When you consider the intricate process by which a fertilized egg, no more than 0.13 mm (0.005 inch) in diameter, and considerably smaller than the size of a full-stop on this page, grows and develops into a new human being, it is surprising not that some of us have difficulties in conceiving and bearing a child, but that it ever happens at all. Even so, for one in every 10 couples, regular unprotected sex for over a year will not result in conception. While nothing is more agonizing to a couple attempting to conceive than the dawning anxiety that one of them may be infertile, the fear of a childless future is often unfounded. The treatment of infertility is one of the most optimistic areas in medicine and is now coming to the rescue of six out of every 10 couples referred to infertility clinics for further investigation.
If you have been trying to conceive for two or more years or you are older and the pressure of time is upon you, make an appointment with your doctor. In a surprisingly high number of cases, a preliminary interview with both of you will be enough to bring on conception. It may be that a return to normal, non-anxious lovemaking works the magic. But the connection between consultation and conception, about 20 per cent, is too high to be coincidental. During the interview, your doctor may suggest that you try some simple, self-help methods to increase your chances of conception.
If these methods fail or the necessary premeditation for carrying them out is placing strains on the relationship, further investigation should be embarked upon right away. It is important that both partners should be tested for possible infertility. First, the incidence divides fairly equally between men and women at 40 and 50 percent respectively (in 10 percent of cases, no clear reason for infertility is found). Second, tests for male infertility (sperm count and clinical examination) are considerably simpler and less extensive.
Ovulatory disorders are the most common cause of female infertility and, therefore, tend to be investigated first. Such disorders maybe the result of inadequate hormonal stimulation or, less often, an imbalance caused by raised pro lactin levels (this can be treated by a course of tablets). Or they may simply reflect a temporary difficulty in conceiving. This is particularly possible in the late twenties or thirties, as frequency of ovulation declines past the age of 25. A blood test or endometrial biopsy (scraping taken from the lining of the uterus) taken in the second half of the cycle will establish whether or not ovulation has occurred by testing for levels of the ovarian hormone, progesterone. This is the key hormone because it is secreted by the ruptured follicle once ovulation has taken place.
In the event of ovarian malfunction, the ovaries can often be stimulated with a weak anti estrogen, chlomiphene citrate. This raises the level of naturally occurring ovarian stimulating hormones in the pituitary gland to induce ovulation in about 80 percent of women. There is a six percent risk of multiple birth, almost always twins and very occasionally triplets. If this fails, the stronger gonadotrophin hormones (LH and FSH) may be prescribed. As these act directly on the ovaries, excessive stimulation gives a higher (20 per cent) chance of multiple pregnancy. Although usually twins, these drugs are responsible for the dramatic incidences of quintuplets and sextuplets and careful assessment of the level of stimulation required is therefore essential.
Damaged Fallopian Tubes:
The second most common cause of female infertility, damaged Fallopian tubes, unfortunately, cannot usually be as easily or as successfully treated as ovulatory disorders. The Fallopian tubes are most commonly damaged by venereal infection, but other factors can be an ectopic pregnancy, in which part oral! of the Fallopian tube is removed with the growing embryo, any type of pelvic surgery and even a ruptured appendix. Sometimes, micro surgical techniques are used in order to free blocked or scarred tissue that might be interfering with the passage of the egg from the ovaries to the uterus. This, however, sounds much simpler than it is. The Fallopian tubes are so delicate that surgery can sometimes aggravate, rather than mend, the damage.
In the future, correction of this type of infertility probably lies with the newly-developed methods of ‘in vitro’ (test tube) fertilization. The egg is taken from the ovary, either during natural or stimulated ovulation, fertilized by the sperm outside the body and then re-implanted in the uterus. But it is still a young science and several difficulties must be overcome before it becomes more widely available.