What is Infertility?
Infertility is defined as the incapacity to fulfil pregnancy after a reasonable time of sexual intercourse with no contraceptive measures taken. It implies a deficiency that does not compromise the physical integrity of the individual, nor is it life-threatening. It may negatively impact the development of the individual, bringing about frustration and weakening the personality, since most couples consider having children as a vital objective. Infertility is a common problem affecting one couple in six.
Fertility efficiency in human being
As compared to other species, the human being is highly inefficient in terms of reproduction. The fertility rate per cycle is about 20% and the accumulated pregnancy rate in couples with proven fertility is ~90% after 12 months and 94% after 2 years. Delayed childbearing, alterations in semen quality due to habits such as cigarette smoking and alcohol, changes in sexual behaviour and eliminations of most taboos are some of the modifiable factors of infertility. The study of infertile couple has always been focussed on different factors: ovulatory factor (present in about 20% of couples), utero-tubal peritoneal factor (present in ~30% of couples), semen migration factor (10% of cases) and male factor (30% of couples).
Around 40% of all infertile couples exhibit a combination of factors and about 15 % of couples may not display any objective alteration leading to a definite diagnosis.
Waiting period for conception
Fecundity is the probability of becoming pregnant in one particular menstrual cycle and is about 20%, depending on the age of the woman. This entails that the average time to develop pregnancy is around 4 months.
The concept of “reasonable time” is debatable; the World Health Organisation (WHO, 1992a) as well as the European Society of Human Reproduction and Embryology (ESHRE, 1996) in their recommendations mention a 2year minimum deadline for developing pregnancy.
Most physicians initiate study of an infertile couple following 1 year of failed pregnancy attempts. When the woman is >39 years, it might be advisable to begin the study after 6 months of unsuccessful attempts. The waiting time should be related to the age of the woman, the history of alterations that affect fertility, the desires and wishes of the couple.
Delayed decision for pregnancy and the consequences
There is an increase in the number of visits to infertility clinics in the last few years. This may be due to increased awareness and declining fertility. The average age at which women wish to become pregnant has increased due to postponement of the decision about pregnancy. Marital instability like divorce and seeking stability with new partners implies waiting longer before making the decision to have any children.
Alterations in semen quality can influence the need for advice on infertility. Habits such as cigarette smoking and alcohol abuse are harmful for semen quality. There have been changes in sexual behaviour like changing partners and use of proper contraception among younger couples. This may lead to higher incidence of sexually transmitted diseases (ST) to tubal–peritoneal infections that have consequences for fertility. Elimination of most taboos about fertility results in a higher frequency of visits by couples to the doctor.
A desire to become pregnant at ~40 years of age does not only entail a low possibility of success, but also an increased risk of developing maternal pregnancy ailments such as pre-eclampsia, hypertension and diabetes, as well as foetal chromosomal abnormalities and miscarriages.
The Fertility Hospital