If pregnancy does not occur within 12 months of regular intercourse without contraception, there is enough concern to start talking about infertility [1].
What causes infertility and can it be prevented?
Infertility is considered primary if a pregnancy has never occurred, and secondary if there has been successful conception in the past.
Primary infertility in men and women can be caused by many factors. Some can't be controlled, but others can be successfully addressed.
Primary infertility can be caused by genetic or hormonal disorders, infectious and non-communicable diseases, as well as exposure of the reproductive system to certain chemicals (including tobacco, alcohol, drugs) and other toxins [2].
Being overweight or, conversely, presenting low body weight are also risk factors for both women and men [3]. High blood pressure may reduce male fertility [3].
Age is a common factor in female infertility. Women over 35 are about half as likely to get pregnant as women in their 20s [4, 5].Secondary infertility may be due to the same reasons as primary infertility, or it may be due to complications that occurred during previous pregnancies and childbirth. The highest level of secondary infertility in the world is observed in Russia and Eastern Europe. Experts associate this with the prevalence of abortions there and the complications that may ensue with such procedures [2].
When should you start testing for infertility?
If both partners are under 30 years old and have no obvious health problems, then there is an 84% probability of pregnancy occurring within a year. If this does not happen, you can start exploring your options by consulting your doctor.
Women over 35 may want to start screenings and treatment if pregnancy has not occurred within six months.
It does not make sense to wait at all, and treatment can be discussed immediately, if the cause of infertility is obvious, for example if a man does not have an erection or is unable to ejaculate [6].
Who should be screened first? The man or the woman?
In most cases it is necessary to examine both partners at the same time. Statistics show that:
In a third of infertile couples, the issue is associated with the male.
Another third with the female.
In the remaining third of the cases, the issue may either be undetected (the so-called "unexplained infertility"), or the male and female factors of infertility have presented simultaneously [5].
But traditionally, the examination begins with the woman; simply because in most countries gynecologists are more accessible than andrologists or reproductive specialists. Usually the gynecologist will refer the couple to a reproductive specialist [6]. Since the most common causes of infertility are sperm abnormalities, ovulation dysfunction and blocked fallopian tubes, it reasons to start the screenings with a semen analysis of the male partner and a hormonal blood test for the female partner. The woman may also be offered an ultrasound to exclude anatomical abnormalities. If at this stage it becomes obvious that IVF will be required, then there is no need for further complex examinations (for example, tubal patency) [7].
How is infertility treated?
The method of treatment will depend on the identified cause. Sometimes a course of certain medications is enough. In other cases, surgery may be required. Assisted reproductive technologies (ART) are also often used [7], again, it all depends on the particular case.
If you are facing infertility, make sure to create a support system around you and try not to assume anything. Patience and good medical care will give you the best possible chances of becoming pregnant.
This article was created in association with UNFPA, the United Nations sexual and reproductive health agency.
