Infertility: The Basic Facts
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For most couples, the decision to start a family is both emotive and exciting. But there can also be an element of trepidation as most people understand that this decision will, more than likely, change their lives forever. Most couples will have little or no understanding of the process of conception and growth of their baby within the womb. Quite rightly, this is a "natural" process, with the most important factor being the birth of a healthy and happy baby.
Although this does happen for the majority of couples, there is a sizable minority where things don't quite work as naturally as they should. The reasons for having difficulty conceiving are numerous and complex and are discussed in some depth in the following few pages. If you are such a couple (or individual), then this guide to assisted conception (also commonly known as infertility) is for you.
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Description of Infertility: The Basic Facts
In the world of reproductive medicine, there are numerous terms that are used which mean very specific things. It is therefore important to understand some of the basic terms that you will hear.
* Infertility: this is when an otherwise healthy couple cannot conceive (fall pregnant) despite taking the usual steps such as having regular sexual intercourse without the use of any contraception. This happens in the minority of apparently "infertile" couples.
* Subfertility: this is when there is some difficulty falling pregnant but it is possible, perhaps with some medical assistance. It may take subfertile couples longer than average to conceive. Couples are also subfertile if they do conceive but keep having miscarriages. The majority of couples who are treated in infertility clinics are subfertile rather than infertile.
* Primary Infertility: this is where a couple have never managed to conceive.
* Secondary Infertility: this is where a couple are presently having difficult conceiving but where they have previously managed to conceive and either gone on to deliver a normal baby, a stillbirth or have suffered recurrent miscarriages.
How Long Does It Normally Take to get Pregnant?
Falling pregnant can take a long time. But as a starting point, couples may wish to consult a doctor after approximately one year of trying without contraception. This is certainly true for women aged 35 years or above as these women may take longer to conceive. It is thought that around 1 in 7 couples have some difficulty with conception. However, generally, the average time taken for couples to fall pregnant can be viewed like this;
- 20% of couples will conceive within 1 month;
- 40% of couples will conceive within 3 months;
- 70% of couples will conceive within 6 months;
- 85% of couples will conceive within 1 year;
- 95% of couples will conceive within 2 years.
There are many factors that can change the time taken for conception to occur. The most important include;
* Maternal Age: normally, most women reach their peak fertility in their mid twenties. After they reach 30 years of age, fertility levels start to decline until women reach 35 years of age. Thereafter, fertility levels decline much more steeply and after reaching 40 years of age, this rate of decline is steeper still. Therefore, as a general rule, the older a women is after age 35, the longer she will take to fall pregnant.
* Disturbances of the Menstrual Cycle (causing Irregular Periods): the more irregular your periods are, the more difficulty you will have in accurately determining the date of ovulation. Ovulation is when an ovary sheds a mature egg, ready to be fertilized. This is therefore the most fertile time in a woman's menstrual cycle.
* The Time Already Taken in Trying to Conceive: as is shown above with average couples falling pregnant after different times, if you have not fallen pregnant within one year, there may potentially be a problem. However, this is not always the case as even after one year, many couples will naturally fall pregnant in their second year of trying. It may be prudent to discuss the situation with your doctor after the first year so that problems can be identified earlier.
* Frequency of Sexual Intercourse: the more frequent a couple has sex, the more likely they are to conceive. This is especially true for sex around the time of ovulation. Couples may try many methods to identify as precisely as possible the exact date of ovulation to maximise their chances of conception. Some of these factors are outlined in the following pages. However, although this is important, it is also vital that couples remain intimate and loving, thus reducing stress and tension in their relationship which can itself be a contributory factor in infertility.
* The Type of Contraception Previously Used: if you have used a barrier method of contraception such as sheaths (male or female condoms), caps or diaphragms, then your ability to conceive quickly should not be altered as you should be able to conceive immediately on stopping these methods. However, the situation with many hormonal methods is more uncertain in that a women may not be able to conceive for some weeks or months after stopping such contraception. Examples of hormonal methods include; the combined oral contraceptive pill (COC), progesterone only pill (POP), combined patch, depo injections, implants and intra-uterine devices. In theory, a women may conceive within just a few days after stopping any of these hormonal methods, but in practice, ovulation may be delayed, thus delaying conception.
* Other Medical Conditions: almost any chronic condition which is not treated adequately can lead to difficulty with conception. Examples include heart disease and diabetes.
In order to avoid getting disheartened by your failure to conceive, it is vital to understand the above points and recognise the appropriate timescales involved in falling pregnant. It is equally vital to have some knowledge about the normal menstrual cycle. For further information, please read the page entitled, "Understanding the Normal Menstrual Cycle".
What is Conception?
For conception to occur it requires a male and female gamete. The male gamete is the sperm and the female gamete is the egg (also called an ovum or oocyte). When a male and female gamete come together and fuse, a zygote is formed. In other words, when a single sperm burrows into an egg, the two fuse together in a process called fertilisation, thus forming a fertilised egg (a zygote). Conception generally occurs in a fallopian tube. Eggs are released from the ovary by a process known as ovulation.
What is Implantation?
After conception the fertilised egg travels down into the uterus (womb) which at this stage will be receptive to the fertilised egg. In this state the fertilised egg attaches itself to the womb lining called the endometrium. The process of attachment is called implantation. It then grows to form an embryo which may then develop into a foetus.
When a zygote undergoes cell division it is called an embryo. An embryo aged 5 to 6 days is called a blastocyst. When an embryo reaches 8 weeks old it is then called a foetus. The age of the foetus is known as its gestational age and is usually expressed in weeks.
It is only after implantation has occurred that a woman is pregnant. For a pregnancy to take place, many different things must be in place. For example, the environment for an egg and sperm to meet must be right. Therefore, the timing of sexual intercourse is important and the structure of the fallopian tubes and uterus must be normal. The hormonal balance of the body must also be conducive to falling pregnant.
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