Approximately one out of five couples of fertile age cannot achieve a natural pregnancy or a pregnancy that can be properly carried up to term. When this happens after they have been trying for at least one year it is known as infertility or sterility, and the causes may depend on both the man and woman. In approximately half of the cases there is a problem with the semen, either because there is a low sperm count or there is low quality in terms of sperm motility and morphology. In other cases the problem lies with the woman, because her ovulation is not normal or because her Fallopian tubes are obstructed, for instance. There are many other causes of infertility, and the problem can often be associated both with man and woman. The best advice is to turn to a specialized medical centre. This is because, luckily, the majority of cases have a simple solution once studied. Requesting an appointment with a clinic is especially important, because it is necessary to perhaps rule out a more serious illness, requiring more specific treatment which may be causing the infertility in either in the man or the woman.
We refer equally to sterility and infertility when we talk about couples who cannot have children. In medicine we distinguish between these two terms. On one hand, we refer to infertility when the woman achieves a pregnancy that does not end properly; when this happens in a couple who has already experienced a normal pregnancy and birth, we refer to it as secondary infertility. On the other hand, we refer to sterility as when the couple have not achieved a pregnancy after a year of sexual relations without taking contraceptive measures. We refer to secondary infertility when the couple does not achieve a new pregnancy for two years after having their first child. In practice this difference is not so important for the couple, because there will be a possible solution in the majority of cases, whatever their situation is, and a pregnancy will be achieved. We will refer both to infertility and sterility to talk about all those cases when a spontaneous pregnancy is not achieved.
One or two out of approximately ten couples of fertile age, who have regular sexual relations without taking contraceptive measures in one year, do not achieve a spontaneous pregnancy without specific treatment. This means that in Spain, about one million couples suffer from infertility problems. Nowadays we estimate that at least one out of ten newborn children are conceived through some kind of medical assistance.
Cases of infertility in developed countries are actually increasing and there is a fall in the birth rate. On one hand, more and more women try to have children at an advanced age, when the chances of achieving a spontaneous pregnancy are lower. On the other hand, at the same time it has been noticed that an increase in the infertility of males is caused by a gradual decline in semen quality. This is likely due to environmental agents like pesticides, pollutants, and also the use of substances and additives contained in some foods that may affect sperm production, as well as other factors such as stress and alcohol abuse, drugs, tobacco, etc.
Approximately in 40 out of 100 cases there is low quality in the sperm that may be due to incorrect functioning of the testicles, a hormone alteration, an infection of the seminal path, an obstruction of the tubes, etc. In a similar percentage of cases the semen is normal, and there is a problem concerning the woman because her ovaries do not ovulate properly, maybe due to a genetic or hormone alteration, an obstruction of the Fallopian tubes, an uterine alteration, or to a rejection of the spermatozoa, etc. In many couples the problems are associated with both men and women, and yet there are other cases where the reason for not achieving pregnancy is unknown. Sometimes the infertility is caused by a general illness, like hormone alterations, neoplasy, and viral infections or also by extreme obesity, anorexia, over exercising, daily substance abuse, alcohol, tobacco, etc. Finally, working in toxic or unsuitable environments can also affect fertility.
Nowadays, it is possible to offer solutions in the majority of infertility cases. It is important for the couple to consult a doctor in a specialized clinic. Conception with medical help is more and more frequent and better accepted. Only one out of ten couples resign themselves to their situation and choose not to have children. Every year more than one hundred thousand children are born thanks to assisted reproduction techniques.
There is no doubt about the importance of leading a healthy life for the proper development of the foetus during pregnancy. It can be equally important to take some precautions and take up a certain life-style when we are trying to achieve a pregnancy. Firstly, it is important to eat healthily and to keep to an optimum weight, both for men and women, so that the hormonal system and the genital organs can respond properly. There is no kind of food that increases fertility on its own, it is fundamental to enjoy a healthy diet however. It may be beneficial (although under specialist supervision) to increase the quantity of vitamins C, D and E, calcium, etc, as well as a diet rich in Zinc and Selenium contained in fresh fish and meat. However, an incorrect diet can cause a vitamin deficiency or anaemia which affect gonad function. An excessive percentage of fat in the body mass can affect hormone levels directly. Overweight can be counter-productive in achieving pregnancy and, on the contrary, an excessively thin person can experience alterations in the menstrual cycle. Daily, moderate exercise is suitable and advisable. Secondly, it is necessary to avoid ingesting and inhaling substances which affect the chances of pregnancy. There is proof for example, that tobacco and alcohol can affect fertility and can subsequently cause low weight in the newborn child. Similar research finds a connection between excess caffeine and hormone alterations. Other toxins are found in the environment or in the work place, such as pesticides or chemical substances, which can be inhaled and may act by modifying the hormones. Measures should be undertaken in order to avoid an excessively hot work place, especially for the man. Excessively tight clothes or those made of materials that increase temperature can also affect testicle function. Stress is another factor that can have influence. The American Society for Reproductive Medicine states that high levels of stress can cause spasms in the Fallopian tubes, or in the male a decrease in spermatozoa production. We all have the reference of some relative or acquaintance who, after a long time without achieving a pregnancy, has been successful after some holiday or leisure trip.
Ovulation, or the fertile period of the woman, occurs halfway through each cycle on about the fourteenth day of a hypothetical 28-day cycle. Ovulation can be detected in many different ways. One of the most traditional is to measure the basal temperature, because after ovulation it increases slightly due to a hormone called progesterone. Another way to detect ovulation is through the appearance of the mucus produced by the cervix. As we approach ovulation the quantity of this mucus increases and it becomes a clear and stretchy secretion. This kind of mucus facilitates the upward path of spermatozoa. This mucus is more compact and opaque before and after ovulation. Another way to detect ovulation is through the measurement of a hormone called LH which unleashes the ovulation. LH is detectable both in the blood and urine. When the analysis is positive it means that ovulation will take place within the following 40 hours. There are other methods of monitoring ovulation, but they cannot be carried out at home. These are basically hormone quantifying - like oestradiol or progesterone - and the monitoring of the growth of the ovarian follicle (where the egg is located), through transvaginal sonogram.
If the woman has a regular cycle, it is generally recommended to begin relations from the ninth or tenth day of the cycle (the male partner should have not ejaculated for four or five days) and from this day onwards they should have relation every other day for about a week. If the semen is normal, having sexual relations every day will not affect the prediction, but if the quality or quantity of spermatozoa is low or just fair, having relations more frequently could decrease the chances of pregnancy.
There is a series of sayings, general beliefs and unfounded prejudices which make us wonder if certain actions can complicate or favour the chances of pregnancy. For instance, it is known that no type of position used during coitus affects the chances of pregnancy. Reaching orgasm or not does not actually affect the path of spermatozoa and thereby the chances of pregnancy, neither does remaining lying down after having sexual relations to favour the upward path of spermatozoa towards the uterus. This is because this upward movement occurs immediately, and therefore lying down together with actions like raising the legs or similar positions is not required. Nor is it better for the male partner to remain inside the female without withdrawing for a while so that semen does not come out, because uterine contractions allow spermatozoa to move quickly into the uterus. It is not advisable to do a vaginal wash immediately after coitus or use lubricants that may affect sperm motility. The habitual use of tampons will also not affect a woman’s fertility nor the fact of having used contraceptives, if done so correctly.
Anxiety and stress have been related to a decrease in fertility, although it is difficult to gauge to what extent this can be cause enough for not achieving a pregnancy. There is no doubt that infertility causes a state of anxiety in the couple, which can also damage their relationship and quality of life, and this is yet another reason why it should be specifically treated.
Nowadays it is more and more frequent for couples to try to achieve their first pregnancy when the most fertile age of woman has been exceeded. Female fertility drops considerably after thirty-five and, after forty-five, the chance of pregnancy is very small. As regards men, it seems that it is only after the age of fifty that the quality of semen worsens, although it is possible to achieve a pregnancy with men older than seventy.
It is nobody’s fault, just as a diabetic, for example, is not to blame for the poor working of his or her pancreas. Statistically it has to be said that in fifty percent of cases there is a male cause, whether it is due to an alteration in the testicles, an obstruction of tubes, alterations in the prostate, erection or ejaculation problems, hormone alterations, etc. In a similar percentage of cases there is a female cause, such as endometriosis, obstruction of the Fallopian tubes, ovarian malfunction or bad ovulation due to a genetic or hormonal problem, premature menopause, uterine alterations, etc. In the rest of the cases there are mixed or combined causes, or there is no cause given for the pregnancy not being achieved. Wherever the problem lies, study and treatment must always be undertaken as a matter for the couple, and the collaboration of both partners is very important for achieving pregnancy.