What is Infertility?

To understand the causes of infertility you need to understand how natural conception occurs. Firstly, there must be an egg from the woman which unites with a sperm from the man. A single egg is released from the woman's ovary every month. This is called ovulation.

Union of the egg and sperm happens in the woman's fallopian tubes. These are two tubes which join the ovary to the womb or uterus. To arrive in the fallopian tubes, the sperm must swim upwards through barriers - such as the jelly-like substance found at the neck of the womb (cervical mucus). This mucus can be hostile to sperm and halt their forward march.

When the sperm meets the egg, it makes a hole in the egg's 'shell' before entering it. This is fertilization. A fertilized egg is known as an embryo. The embryo, like a seed, needs nourishment to survive and grow. To grow a plant, we need good soil. To grow an embryo, a good inner womb lining is required. This inner lining is known as the endometrium. It is in the womb that this earliest seed of human life will grow and to become a baby, ready to be delivered after 9 months.

Sounds straightforward? In theory conception is a simple process. In reality, problems can occur at many stages, causing infertility. In truth, human reproduction is an inefficient process. In a couple having regular unprotected sexual intercourse, there is only a 15-20% chance of conceiving in a menstrual cycle. In assisted conception, the chance can be increased to 30-40% prompting some to say that "assisted conception is as good as nature - if not even better." Why so? Built into nature are many quality control officers checking the baby-making production line. At various stages, nature's quality control officers will call "Reject!".

Firstly, assuming there is sperm and egg production at all, the quality of sperm or egg may be inferior. Poor quality eggs are mainly due to ageing. The sperm may be lazy and plain refuse to swim or it may be too few in numbers. Some just appear abnormal.

Secondly, the sperm, in its upward swim may fail to pass barriers set up by the woman - at the cervix by thick mucus or further upstream at the fallopian tubes. The fallopian tubes may be blocked due to disease or previous surgery in the area.

Thirdly, upon meeting the egg, the two are simply incompatible. The egg refuses entry to the sperm by having an impenetrable 'shell'.

Let us say the egg and sperm manage to unite. Sometimes the union still does not result in an embryo. If an embryo forms successfully, don't pop the champagne bottle yet. Even at this advanced stage, nature can still reject the union by preventing the embryo from implanting into the endometrium. Sometimes even after implantation, the endometrium decides it does not like to house the embryo and sheds it off with bleeding. About 15% of pregnancies end up in miscarriage.

It is important to realise that sometimes despite a thorough investigation, the doctor may still not be able to find the cause in your case. This happens in 10% of couples. In the other 90% of cases, the cause is evenly split between man, woman and both man and woman.

Even without a clear explanation of the cause of infertility, there are still suitable treatment options. Assisted conception may help in most cases of infertility, given enough attempts. However, you must be aware that in some instances, some couples are unable to conceive despite repeated trials using the most advanced treatment. As with many situations in life, you as a couple must hope for the best but prepare for the worst. By setting your expectations realistically, you will be able to cope better if there is treatment failure.

Causes of Infertility

Male

• No sperm production or blockage in the distribution line
• Low sperm count
• Poor sperm motility
• Abnormal sperm appearance
• Impotence and other coital difficulties

Female

• Hormonal disorders leading to problems in egg growth or ovulation
• Damaged or blocked fallopian tubes
• Endometriosis
• Excessively thick cervical mucus

When should you get medical help?

Many couples expect to get pregnant quickly once they make a conscious decision to try for a baby. In reality, there is only a 15-20% chance of falling pregnant during any given menstrual cycle even in a woman below 30 years old. Errors in nature help to eliminate imperfect matches or poor quality embryos to ensure the survival of the fittest.

Age (years) of woman	Her chance of conceiving after 1 year
< 25	96%
25 - 34	86%
35 - 44	78%

Source: National Centre of Health Statistic in USA

How early you should seek medical attention depends on your age and whether you have any medical problems. If you have abnormal periods (painful, heavy or irregular; scanty or absent), have gained a lot of weight or start noticing fine facial hairs, then you should see your gynaecologist immediately. In general, the older the female partner is, the earlier you should seek medical attention. Like it or not, there really is a biological clock. Older women have lower chances of conceiving as their egg quality deteriorates. Similar to eggs on the supermarket shelves, a woman's eggs also have 'use-by' dates!

What this means to you is that it is important to seek medical attention early if you have not been able to fall pregnant. Make haste if your 35th birthday is looming. And if you are approaching 40, then it becomes urgent. To maximize your chances of successful assisted reproduction, seek an assessment as early as possible once you suspect problems conceiving. Your gynaecologist may find nothing wrong with you and encourage you and your partner to try some more. Or he might find that you really have infertility - in which case, seeking help early would improve your chances of pregnancy.

Age (years) of woman	How long to wait?
< 30	1 year
30 - 35	6 - 9 months
35 - 40	6 months
> 40	3 months

Note: In the absence of any medical symptoms and with regular unprotected intercourse

Women suffering from medical problems should not wait as some medical problems can affect your fertility. It is time to pick up that phone and get an appointment with a gynaecologist if you answer "yes" to the following questions:

• Older than 35 years?
• Trying for a baby for more than 2 years?
• Irregular, painful or heavy periods? Alternatively, scanty or no periods at all?
• Sexual problems?
• Previous abdominal operations?
• More than 6 cycles of clomiphene?
• More than 3 cycles of SOIUI (Superovulation Intrauterine Insemination)

Don't wait much longer. Come and talk to us to find out more about iCare's fertility treatment services.

Links

Below are some helpful websites which offer more information on fertility and conception. More will be added soon.

The Human Fertilisation and Embryology Authority (HFEA) is the UK's independent regulator overseeing safe and appropriate practice in fertility treatment and embryo research. They license and monitor centres carrying out IVF, donor insemination and human embryo research. Their website provides detailed information for patients and their supporters about infertility and treatments.

Go to www.hfea.gov.uk

The American College of Obstetricians and Gynecologists is a private, voluntary, nonprofit membership organization. Its website has a patient page which provides good education pamphlets on 'Treating Infertility' and 'Evaluating Infertility'.

Go to www.acog.org

Now that you know about infertility, here's how we can help you.

Public Education Talks

We are having a Public Health Talk on Fibroids, Cysts & HRT.

Date: 24 May 2008
Time: 2:30pm - 4:30pm
Venue:
2nd floor Seminar Room, Island Hospital

Talk will be given by
Dr. Mah Siew Lee. Admission is free.

For seat booking and more information, kindly contact:
Ms. Mei 04-220 5043 or
Island Hospital 04-228 8222

Success Stories

"His patience, confidence, kindness & professionalism really encouraged me. We tried a few cycles of IUI as well but weren't successful. He then introduced IVF to us in year 2002. I gave birth to our triplets through C-section. I could hear the cheers from the operating team when they saw our first princess. They are turning 3 this year. They have different personalities and looks. They bring joy and happiness to our family."

CE, Kedah

"What I thought would be almost impossible was made possible. It was a truly worthy second try for a patient like me. I delivered a 4.3kg baby boy on 25th February 2006."

PA, Sabah

Important

Women who are age 30 and above must not wait too long before seeing a gynaecologist. It becomes increasingly urgent after 35. For women over 40 time is truly running out.

Partner O & G

See our O & G partners here