Infertility is usually defined as the failure of a couple to start a pregnancy after at least one year of regular intercourse without contraception. Sadly, in many societies,is thought to indicate much more. An infertile person may be accused of being unfeminine or unmasculine or of being a freak. Couples who are desperately keen to become parents may find friends and family saying they are ‘too selfish to want children’ if marriage is not followed nine months later by the arrival of a child.
In fact only one in 20 couples is successful the very first time they try for a baby. By the end of four months, six out of ten couples are still trying, and two in ten will wait a year before conceiving. One in ten will be unsuccessful after 18 months.
The point at which fertility becomesis thus a fine one. Very few people are totally infertile. In discussing the problem most doctors now prefer to talk about ‘sub-fertility’ because in the vast majority of cases the capability of pregnancy does actually exist. It is estimated that as many as two-thirds of the unlucky ten per cent who do have real problems can be helped to have a child of their own.
Because it is the woman who actually bears the child, historically it has been accepted that infertility is her problem. Many women have experienced social stigma and unpleasant tests and treatment, even in recent times, when in fact it is the man who may be having the difficulties. Doctors now recognize that, statistically speaking, of couples presented with such a problem, a third will find the cause lies with the woman, a third with the man and a third will have a joint problem.
Causes of infertility
If, after a year of trying for a pregnancy, conception has not occurred, the couple might choose to ask for help and advice. The best first source would be their own family doctor. Infertility can be the result of many conditions, both physical and emotional. Men and women can be rendered infertile by untreated sexually transmitted disease infecting the vas deferens or the Fallopian tubes and blocking the passage of sperm or egg with scar tissue.
Severe illness can also affect ovulation or spermatogenesis. Mumps in adult men for instance is sometimes complicated by an inflammation of the testes. The result of this may be infertility. The inability to produce viable sperm is also the case when at puberty the testes have failed to descend into the scrotum. In a woman, hormonal imbalances can prevent ovulation, or a fertilized egg from implanting in her womb. Cysts, or conditions such as endometriosis* can also prevent pregnancy. Both sexes can also be affected by emotional difficulties, either making sexual intercourse impossible or difficult, or making them so unhappy and tense that the normal biological processes are interrupted.
There are various tests that can be applied in an attempt to determine the origin of a couple’s fertility problems. Both partners will be given a routine medical examination, because a couple’s general physical and mentalcan greatly affect their fertility. The sex organs of both will be examined to ensure that there is no obvious obstruction or abnormality. For instance, the man may have a defect in his penis such as the congenital defect epispadias in which the urethra emerges from the upper surface of the penis, or hypospadias in which it comes out from the under surface rather than the tip. Both conditions can mean that too little semen finds its way to his partner’s uterus. An unbroken and thick hymen blocking the woman’s vagina can mean that penetration is difficult or impossible. ‘Infertility’ can also be the result of emotionally based sexual difficulties preventing the couple from having sexual intercourse. Impotence, premature ejaculation or vaginismus are other common problems all of which can mean that a couple are unable to start a pregnancy.
A sensitive and sympathetic doctor would be able to discern any such difficulties before proceeding to other tests.