Before beginning to get worried, one should 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. Despite the phenomenal population growth, it should be emphasized that 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. It’s impossible to predict when an individual couple will succeed in achieving pregnancy! However, over a period of one year, the chance of achieving a successful pregnancy is between 80% and 90% ; in other words, 7 out of 8 couples will be on their way to becoming parents within a year. These are the normal ‘fertile’ couples and the rest are labelled ‘infertile’; the medical textbook definition of infertility being ‘the inability to conceive even after trying for one year’. Couples who have never had a child are said to have ‘primary infertility’; those women who have become pregnant at least once but are unable to conceive again, are said to have ‘secondary infertility’.
The chances of achieving pregnancy for a couple in a given cycle will depend upon many factors, and the most important ones are :
The age of the woman. As the biological 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 the woman is trying to get pregnant) is about 3 times a week during 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 an infertility problem?
The chances of the wife getting pregnant depends upon a number of variables multiplied together. Let us consider a hypothetical example where both the husband and the wife have a condition that impairs their fertility. The wife have a condition that impairs their fertility. The husband’s fertility, based on a reduced sperm count, is 50% of the normal value. His wife ovulates only in 50% of cycles; and one of her fallopian tubes is blocked. With 3 relative infertility factors, the chance of conception is calculated as follows : 0.5 (sperm count) x 0.5 (ovulation factor) x 0.5 (tubal factor) = 0.125, or 12.5% of normal. Since the chance 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 about 3% (0.125 x 25 = 0.03125)! Even if they kept on trying for 5 years, the 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 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 have not become 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 precise ‘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 facing this problem, you should not forget that you are not alone. Many couples experience infertility and many can be helped.
A note of caution should be sounded at this stage.
There are certain conditions that warrant seeing a doctor sooner :
- Period occurring at three-week (or less) intervals.
- Periods not occuring for longer than three months.
- Irregular periods.
- A history of pelvic infection.
- Two or more miscarriages.
- Women over the age of 35—time is not at a premium!
- Men who have had prostat infections.
- Men whose testes are not felt in the scrotum.
Tips for Self-help
Before seeking medical help, remember some of the things you can do to enhance your own fertility potential.
Body weight, diet and exercise: Proper diet and exercise are important for optimal reproductive function. Women who are significantly overweight or underweight can face difficulties in getting pregnant. Consult you doctor about a healthy diet. Normal exercise, including aerobics, tennis or jogging, may improve your chance of conceiving; However excessive exercise (for example, jogging over three miles per day) can adversely affect your valuation.
Stop smoking : In men, cigarette smoking has been associated with a decreased sperm count. Women who smoke take longer to conceive.
Stop drinking alcohol : Alcohol (beer and wine as well as hard liquor) intake in men has been associated with a low sperm count.
Review your meditations : A number of medications, including some of these used to treat ulcer problems and high blood pressure, can influence a man’s sperm count. If you are taking any medications, have a talk with your doctor about whether or not such medication can affect your fertility.
Many medications taken during early pregnancy can affect the foetus. It is important to inform your doctor that you are attempting to become pregnant before taking prescription medications or over-the-counter medications, such as aspirin, antihistamines, or diet pills.
Stop abusing drugs: Drugs such as marijuana and anabolic steroids decrease sperm counts. If you have used drugs, discuss this aspect with your doctor. This is confidential information. Both partners should stop using any illicut drugs if they want a healthy baby. Also, limit your caffeine (tea, soft drinks and coffee) intake.
Frequency of intercourse : The simple rule is : as often as you like ; the more often you have sex, the better your chances. Thus, for couples who have sex only on weekends (often the price they pay for a heavy work schedule) the chance of having sex on the fertile prevulatory day is only one-third that of couples who have sex every other day. This means they (the ‘weekends’) may take three times as long to conceive.
Timing of intercourse : Unlike animals, who know instinctively when to have sex in order to conceive (because the female is in ‘heat’ or when she ovulates), most couples have no idea when the woman ovulates. Timing intercourse during the ‘fertile period’ is important and can be easily learnt. However, some couples are so anxious about having sex at exactly the right time that they may abstain for a whole week prior to the ‘evaluator day’ – and often the doctor is the culprit in this overrigorous scheduling of sex. Such overattention can be counter-productive (because of the anxiety and stress it generates) and is not advisable.
Position and technique of intercourse : A very interesting fact of nature is that pigs are very efficient at conserving semen— the boar literally screws his penis into the vagina of the sow, obtaining a tight lock prior to ejaculation, to ensure that no semen leaks out. Humans do not have such well-designed mechanisms of technique; perhaps this is because they are really not necessary. Most doctors advise a male superior position and also advise that the woman remain lying down for at least 5 minutes after sex and not wash or douche afterwards. A number of products used for lubrication during intercourse, such as petroleum jelly or vaginal cream, have been shown to affect sperm quality. Therefore, these products should be avoided if you are trying to get pregnant (a suitable alternative is raw egg white).
Is Fertility Lower at Present?
Has the fertility of couples declined in modern times? Possibly. The reasons for this downfall include the following :
1. The increasing age of women at the time of marriage and child bearing.
2. The increased incidence of sexually transmitted diseases (STDs) which damage the reproductive tract in both men and women.
3. Decreasing sperm counts in men which is a global phenomenon. An interesting observation made recently has been that men’s sperm counts worldwide have been falling in the last few decades. Whether this pehnomenon is due to environmental pollution, or due to the stresses of modern day life, remains unclear.
Where to Get Help
Most couples usually consult their family physician, who will refer them to an obstetrician-gynecologist when infertility poses problems. This first visit should include both partners. The physician will usually outline the possible causes of infertility and provide an evaluation plan. The first step should be to achieve an accurate diagnosis to try to find out why pregnancy isn’t occurring. Once a diagnosis has been determined, the couple and physician should meet again and chalk out a treatment plan. For difficult and complex problems, an infertility specialist should be consulted.
