WHEN TO SEE A DOCTOR TO HELP YOU GET PREGNANT
By Dr Dharmini Veerakumaran,
MBBS (Manglore),M.Med.O&G (Malaya)
Consultant Obstetrician & Gynaecologist,
Kelana Jaya Medical Centre, PJ
Over the years, we see more and more couples facing difficulty in conceiving. Getting pregnant is not only the woman’s responsibility; men have a part to play, too. Around 85 per cent of couples should get pregnant within the first year of trying while 10 per cent succeed within the second year. However, older couples (more than 35 years old) who have not conceived after six months of trying should see a gynaecologist to have their fertility levels checked.
How do women get pregnant?
For a woman to get pregnant, the egg (ovum) released from her ovaries (ovulation) must travel through the fallopian tube toward the uterus (womb). Her partner’s sperms will ‘swim’ through the vagina and uterus to meet (fertilise) the egg at the fallopian tube. The fertilised egg then forms an embryo which will be implanted at the lining of the uterus (implantation). The embryo grows to become a fetus inside the uterus.
Can infertility be just a woman’s problem?
About 30 per cent of infertility cases are caused by women while 30 per cent of fertility problems are because the men. Another 30 per cent is a combination of problems from both the man and woman, and the last 10 per cent is due to unknown causes.
What are the common causes of fertility problems in women?
Fertility problems in women are mainly caused by anovulation, which means the absence of ovulation during some menstrual cycles. This is more apparent in women with Polycystic Ovarian Syndrome (PCOS). Women who do not ovulate may have irregular menstrual cycles. However, up to five per cent of women with regular menstruation may not ovulate regularly.
One cause of infertility in women is blocked fallopian tubes. This problem can be due to endometriosis, a condition associated with deposits of endometrial tissues outside the lining of the womb, causing inflammation and destruction of surrounding tissues. This is caused by a reverse in the menstrual flow which drives bleeding back into the pelvis through the fallopian tubes. Pelvic inflammatory disease could be another cause for blocked tubes. In both of these conditions, the inner lining of the fallopian tubes are damaged, causing pelvic adhesion and leading to distortion and blockage of the tubes.
Structural problems in the uterus such as the presence of fibroids or endometrial polyps may cause failure of embryo implantation and, in turn, result in difficulty in getting pregnant.
What is the common cause of fertility problems in men?
Men have fertility problems when their sperm is poor in quality or quantity. There could be problems with the sperm count, morphology (shape) or motility (the degree of movement). These problems can be congenital or acquired.
Men with congenital fertility problems are born with defective sperm production, resulting in low sperm count or no sperm in their ejaculation. Acquired problems can be localised at the reproductive organs or can be a systemic problem. Varicocele, which refers to the enlargement of veins on the testicles, is an example of a common localised problem. This causes the temperature around the testicles to rise, thus affecting sperm quality and quantity. Other localised problems include injuries to the testicles. Some systemic conditions such as cystic fibrosis and infections such as mumps, are known to cause fertility problems in men.
What are the other reasons that cause women difficulty in getting pregnant?
Many women tend to compare themselves with women in the past – if their mothers, grandmothers and mothers-in-law did not face problems conceiving, then they, too, should not encounter fertility problems. This observation is true to a certain extent. However, infertility can be caused by the following:
- Age: More modern women are marrying later in life and couples tend to delay conception due to financial or professional reasons
- Stress: Modern lifestyle is the cause of high stress levels. In general, our population is faced with more stress at work and home. This causes a decline in fertility
- Poor diet
- Weight: Being overweight or underweight can cause anovulatory cycles.
- Infection: Pelvic infections with chlamydia or gonorrhea can be associated with infertility
- Smoking and excessive alcohol intake
What are the other causes of infertility in men?
Certain fertility problems in men are related to health and lifestyle such as:
- Heavy alcohol and drug use
- Occupation (heated environment)
What should a couple expect during a doctor’s appointment?
It would be ideal for the couple to attend a doctor’s appointment together. This is important because the doctor can look into the couple’s medical and lifestyle history and perform a physical examination on both partners. Medical assessments such as blood test, semen analysis and ultrasound scan will be carried out as part of the fertility assessmen