Not all couples who want a pregnancy will achieve one spontaneously and many will need to seek medical treatment to help resolve underlying fertility problems. It’s therefore understandable that infertility has been recognised as a public health issue worldwide by the World Health Organization (WHO).
“Infertility is when you cannot get, or stay pregnant, after trying to conceive for at least a year, and you are under the age of 35,” says Dr Sulaiman Heylen, president of the Southern African Society of Reproductive Medicine and Gynaecological Endoscopy (SASREG).
One in every four couples in developing countries is affected by infertility, while one in six couples worldwide experience some form of infertility problem at least once during their reproductive lifetime. The current prevalence of infertility lasting for at least 12 months is estimated to affect between 8 and 12% of women between the ages of 20 and 44 years worldwide.
In recent years, the number of couples seeking infertility treatment has dramatically increased due to factors such as women having children later on in life due to work and financial commitments , development of newer and more successful techniques for infertility treatment, and increasing awareness of available services.
This increasing participation in fertility treatment has also raised awareness and research has shown that the psychological ramifications of infertility include. stress, depression and anxiety, which is why it’s important to know there are options available for treatment.
Factors which may contribute toward infertility
Age is a key factor
“Up to 50% of all patients who visit a fertility centre are 35 years or older,” says Dr Heylen. If you and your partner do want children, but are not ready to take this step yet, it might be worth looking into fertility options and fertility preservation such as freezing your eggs, for when you are ready to start a family.
What role do men play?
Between 20 and 30% of infertility cases are explained by physiological causes in men, between 20 and 35% by physiological causes in women, and between 25 and 40% of cases are due to a problem in both partners. In 10-20% no cause is found.
The decrease in a man’s fertility appears to occur later in life than in a woman’s fertility. In their mid-to-late 40s, men experience changes in their sperm that can cause issues with fertility, and chromosomal or developmental problems with their children.
Infertility is also associated with lifestyle factors such as smoking, body weight and stress. A woman’s age is one of the most important factors affecting whether she is able to conceive and give birth to a healthy child. This is due to several changes that are a natural part of ageing:
- The number and quality of eggs (ovarian reserve) decreases naturally and progressively from the time a woman is born until the time she reaches menopause.
- It is not only more difficult to get pregnant (conceive), but miscarriage and chromosomal abnormalities in the child (such as Down Syndrome) are more common in older mothers.
- Fibroids, endometriosis, and tubal disease are more common and can affect fertility.
- Women who become pregnant at an older age have a higher risk of complications during the pregnancy, such as gestational diabetes and pre-eclampsia.
If you have any of the following risk factors, you should also consider seeking advice earlier:
- Family history (i.e., mother or sister) of early menopause (before age 51)
- Previous ovarian surgery
- Exposure to chemotherapy or radiation to treat cancer in either partner
- Shortening in the time between periods
- Skipped or missed periods
- History of injury to the testicles
- Exposure to toxic chemicals (certain pesticides or solvents)
Pregnancy is a complex process
Pregnancy is the result of a process that has many steps. To get pregnant:
- A woman’s body must release an egg from one of her ovaries (ovulation).
- A man’s sperm must join with the egg along the way (fertilise).
- The fertilised egg must go through a fallopian tube toward the uterus.
- The fertilised egg must attach to the inside of the uterus (implantation).
Infertility may result from a problem with any or several of these steps. For the pregnancy to continue to full term, the embryo must be healthy and the woman’s hormonal environment adequate for its development. Even if just one of these factors is impaired, infertility can result.
When to seek advice
Couples, dependent on the ages of the partners, are generally advised to seek medical help if they are unable to achieve pregnancy after a year of unprotected sex. The doctor will conduct a physical examination of both partners to determine their general state of health and to evaluate physical disorders that may be causing infertility. Usually both partners are interviewed about their sexual habits in order to determine whether sex is taking place properly for conception.
If no cause can be determined at this point, more specific tests may be recommended. For women, these include an analysis of ovulation, x-ray of the fallopian tubes and uterus, and laparoscopy. For men, initial tests focus on semen analysis.
Before a treatment option can be decided on, you and your partner will need to be evaluated by your fertility specialist to find what is causing your infertility.
“If you find yourself feeling anxious, depressed, out of control, or isolated, you are not alone,” says Dr Heylen. “Infertility is more common than you might think, but there is no reason to lose hope. Visit a fertility clinic near you to speak to a doctor about the options available to you and your partner.”
For more information, visit www.merckfertilityjourney.co.za.
More about the expert:
Dr Sulaiman Heylen qualified as a medical doctor and specialist in Obstetrics and Gynaecology at the University of Leuven in Belgium. He obtained the Gynaecological Endoscopist Certificate from the European Academy of Gynaecological Surgery in 2013. He is an EHSRE-certified master reproductive endoscopic surgeon. He is a specialist in reproductive endoscopic surgery (laparoscopy and hysteroscopy) and reproductive medicine. He is also registered as an obstetrician and gynaecologist with the Health Professions Council of South Africa (HPCSA) and as a Subspecialist in Reproductive Medicine with the same body. He is also president of SASREG (South African Society of Reproductive medicine and Gynaecological Endoscopy). Learn more about Dr Sulaiman Heylen here.
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