After marriage the next wish of
any couple is to have a child. But this desire can at times grow in to an
unhealthy obsession. The influence from parents and relatives may only increase
the pressure.
But why is it exactly that some
couples fail to conceive? This condition is called “subfertility” in medical
terminology. For this definition the age of the female partner is a very important
factor. Other conditions of the female partner are also taken into
consideration. Here, problems with menstruation, and problems with female
genital system take precedent. If none of these problems exist a wait and see
period of one year is acceptable. But if the woman is over thirty five years
old, this period is usually not more than six years.
Reasons for subfertility
Even in a normal couple the
conception can be delayed up to one year in eighty percent of the couples. Half
of the remaining twenty percent that is ten percent conceive during the next
year. Only ten percent will not conceive under normal circumstances. Out of these conception failures forty
percent is caused by the problems in the male partner. Another forty percent is
caused by problems in the female partner. Ten percent is caused by problems in
both the male and female partners.
Remaining ten percent is usually without a definitive reason even after
investigation.
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Problems in the male partner
Quantitative and qualitative
problems with male sperms are a main reason for problems in the male partner.
Also erectile dysfunction, problems with ejaculation can be seen. Several infections and blockages can cause
these problems in ejaculation. Although
not as common hormonal problems also can cause problems in production of sperm.
Problems in the female partner
There are many reasons that may cause subfertility in a female. The
anatomical and hormonal complexity of the female reproductive system is
probably the reason for these numerous problems. There are eight million ova
(eggs) in the female embryo when it is developing inside the uterus. This
number is reduced to one million at birth.
But during the reproductive life period of a female only about four
hundred ova are released. From this release of ovum to the implantation of the
fertilized ovum in the uterus, there can be problems in many stages.
One of the commonly seen abnormalities is the formation of cysts like a
“bunch of grapes” in the ovaries. In this situation the release of ova has been
significantly affected. Another problem is the obstruction of fallopian tubes
due to various reasons. Abnormalities in the uterus can also cause
subfertility. Also the condition called endometriosis can cause this problem.
This condition can cause obstruction of fallopian tubes, problems with release
of ova, and also pain when having sexual intercourse.
Investigating for the cause
When having subfertility both the husband and wife should be
investigated. First a semen sample of the husband should be analyzed and for
this he must abstain from sexual intercourse for three days. When analyzed a
healthy male should have at least fifteen million sperms in one milliliter and
forty percent of those sperm must be healthy sperm.
When investigating female partner several investigations like hormonal
assays, ultrasound scanning of abdomen, laparoscopic testing are available
based on the requirements of the specific individual. Also other illnesses such
as diabetes, hypothyroidism that can affect fertility is also investigated.
Treating subfertility
When there is a problem with number of male sperm being produced there
is no definitive treatment for that. But when there are problems with release
of female ova hormonal stimulation techniques can be used.
Artificial insemination is also used nowadays. Depending on the problems
that are causing subfertility, if this treatment method is deemed suitable your
doctors can select good sperm from a sample of semen from your husband and can
place it in your uterus.
In vitro fertilization is another method. These are the babies that are
more commonly known as tube babies. In this method sperm and ova are brought
together and fertilized in a laboratory under highly controlled environments
and the resultant embryo is then placed In the mothers uterus. For this method
to be adopted various parameters should be considered. Here clinical
determinants take precedent.
As discussed here, there are various treatment methods with varying
complexity for treating subfertility. Therefor if a couple is having a problem
with subfertility consulting a obstetrician and gynecologist is the best
option.
Dr.
Prashantha Gange,
Consultant
obstetrician and gynecologist, Family Health Bureau
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