Factors affecting fertility

Dear Dr. Sangani, I have been married for five years. We do not have any children. I am getting worried that there may be something wrong with me. At what point should I go to a specialist for further evaluation for infertility or is it normal not to have a children for five years after marriage?

From somebody who is afraid of infertility.

Dear Ms. Infertility,

It was not mentioned in your letter but I am assuming that you have tried all normal methods to get pregnant and that you have not had any stillbirths, etc.

I have invited Dr. Subodh Chauhan, who is a board certified obstetrics-gynecologist practicing in Houston, Tex., to answer your question.

Q: What is infertility?

A: Infertility is failure to achieve pregnancy within 12 months of trying. Those who have never been pregnant have primary infertility. Those couples who once were pregnant and now fail to get pregnant are said to have secondary infertility. One in six couples will seek help for infertility. Fortunately recent advances are able to help a large number of women.

Q: What causes infertility?

A: Infertility has many causes. Lack of ovulation, tubal block, male infertility, tubal adhesions, endometriosis, uterine distortion due to fibroids are some of the common causes.

Lack of ovulation: A common cause is polycystic ovarian disease which occurs in six percent of women. It is characterized by irregular cycles, excessive hair growth, overweight and associated with insulin dysfunction (insulin resistance]. Some women have a small quantity of eggs which get used up earlier. This leads to failure of ovulation. These conditions can be due to genetics or destruction of ovarian tissue due to surgery or chemotherapy. Women who fail to have menstrual cycles are unlikely to have ovulation. They need expert evaluation. Women treated by depo provera may ovulate after nine to 12 months.

Tubal block: Tubal blockage is caused by infection. Sexually transmitted diseases are the known culprits but in the majority there is no evidence of sexually transmitted disease and the subclinical infection due to other bacteria is the likely offender. At times, the tube gets blocked and filled with fluid which is called hydrosalpinx. If there is history of tubal pregnancy (ectopic pregnancy) and surgery is done, a part of the tube is lost and causes tubal block. Tubal ligation causes tubal block.

Male infertility: In 40 percent of couples, male factor is the cause for infertility. Smoking, excessive alcohol, street drugs, exposure to pesticides and radiation can affect the sperm count. At times, lost genetic material or abnormal number of chromosomes can cause low or absent sperm count. Sperm production is optimum at temperatures lower than core body temperature. Using hot tubs in excess can influence sperm count. If there was an undescended testis which was not repaired in infancy the prognosis of sperm production is poor. Hernia surgery, injury to testis during sports and twisting of testis affect blood flow and can affect sperm function.

Tubal adhesions: These are commonly due to previous surgery or due to endometriosis. Endometriosis is presence of cells outside the uterus which are normally in the uterus During menses, the uterine lining is shed and patients who have endometriosis have bleeding in the abdomen that is associated with pelvic pain and at times with pain during intercourse.

Fibroids: These are tumors of the uterine muscle which are benign in nature and cause distortion of the uterine cavity.

(from the Sun Herald)