• Only around 84 per cent of normal fertile couples conceive within a year of regular unprotected intercourse.
• In those couples who have not conceived after a year, around half of those continuing to try to conceive succeed within a further twelve months.
• Therefore, after two years of unprotected intercourse, around 92 per cent of couples have conceived.
half of those continuing to try to conceive will succeed within a further twelve months. So do not be alarmed if you do not get pregnant within the first few months of trying for a baby. Infertility is usually defined as an inability to conceive after a minimum of twelve months of unprotected intercourse. Doctors do not usually investigate for a fertility problem unless you had been trying unsuccessfully for at least a year. This is because many ‘normal’ couples take at least this long to conceive.
• Primary infertility is a term used to describe couples who are having difficulty in conceiving and who have not previously had a pregnancy.
• Secondary infertility is used to describe couples who have previously had a pregnancy but subsequently found they have difficulty conceiving. This applies even if the first pregnancy was not successful. For example, a woman who has had several miscarriages and then has difficulty conceiving again has secondary infertility.
So even if you have had a pregnancy in the past, you may still have difficulty conceiving. When this happens, you should consider whether there have been any changes since your pregnancy. For example:
• has one of you developed a medical problem since the previous pregnancy? This could be something such as an operation for appendicitis in the woman or treatment for testicular cancer in the man
• have you formed a new relationship and so have a different partner since your previous pregnancy?
• has it been a long time since the previous pregnancy such that you are now a lot older than you were when you last conceived? Doctors know that fertility declines in a woman as she gets older, particularly after the age of 35 years.
must know
Causes of endometriosis
Doctors don’t really know why
endometriosis occurs. It may result from fragments of the tissue lining the womb (endometrium) ‘escaping’ down the fallopian tube and into the abdomen during a menstrual period. These fragments then ‘seed’ onto the tissues in the abdomen and patches of endometriosis form. These patches behave as though they were in the womb, producing a ‘period’ each month. The endometriosis tissue needs the female hormone oestrogen to survive, so endometriosis is not found in girls before puberty or in women after the menopause when oestrogen levels are very low.
The main fertility problems in women
• The ovaries may not produce or release an egg every month.
• The fallopian tubes that carry the egg from the ovary down to the womb may be blocked. This blockage prevents the fertilized egg reaching the womb or even being fertilized, as the sperm meets the egg in the fallopian tube.
• Endometriosis can also cause damage to the tubes and ovaries. This is a condition where tissue similar to the lining of the womb grows on places such as the ovary, the tube or in the pelvis. Every month this tissue passes through a cycle, just as the lining of the womb, but, there is no way for the blood to escape and this leads to inflammation and scarring.
• Sometimes, the lining of the womb may not be ready for the implantation of a fertilized egg.
• There can be difficulty in the sperm getting from the vagina to the womb. This is because the mucous, which is at the neck of the womb, may be too thick or hostile to the sperm, preventing them from passing through the mucous at the cervix and into the womb itself.
• Age. Fertility wanes after the age of 35 years and especially after a woman passes 40. For example, only 77 per cent of fertile 38-year-old women conceive after three years of unprotected intercourse. Older women are likely to not only produce fewer eggs, but the eggs they do produce may not be so able to implant into the womb after fertilization as they were at a younger age. Age has much less of an effect on male fertility.
Lack of egg production
A common cause for a woman having difficulty conceiving is a hormonal imbalance that upsets the process of egg production or ovulation every month. Polycystic ovary syndrome (PCOS) is one of the most common disorders that upset ovulation. This is considered the major reason for women not producing an egg every month. If you have PCOS, the symptoms you are likely to experience are irregular, very spaced out or even absent periods, a greasier skin and acne and excess body hair. These three features do not always occur together. In this condition, an egg starts to develop every month, but because the hormone levels that control egg production are imbalanced, the egg stops maturating and is left as a tiny follicle or ‘cyst’ on the ovary. These are not true cysts on the ovary but rather small follicles where an egg has started to develop but stops before it matures.
Other medical problems, like thyroid disease, can also affect production of the egg. If you are very overweight with a BMI of over 29, this can also upset the ability of your ovaries to produce an egg every month because excess fat can cause a hormonal imbalance. This can be improved simply by losing weight, which often leads not only to a more regular menstrual cycle but also better fertility. Even a modest amount of weight loss in this situation can make a big difference. Women who are very underweight may also have a disturbance in their menstrual cycle. In this situation, weight gain makes a difference.
Fallopian tube blockage
The fallopian tubes can be blocked by an infection, such as a sexually transmitted disease, which can cause scarring of the tube and so prevent the sperm and the egg meeting. In the worst cases both tubes can be
must know
Fibroids
A fibroid is a benign lump of muscle in your womb and although fibroids can sometimes cause your periods to be heavy simply because they make the womb bigger so that there is more lining to shed each time you have a period, it is unusual for fibroids to affect your fertility. Very occasionally the womb can become so distorted by a large fibroid or multiple fibroids that this can lead to recurrent miscarriages, but such cases are usually not common.
blocked. Previous surgery in the abdomen can also cause scarring to the tube. One of the most common causes of this would be surgery for appendicitis. With appendicitis there is a significant amount of inflammation within the pelvis and that, plus the surgery itself, can irritate the tissues and cause problems, such as adhesions around the fallopian tube, and so lead to a blockage. Damage to a tube can also occur after an ectopic pregnancy, which often requires all or part of the tube to be removed completely.
Endometriosis
Endometriosis is a condition where tissue similar to the tissue found in the lining of the womb (endometrium) occurs in small patches in sites outside the womb. It can sometimes be found in the muscle of the womb, when it is termed adenomyosis. The most common sites are on the ovaries, fallopian tubes and the ligaments in the pelvis that support the womb. Often it produces no symptoms, but sometimes it can cause problems because each month, when a period occurs, the small patches of endometriosis also bleed. The blood cannot escape from the body and it irritates and inflames the surrounding tissues, causing pain. Chronic irritation of the tissues can lead to scarring and adhesions in the pelvis where tissues stick together. This can sometimes cause problems with a woman’s fertility due to the tubes being obstructed by adhesions or the ovaries being caught up with adhesions, preventing release of the egg. The main symptoms of endometriosis are pain in the abdomen and pelvis, pain when a woman is on her period (dysmenorrhea) and pain experienced