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]]>About one in nine couples experience fertility difficulties. There are many reasons for this, some relating to the male partner and some to the female partner. If you suspect an infertility problem , talk to your Sexologist, infertility specialist who will guide you through the steps of an infertility investigation.
For people who have been diagnosed with cancer, fertility preservation is an important consideration if there is a chance that their cancer treatment may affect their fertility. Increasingly, fertility preservation is now also being used for non-medical purposes. Egg freezing for social reasons has seen a rise in demand in recent years.
Most people take their fertility for granted and do not expect to have problems conceiving. However, one in nine couples experience fertility difficulties.
If you have been trying to conceive for a year or more, it is time to seek medical advice. If you are over 35, you should see a doctor if you have been trying to conceive for six months or more.
The first point of contact should be your general practitioner (GP) who will start an infertility investigation. This involves a detailed medical history and a physical examination of both partners and some basic tests to make sure that the woman is ovulating and that the man produces sperm. If everything seems in order, your GP may advise you to keep trying for a little longer before consulting a fertility specialist. However, if your test results indicate a problem, your doctor will refer you to a fertility specialist without delay. The fertility specialist will do more tests to establish the cause of infertility and determine the type of treatment you may need.
There are many reasons why pregnancy does not occur. About one-third of infertility cases are due to male factors and one-third due to female factors. Sometimes both partners have a fertility problem. In about 20 per cent of cases, there is no apparent cause of infertility, so-called unexplained or idiopathic infertility. As more couples delay childbearing age-related infertility is becoming more common.
A diagnosis of infertility often comes as a shock. It is unexpected and unwelcome and emotionally challenging. Unlike other adverse life events, which may have a clear resolution, infertility is uniquely distressing because it can last for many years and the outcome is uncertain. Some people find it helpful to discuss their feelings with a psychologist or counsellor. Others feel better if they take action by starting treatment.
Once the cause of infertility has been pin-pointed, your doctor will discuss treatment options with you. These will vary depending on the cause of infertility but will most likely involve some form of assisted reproductive treatment. You need a referral from your GP to see a fertility specialist. Your GP may recommend a fertility specialist, unless you have a preference for a particular ART clinics or individual fertility specialist.
The chance of ART treatment working has greatly improved since the late seventies when the first IVF baby was born. Although your chance of having a baby with ART depends largely on factors that are beyond your control, there are some things that you can do to improve the odds. The lifestyle factors that influence the chance of natural conception for both men and women also affect your chance of ART success.
It is useful to understand how eggs and sperm are normally formed, and how conception occurs to understand the causes of infertility and how they are targeted in ART.
The hormones which control the production of sperm and eggs are called gonadotropins. There are two types of gonadotropins: follicle-stimulating hormone (FSA) and luteinising hormone (LH). In men, they stimulate the testicles to produce sperm and testosterone. In women, they act on the ovaries, where the eggs develop. The female sex hormones, oestrogen and progesterone, are produced by the ovaries when eggs mature and are released (ovulation).
The production of sex hormones and the release of an egg is known as the menstrual cycle. It is counted from the first day of the period until the day before the start of the next period. In an average cycle of 28 days, ovulation happens on day 14. However, and it is important to note that, ovulation occurs earlier in women with shorter cycles and later in women with longer cycles.
Sperm are produced at the rate of about 300 million per day. They take some 80 days to mature. Each sperm has a head, which contains the genetic material, and a tail, which propels it up through the vagina, uterus, and Fallopian tubes where the conception occurs when an egg and a sperm come together. At ovulation, an egg is released from the ovary into the fallopian tube. If sperm is present at that time, the egg can be fertilised. The fertilised egg then starts to divide and becomes an embryo. After ovulation, the ovary produces progesterone which prepares the lining of the uterus – the endometrium – for the growing embryo. If an embryo does not form or attach to the endometrium (implantation), the level of progesterone drops and the next period starts.
A few days after implantation, the embryo starts to produce Human Chorionic Gonadotropins (HCG) – the hormone that gives a positive pregnancy test reading.
Dr. Sharmila Majumdar
Chief Consultant Sexologist
Sexual and Mental Health Clinic
Avis Hospital, Jubilee hills
Next to Chiranjivee Blood Bank
Hyderabad 500033
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]]>This is one of the most common misconceptions, responsible for many unwanted pregnancies. Also known as the withdrawal method, it has a high rate of contraception failure. This is because some pre-ejaculation fluid (or pre-come) may be released before the man actually ejaculates. This pre-come contains spermatozoids, and it takes only one sperm to get you pregnant! In addition, some men may not have enough self control to withdraw in time…
Keep in mind that pre-ejaculation fluid can also contain sexually transmitted infections, so pulling out will not prevent you from getting an infection.
The chances of getting pregnant while on your period are low, but it may happen, mainly in women with shorter cycle –i.e., if you get your period every 21-24 days. In such case, your ovulation occurs around the 10th to 12th day after the beginning of your period. Since sperm can live up to 5 days inside your body, if you have sex towards the end of your period, sperm can wait for the egg to be released and you may become pregnant.
But even in women with longer, regular cycles, the ovulation may eventually take place earlier… So remember, you can get pregnant at any time of the month if you have sex without contraception.
It has been suggested (mostly by internet rumours) that it is dangerous to take the emergency contraception pill more than one or twice in your life. According to the World Health Organisation: “Emergency contraceptive pills are for emergency use only and are not appropriate for regular use as an ongoing contraceptive method because of the higher possibility of failure compared with non-emergency contraceptives. In addition, frequent use of emergency contraception can result in side-effects such as menstrual irregularities, although their repeated use poses no known health risks.” Emergency contraception pills are very safe and do not harm future fertility. Side effects are uncommon and generally mild.
Some women believe that having sex in certain positions, such as standing up, sitting down, or if they jump up and down afterwards, they won’t get pregnant as sperm will be forced out of the vagina. In fact, sperm are very strong swimmers! It has been showed that within 5 minutes, sperm are able to reach the tube, where the fertilization of the egg takes place, and this happens regardless of the position you have sex in.
There’s no such thing as a “safe” position if you’re having sex without a condom or another form of contraception. There are also no “safe” places to have sex, including the bathtub, the shower or the sea.
Although these three methods are the best-known, there are 15 different methods of contraception (the available options differ in each country). Unfortunately -for women- there are only two choices for men (the male condom and permanent sterilization). Women have a choice of about 13 methods, including several of long-acting reversible contraception -this means you don’t need to remember to take it or use it every day or every time you have sex.
In the USA, 44% of adolescent girls ages 15 to 19 have had sexual intercourse. Although most of them have used contraception, teenagers frequently use methods with high failure rates -such as withdrawal, or they incorrectly use more reliable methods -such as the pill. In fact, 8 out of every 10 adolescent pregnancies are unintended.
The intrauterine device (IUD), a small device that is inserted into the uterus, has been traditionally reserved to women who have had children. However, new guidelines issued by the American College of Obstetricians and Gynecologists have changed this old perception. The IUD, together with the contraceptive implant, are considered now first-line contraceptive options for sexually active adolescents and young women. They are the most effective reversible contraceptives for preventing unintended pregnancy, with about 99% effectiveness.
Of course, the IUD and the implant do not protect against sexually transmitted infections, therefore you should also use condoms for that purpose.
These persistent misconceptions are, unfortunately, still responsible for many unplanned pregnancies. If the intercourse takes place during your fertile period, you may become pregnant, whether it’s the first or the hundredth time you’ve had sex, whether you liked it or not.
Condoms may occasionally break. Many people think that using two condoms (also known as “double bagging”) is safer than using one. Actually, it’s exactly the opposite: using two condoms causes friction between them, increasing the risk of breakage. Thus, two condoms should not be used, neither for pregnancy prevention or for safer sex. This is also true for using a male and a female condom at the same time. When used properly, a male condom is 98% effective at preventing pregnancy, a female condom is 95% effective.
During intercourse, adding lubricant may ease penetration, so sex is pleasurable and not painful. This is important when, for many reasons (such as stress, medications, taking the pill, etc) the natural wetness of the genital area is reduced.
Lubricants can be made from water, oil, petroleum or silicone. However, when using condoms, water-based lubricants should be used. Oil-based products such as petroleum jelly, creams, or baby oil and can damage the latex and make the condom more likely to split, resulting in no contraceptive protection.
Silicone-based lubricants are a newer form of lubrication; they are safe to use with condoms. However, they can be harder to wash off and may cause irritation.
This is another very common misconception. After stopping the oral contraceptive pill you may get pregnant immediately. But sometimes it may take two or three cycles for your fertility to fully return, no matter how long you have been using it. Some studies have shown that, within a year after going off the pill, 80% of women trying to get pregnant will get pregnant – exactly like women who were never on the pill.
Vaginal douching (washing out the vagina) after sex won’t help to prevent a pregnancy. Again, this has to do with spermatozoa being fast swimmers. By the time a woman starts douching, sperm are already well inside the uterine cervix, where no douching solution can reach them.
In fact, you should never douche. Douching can lead to many health problems, including problems getting pregnant, vaginal infections and sexually transmitted infections.
While you’re less fertile when breastfeeding, you may become pregnant. There is no accurate way to predict when fertility returns, even if you breastfeed exclusively. You may not menstruate for several months after giving birth, but at some point you will have your first ovulation. This is where you can get pregnant- and this will occur two weeks before you get your first period.
Thus, when nursing you should use birth control if you wish to avoid pregnancy.
If you have a regular cycle of 28 days, the ovulation usually occurs the 14th day of your cycle. But it’s not only that day that you are fertile. As said before, sperm can live in the cervix for up to 5 days, waiting for the egg to be released. Studies have shown that most pregnancies result from intercourse that takes place during a six-day period ending on the day of ovulation. Once the egg leaves the ovary, in about 24 hours it dies, and the fertile period is over.
However, even in women with a perfectly regular cycle, the hormonal balance involved in the ovulation process can be disrupted by many factors. These include stress, medications, etc, which can lead to an earlier or delayed ovulation. Thus, trying to avoid a pregnancy by just having intercourse on the “safe” days can be difficult and may eventually result in an unwanted pregnancy.
A survey conducted in France showed that “…one in ten young women ages 15 to 20 is not aware that the pill does not protect against HIV and sexually transmitted infections”. In fact, the only contraceptive method that offers protection against STIs is the condom. Barrier methods, such as the diaphragm, do not to keep bacteria out of the vagina. Others like the pill and IUD offer no STI protection at all.
Dr. Sharmila Majumdar
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