Although conception of a child seems to be the simplest thing in the world, this is not always the case in point. 2% to 10% of couples are unable to conceive a child in a natural way, and another 10% to 25% are unable to conceive another child. Man is subfertile compared to other animals, which means that s/he naturally has a lower fertility capacity. A substantial majority of the couples who have difficulty becoming pregnant cannot be classified as sterile. Infertility does not mean childlessness. Therefore, it would be preferable to speak of subfertility or reduced fertility rather than of sterility, i.e. infertility. In the following interpretation, we will use the term infertility even in terms of decreased fertility.
When is it necessary to start dealing with infertility?
The definition of infertility (sterility) according to the WHO (World Health Organization) says that the couple may be considered infertile in whom a woman has not become pregnant for one year during regular unprotected sexual intercourse. If you do not become pregnant for longer than one year and you have regular unprotected sexual intercourse, you should seek a doctor.
In some cases, you would even need to seek professional assistance earlier.
– the cause of sterility is known in advance (e.g. genetic disorder in one of the partners, obstruction of both ovaries in a woman, etc.)
– the woman is over 35 years of age
– the irregular menstrual cycle
– the menstrual cycle is shorter than 21 days or longer than 90 days
– overcoming sexual organs inflammation or surgical interventions in the abdominal cavity
– two or more spontaneous miscarriages
In the above instances, it is advisable to see a doctor after 6 months of unsuccessful attempts to become pregnant.
How high is the incidence of infertility?
The likelihood that a healthy woman becomes pregnant during one menstrual cycle is about 25%, which means that about nine out of ten couples attempting at fertilization succeed within one year. Every tenth couple is so indiscriminately childless, making it 60 – 80 million coouples globally.
It is reported statistically that both female and male factors contribute to the infertility of the couple equally (about 30% and 30%), and male infertility is beginning to prevail even in this population. About 30% of the causes of infertility are found in both partners, and in approximately 10% the exact cause of infertility cannot be determined through current diagnostic procedures.
What is the success rate of infertility treatment?
We already know that the probability of becoming pregnant during one menstrual cycle in a healthy woman is about 25%. Even modern medicine is not more successful than nature, so the probability of becoming pregnant is approximately the same when treated properly. However, infertility treatment requires some time and patience from both the partners and the doctor. Hope for success increases with each cycle of the treatment. Moreover, science and research in assisted reproduction have made significant advances in recent years, so over three quarters of the couples experience having their baby in the right treatment.
Causes of infertility
Difficulties with pregnancy relate equally to both partners and to investigate the causes of infertility and follow-up treatment is a matter for both woman and man. Therefore, it is desirable for them to seek help together.
Female causes of infertility
Damage of or obstruction to ovarian ducts
Ovarian obstruction is the most common cause of infertility in women. Damaged or obstructed ovarian ducts prevent the ova and the sperm in meeting each other. The most common cause includes inflammation due to untreated infections of sexual organs. At present, the widely widespread cause of ovarian ducts inflammation is chlamydia infection. It is transmitted through unprotected sexual intercourse, and its danger is that it often goes on without significant symptoms, so the woman need not notice that she has overcome the inflammation.
Another cause of ovarian ducts damage is endometriosis or surgery in the abdominal cavity, resulting in fornicommissure. The cause of ovarian ducts absence is most often in their surgical removal for extra-uterine pregnancy.
For the ovum maturation, ovulation and pregnancy, the correct level and balance of certain hormones are necessary. Disturbances in hormonal levels cause no ovulation, or the yellow body does not produce enough progesterone hormone necessary to maintain pregnancy.
In some women, a greater number of male sex hormones (androgens) is produced that disturb their hormonal balance. The hormonal balance is also distorted by a too high or too low weight of a woman, abrupt changes in weight, physical strain, thyroid gland disorders, increased formation of the hypophysis hormone prolactin, some medications, and the stress.
Endometriosis is a disease in which the tissue of the uterus mucosa (endometrium) occurs outside the cavity of the uterus. It may cause fornicommisure in the abdominal cavity and damage to the ovarian ducts.
Congenital developmental disorders of female genital organs
These are diagnosed in about 5% of infertile women. They are present from the birth and most often affect the uterus.
Immunological causes of infertility
In some women, their immune system may respond by producing antibodies against the sperms, the ovum, or against the embryo. As a result, there is either no fertilization of the ovum or, if it occurs, the embryo does not hatch in the uterus and does not develop any further.
Ovarian ducts depletion
This occurs by age, radiation, cytostatics, repeated ovarian ducts surgery
In conjunction with another disease
Thyroid gland disorders, malnutrition, cancer, severe vitamin deficiency
– genetic causes of infertility
There exist genetic equipment disturbances that determines the normal development and function of the female genitals.
– mentally conditioned infertility
Male causes of infertility
– Sperm formation and maturation disorders
The most common cause of male infertility is the insufficient production of normal moving sperms. In order for the sperms to be able to fertilize, they must show certain quantitative and qualitative parameters. The most important parameters determining the sperm fertilization capacity include: sperm concentration in the ejaculate, the number of moving sperms and the quality of their movement, and the sperm shape.
– low sperm count
The ejaculate must contain a certain amount of sperms (at least 20 million per one millilitre of the ejaculate) to be able to fertilize the ovum.
– low sperm motility
Low sperm motility may, even at their normal concentration, mean the inability of the sperms to pass through the mucus of the uterine cervix to the site of the sperm-to-ovum connection – into the ovarian duct.
– abnormal sperm shape
The sperms that are not properly shaped are unable to penetrate in the ovum.
One or several of these parameters may be affected. The extent to which the fertilization capacity of such sperms is reduced depends on the degree of infliction.
Sperm formation (spermiogenesis) is affected by a number of factors: hormonal disturbances, stress, harmful environmental effects, sexual organ infections, congenital defects of male sexual organs, such as, for example, testicles undescended in the scrotum, or genetic causes. Spermiogenesis can also be reduced after testicular injury, cancer, mumps, or if enlarged surface varicose veins are present (varicocele).
In most cases, however, detection of the cause of decreased sperm quality is currently not possible.
– sperm transport disorders
In about 4% of infertile men, the sperm production is preserved, but the sperms will not get into the ejaculate because the semen duct canals are impenetrable. It’s a situation similar to the damaged female ovarian ducts. The cause of the semen duct obstruction can be in inflammation as a result of infection or trauma, sterilization or genetic cause.
– immunological infertility
The immunity system of some men produces antibodies against the sperms that reduce their mobility or clustering.
– in conjunction with some other diseases
– diabetes, thyroid gland disease, alcoholism, liver cirrhosis
Causes of infertility in both of the partners
In about one-third of infertile couples, the cause of infertility will be found in both of the partners.
The cause of infertility cannot be determined by current investigation methods in approximately 5% to 10% of the couples seeking medical assistance for fertility problems. However, their share gradually decreases with the improvement of the diagnostic process. We are then talking about the so-called inexplicable (idiopathic) infertility. In this case, problems in becoming pregnant may also be psychological in nature.
It is important to note that even if the cause of infertility is obvious in both of the partners, as well as in idiopathic infertility, the appropriate treatment is often successful.
Psychological aspects of infertility
For most people, child is a natural expression of their relationship and one of the basic senses of life. The unsatisfied desire for a child may become very stressful, and the seemingly endless period of time of waiting for becoming pregnant can be a painful psychological trial. Frustration, confusion, fear, self-accusation, anger, and sadness in repeated maraud trials bring along significant stress, and can, moreover, further exacerbate the existing pregnancy problems, creating thus a vicious circle of constant expectation and growing concern.
It is well known that psychological factors alone are often the only cause of the inability to become pregnant.
The greater the psychological pressure the woman experiences, the greater the likelihood of disturbing the hormonal balance needed for pregnancy. The effect of stress is that there is no ovulation, the stress may even cause seizures of the ovarian ducts, which prevent the transport of the ova into the uterus.
In men, stress can interfere with the sperm formation and adversely affect their mobility, resulting in a temporary reduction of their ability to fertilize.
Desperate desire for a child may then become with both of the partners the cause why this desire is not satisfied. Unfortunately, there is no simple way to ensure that the endeavour to become pregnant does not bring along stressful factors and situations.
But there are a few steps that may help relieve the stress or eliminate it. At the beginning, you need to have some sensitive but all the more so important questions answered in conversation with your partner.
- How important it is for us to have a child?
- How important is a child for our relationship?
- Does any of us suffer by not having a child?
- What is our attitude toward adoption?
- What would our next life be like without a child?
The following counsels could help you:
- Consider the things that are important to you in life and that appeal to you.
- If you are overweight, any weight loss can significantly increase the success of infertility treatment.
- Consume alcohol in reduced quantities.
- If you smoke, it is time to quit. At least reduce smoking significantly.
- Think about the situations that stress you at work, in your family, and what you can do about it.
- Get enough sleep.
- Take a break from time to time, even from your effort to have a child at any costs.
- Do not have sexual intercourse only as planned, but when both of you feel like having it.
- Be patient.
- Always try to accept the results of treatment, whether positive or negative.
- Do not avoid an alternative to live your life without your own child.
If you are already undergoing some of the assisted reproduction methods, even a greater patience and stress avoidance is at stake. The very determination of the cause of infertility is often stressful, increased expectations and fears represent another psychological load. If a woman does not become pregnant after performing the assisted reproduction, it is often much more frustrating than in unsuccessful experiments in natural pregnancy, as assisted reproduction is often perceived as the last option for infertile couples, and its failure is then understood as the end to the hope for having one’s own child. This is not the case: One or two unsuccessful cycles often do not mean anything and the likelihood of success increases with each attempt! There are even many cases when a woman became pregnant after deciding not to pass any more artificial insemination cycles after several unsuccessful attempts.