FAILURE TO CONCEIVE

How may we define an infertile couple? Without the use of any form of contraception, pregnancy can be achieved within a year by around 75 per cent of couples attempting to produce a baby. More than 80 per cent will conceive within the first two years of trying for a baby, but of the rest, over half will remain permanently childless if no treatment is provided.

Most medical teams concerned with the counseling and treatment of infertile couples believe that if they have not managed to start a pregnancy within 12 months of normal sex without contraception, they should be considered potentially infertile.

After this length of time, it is usually regarded as reasonable that the couple should be medically investigated to unravel the cause or causes of their inability to conceive. Infertility is a problem for both partners. It is the couple that should be investigated, since the lay prejudice that infertility is almost always a 'female problem' is far from true, and many couples are unsuccessful in producing pregnancies because of inadequacies of sperm production.

CAUSES OF INFERTILITY IN A MAN

A variety of surveys of infertility at clinica canters around the world has show that poor sperm counts (oligospermia) or complete absence of sperm in the semen (azoospermia) are found in 20 to 35 per cent of investigated couples. Thus, male-related causes of infertility are of considerable importance.

Often in the past, female partners were subjected to a series of investigations or treatments, with little serious attempt to consider possible male partner problems.
Studies show that a man can be expected to be fertile if, with an ejaculate of at least 1.5 ml, the sperm count—comprising mainly healthy (l) rather than defective (2) sperm— exceeds roughly 50 million per ml, with more than 50 per cent of the sperm still moving actively four hours after ejaculation.

The cause of an inadequate sperm count are many and varied and include disorders related to hormone level, the body's immune system and chromosome abnormalities.

It may also be due to a form of varicose veins in the scrotum called varicocele, undescended testicles, infections, disease of the prostate glands or seminal vesicles, impotence, congenital defects in the penis, and several other causes, including hernia operations and tight underwear!

CAUSES OF INFERTILITY IN A WOMAN

On the female side, it is possible to identify three major areas where things go wrong, despite being able to produce a healthy ovum. These are disorders of ovulation, blockage of some sort in the Fallopian tubes, and, lastly, a complex mix of gynaecological and other problems.
In a recent thorough survey of causes of infertility at a London infertility clinic, these three major areas represented 25 per cent, 19 per cent and around 35 per cent respectively of the couples investigated. The last large fraction included a number of situations where problems occurred in both partners. It must also be remembered that in a significant number of cases it is still not possible, even in a specialist center, to diagnose the cause of the infertility.

JOINT CAUSES OF INFERTILITY

Combined factors affecting the fertility of a couple are not unusual. Many workers in this field have stressed that perhaps 15 per cent of couples fully investigated will show that both partners have inadequacies, and that it is this combination that is producing the overall level of difficulty.
A common finding is a slight reduction in sperm density in the man, coupled with infrequent ovulation in the woman. Neither of these problems on its own—that is, teamed up with a fully fertile partner—would be expected to cause serious problems, together other types of joint problems may exist. Cervical mucus and sperm may not be compatible because of immune system reactions or other reasons.

Equally, the actual mechanics of sex can have some influence on fertility levels. Some couples are not achieving pregnancies because of very infrequent sex, sexual activity at the wrong times of the menstrual cycle, or became they use lubricants that affect sperm movement.