non-invasive. Certain special points are to be noted:

Age of both the partners: A woman above the age of 40 years and closer to menopause has less than half the fertility potential and a lower pregnancy rate of a woman of 20 years. And a man above the age of 40 years can also show a lowering sperm count, although he can father children for his lifetime.
Previous children: If one of the partners has children from a previous union, a rough idea of the cause of infertility can be made.
Birth control: If the couple has practiced birth control, especially oral contraceptive pills or used intrauterine contracetive devices (IUCD) at any time, then these have to be taken into account.
Duration of the present Union: If their occupations separate them for any duration of time or if they have been together for less than 6 months, and the age of the female partner is less than 25 years, then tests to investigate the cause of the infertility may be delayed till the couple have been together for at least 1 year.
Frequency of intercourse – Coitus or sex must occur every 48 hours from the 8th to the 18th day of the menstrual cycle for an optimum chance at If the couple has practiced pregnancy. Too frequent coitus however is rarely a cause for infertility. Rare occasions of sex or coitus is more likely to cause infertility.
Pain during intercourse: Many women avoid having sex or have irregular intercourse due to vaginal pain and may complain of infertility.
Coital history : A couple needs to have regular, coitus to avoid infertility. Conditions like vaginismus, impotence and erectile dysfunction can cause infertility.
Menstrual history : A regular menstrual cycle with normal blood flow indicates regular ovulation. Since lack of ovulation accounts for about 30% of all causes of infertility, the history of regular periods is an important pointer to the woman's fertility.
Male partner's occupation: Constant heat can lower the sperm count. So occupations that can cause the male partner to drive long distances can cause infertility. Pesticides and certain anesthetic drugs can also lower the sperm count.
Previous illnesses and operations: The cause of infertility can be due to an operation near or on the genital tracts or if either of them ever had any infections, especially infections by the chlamydia or gonococci (gonorrhea) organisms.
Family medical history of both partners: Certain conditions like diabetes, high blood pressure, thyroid diseases can be genetically transmitted and can lead to infertility or low fertility.
Lubricants: Sometimes when coitus or sex is difficult due to a dry vagina, many couples use lubricants like paraffin or lanolin. Many of these lubricants have a toxic effect on sperm and can cause infertility.
Miscellaneous: Drugs, certain medicines, alcohol and nicotine can lead to infertility if taken in excess.

The causes of female infertility are very different from the causes of male infertility and require different types of tests for an accurate diagnosis.

The treatment procedures of both the male and the female partner are also different.

The aim of treatment is to remove any of the identified factors causing infertility. Most couples appreciate a description of the physiological process of fertilization and conception. A sympathetic hearing of their difficulties goes a long way in decreasing the stress involved in visiting a doctor for treatment.

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