What is the meaning of the term “fertility?
This means the natural (medically or otherwise unaided) capability of producing offspring.
Are there instances where a couple may be unable to have a child naturally?
Yes. This is called “infertility”. This is when a couple cannot conceive even after having regular, contraceptive free intercourse.
When should you seek medical help?
It is not necessary to worry regarding your fertility if you have been trying to get pregnant only for 2-3 months. The general guidelines are as follows;
If a woman under 35 years has not conceived after 12 months of regular, unprotected intercourse, or
If a woman over 35 years has not conceived after 6 months of regular, unprotected intercourse.
During this time period, it is important that you try natural methods of improving your fertility.
Whose “fault” is infertility?
Traditionally, women have had to bear the brunt of childlessness. In the era before the availability of medical tests, if a woman did not conceive within a reasonable period of time, it was deemed that the lack of a pregnancy was due to her infertility. However, modern science has proved that infertility is not unique to women and can affect men too.
The following are some reasons for female infertility:
- Hormonal problems. The simplest way to define a hormone is to say that they are the body’s chemical messengers. They travel in the bloodstream to tissues and organs. When there are complications with hormones, many adverse consequences can occur, the most common being failure to produce mature eggs. It is the female’s egg that is fertilized by the male’s sperm. This means that the egg and the sperm will combine to form a single cell that will form a baby after 9 months in the womb. If the female’s eggs are not fully matured, they are incapable of being fertilized.
- Scarred ovaries. The ovaries are where the female eggs are created. A human female has two ovaries on either side. If the ovaries are physically damaged, this may result in failed ovulation. This means that an egg will not be released.
- Premature menopause. Menopause is usually identified as the stage in which a woman permanently stops getting her period. What actually happens is that the ovaries stop functioning for good and as a result, the monthly cycles come to a halt. Generally, menopause occurs during the ages of late 40s or early 50s. But rarely, it can affect much younger women.
- Infection of the Fallopian tubes (there are 2 fallopian tubes along which the eggs travel from the ovaries to the uterus)
- Previous surgeries. Pelvic or abdominal surgery may cause damage to the tubes which result in the eggs not being able to travel through.
- Ectopic pregnancy. This is a pregnancy that occurs in the tubes itself, and even if carefully removed, may still damage the tubes.
The following are some reasons for male infertility:
- Low sperm count (Oligospermia). The general understanding is that if a millilitre of semen contains less than 20 million sperms, it is a low sperm count. The sperm count may be affected by obstructions in the passageway, illness and age. There may be some males whose semen is completely absent of sperm. This is called Azoospermia.
- Poor sperm motility (Asthenospermia). Motility means the ability to move. The most successful sperm are the fastest as well as the ones moving in a straight line. If more than half of the sperm move sluggishly or not in a straight line then that is considered to be a low sperm count.
- Abnormal sperm morphology (Teratospermia). This refers to sperm that is abnormally shaped. It is not possible for sperm with an abnormal shape and structure to successfully fertilize an egg.
- Overly intense exercise. This produces high levels of adrenal steroid hormones which can cause testosterone deficiency.
- Wearing tight underwear or long exposure to a heated environment. Increases scrotal temperature which results in decreased sperm production. For humans, the optimum scrotum temperature is about 35 degrees Celsius. This is 2 degrees less than the normal body temperature.
The above list is by no means exhaustive. It only includes some of the most common reasons.
Can age affect fertility?
Yes, age is one of the most important factors affecting fertility as well as being a factor common to both females and males.
- Female Age: Women’s fertility peaks in the early 20s, drops after 35 and women usually reach menopause in their late 40s or early 50s.
- Male Age: When male age increases, factors such as semen volume, sperm motility and sperm morphology decrease.
It must also be kept in mind that even if a viable pregnancy does occur, increased age of either one of the parents may adversely affect the health of the baby, leading to conditions such as Down’s syndrome, Autism Spectrum Disorder, and Schizophrenia.
Other miscellaneous factors adversely affecting fertility of both males and females:
- High intake of caffeine
- Vehicle exhaust fumes
- MSG (flavour enhancer)
- Exposure to chemicals such as paint, pesticides etc
How can infertility be identified?
The doctor will commence by taking the history of the couple and conducting a physical examination. Subsequently 3 basic tests will be carried out. These are
- A semen analysis to test the husband’s sperm count and motility,
- A blood test to ascertain if the wife’s blood contains the requisite levels of the necessary hormones, and
- A hysterosalpingogram, which means an x-ray of the wife’s uterus and tubes to confirm that they are normal.
As an unfortunate consequence of habitually laying the blame of childlessness at a woman’s feet, it is commonplace to come across childless couples where the woman has been tested numerous times while the husband has not even been tested once. The importance of both partners undergoing tests cannot be emphasized enough.