Do you have an infertility problem? When to start worrying!
from the book How to Have a Baby:
by Dr. Aniruddha Malpani, MD and Dr. Anjali Malpani, MD.
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Do you have an infertility problem? When to start
worrying! "So, when are you planning to have a baby?" This is
the commonest question most newly married couples in India are asked -
sometimes even as soon as they have returned from the honeymoon! There
is a lot of pressure on couples to have a baby, especially in
traditional families, where the wife's role is still seen to be one of
perpetuating the family name by producing heirs.
Many couples still naively expect they will get pregnant
the very first month they try (the result of watching too many Hindi
films, perhaps!) - and are concerned when a pregnancy does not occur.
All of us go through a brief interlude of doubt and concern when we do
not achieve pregnancy the very first month we try - and we start
wondering about our fertility.
Before worrying, remember that in a single menstrual
cycle, the chance of a perfectly normal couple achieving a successful
pregnancy is only about 25%, even if they have sex every single day.
This is called their fecundity which describes their fertility
potential. Humans are not very efficient at producing babies! There are
many reasons for this, including the fact that some eggs don't fertilize
and some of the fertilized eggs don't grow well in the early
developmental stage. Getting pregnant is a game of odds - it's a bit
like playing Russian Roulette and it's impossible to predict when an
individual couple will get pregnant! However, over a period of a year,
the chance of a successful pregnancy is between 80 and 90%, so that 7
out of 8 couples will be pregnant within a year. These are the normal
"fertile" couples - and the rest are "labeled"
infertile - the medical text book definition of infertility being the
inability to conceive even after trying for a year. Couples who have
never had a child, are said to have "primary infertility",
those who have become pregnant at least once but are unable to conceive
again, are said to have "secondary infertility."
The chances of pregnancy for a couple in a given cycle
will depend upon many things, and the most important of these are:
The age of the woman. At the biologic clock ticks on, the
number of eggs and their quality starts decreasing
Frequency of intercourse. While there is no
"normal" frequency for sex, the "optimal" frequency of
intercourse if you are trying to get pregnant is about 3 times a week in the
fertile period. Simply stated, the more sex the better! Couples who have
intercourse less frequently, have a diminished chance of conceiving.
"Trying time" - that is, how long the couple have
been trying to get pregnant. This is an important concept. The longer a
couple has been trying to conceive without success, the lesser their chances
of getting pregnant without medical help.
The presence of fertility problems.
What happens when a couple has a fertility problem? The
chances of their getting pregnant depends upon a number of variables
multiplied together. Consider a couple where both the husband and wife
have a condition that impairs their fertility. For example, the
husband's fertility, based on a reduced sperm count is 50 percent of
normal values. His wife ovulates only in 50 percent of cycles; and one
of her fallopian tubes is blocked. With three relative infertility
factors, their chance of conception is 0.5 (sperm count) X 0.5
(ovulation factor) X 0.5 (tubal factor) = 0.125, or 12.5 percent of
normal. Since the chance of conception in normal fertile couples is only
25% in any one cycle, the probability of pregnancy in any given month
for this couple without treatment is only 3 percent (0.125 X 25 =
0.03125)! Even if they kept on trying for 5 years, their chance of
conceiving on their own would be 60% only. Thus, infertility problems
multiply together and magnify the odds against a couple achieving a
pregnancy. This is why it is important to correct or improve each
partner's contributing infertility factors as much as possible in order
to maximize the chances of conception.
If infertile couples had 300 years in which to breed,
most wives would get pregnant without any treatment at all! Of course,
time is at a premium, so the odds need to be improved - and this is
where medical treatment comes in.
When should you start worrying and seek medical advice?
If you have been having sexual intercourse two or three
times a week at about the time of ovulation, without any form of birth
control for a year or more and are not pregnant, you meet the definition
of being infertile. Pregnancy may still occur spontaneously, but from a
statistical point of view, the chances are decreasing and you may now
want to start thinking about seeking medical help. There is no
"right" time to do so - and if it is causing you anxiety and
worry, then you should consult a doctor. Even though you may be
embarrassed and feel that you are the only ones in the world with the
problem, you are not alone. Many couples experience infertility and many
can be helped.
Unfortunately, while infertility is always an important
problem, it is usually never an urgent one. This often means that
couples keep on putting off going to the doctor. "We'll take care
of it next month". Tragically, many find that time flies, and
before they realize it, their chances of getting pregnant have started
to decline, even before they have had a chance to take treatment
properly. Remember that everything in life comes back, except for time!
A note of caution.....
There are certain conditions that warrant seeing a
Periods at three-week (or less) intervals
No period for longer than three months
A history of pelvic infection
Two or more miscarriages
Women over the age of 35 - time is now at a premium !
Men who have had prostate infections
Men whose testes are not felt in the scrotum
by Dr. Aniruddha Malpani, MD and Dr. Anjali Malpani, MD.
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