Human beings as a species are much less fertile than most other species.
In a normal menstrual cycle, there is about one in six chances of conceiving.
That is almost like the throw of a dice, and in most cases,
when there is a delay in conception, it's mostly a chance factor.
In the UK, about one in seven couples seek treatment for a delay in fertility. That is almost 3.5 million couples.
So, in general, if a couple, when they are trying to conceive, they don't conceive after a year
of regular unprotected intercourse every two or three days, they should seek medical treatment.
Obviously, if there are other risk factors
like anyone over 35 years of age should seek help even earlier.
Even though pregnancy occurs only in woman, to be pregnant, it needs both a male and a female partner.
In general, among the causes of delayed fertility, about 25% is due to a male factor
and another 25 to 30% is due to unknown or a combined factor; which could be male or female.
About 25 to 30 percent, about 1 in 3, would be due to a delay or fault
in ovulation where the eggs are not released in time or in a proper manner.
And about 10 to 15% would be due to some structural causes in the woman, like in the womb a fibroid or
a polyp or endometriosis or damage to the tubes from a previous infection.
So, in general, about half of the causes could be either due to male or a combined cause.
And another 40 or 50 percent would be due to female factors.
There are various factors. In the male, many lifestyle issues particularly smoking and
drug abuse of course can affect the sperm count and the sperm quality as well.
Apart from that, anything that can affect the genitalia, the testes, like infections in the past which
includes mumps or infections that can affect the tube draining the sperm from the testes
or any trauma to the genitalia or any surgery for hernia - all can affect the sperm count.
Anabolic steroids taken some time for muscle building can also affect the sperm count.
As for the female, the commonest cause for delayed fertility is a delay or a lack of ovulation,
where the eggs are not released in time.
And the commonest cause for that is PCOS or polycystic ovarian syndrome.
It is primarily a hormonal problem that is related in some ways to diabetes and insulin resistance.
And therefore, any gain in weight worsens the condition.
And therefore, weight control, keeping the weight in check is something that
will definitely help in preventing this problem from occurring.
Of course, there are other hormonal problems which may even include an early menopause particularly
if there is a family history, a mother or a sister having early menopause and that can also delay fertility.
There are certain drugs that can affect ovulation as well.
Mainly, some anti-psychiatric – some drugs used in psychiatry and some drugs used for sickness.
Apart from this, there could be local factors; structural problems,
as in a fibroid, which is a localised swelling of the muscles of the womb
that can distort the cavity of the womb and cause problems, and for the same reason a polyp,
which is a little localised swelling of the lining of the womb, can also prevent fertility.
Occasionally, there could be factors outside the womb, but within the pelvis,
within the lower tummy, like endometriosis where bits of lining of
the womb can be found scattered within the tummy, and from previous pelvic infections
or surgery, they can cause scarring and can damage the tubes or a cyst in the ovary.
So, women are born with a finite number of eggs.
And from puberty onwards, in every monthly menstrual cycle, a few eggs are recruited,
out of which one matures and is released into the fallopian tube, and the process is called ovulation.
Therefore, in every menstrual cycle a few eggs are recruited and used up.
By the age of 35, the number of eggs therefore drops drastically.
And the chances of fertility thereby decrease as well.
And by age 40 it reaches a critical level where fertility then becomes very difficult.
And it's not, however, just the number of eggs;
it's also the quality of the eggs, because the eggs are as old as the woman herself.
So, somebody who is 35, the eggs are 35 years old as well. And therefore, their quality decreases.
And this not only decreases the chances of conception,
but also increases the risk of miscarriages and of chromosomal problems like Down syndrome.
There are as of today plenty of treatments available. And IVF has revolutionised fertility treatment,
and thereby, most couples can be treated and can get fertile.
However, many couples who are seeking treatment or help
for fertility investigations and treatment actually do not need any treatment.
Simple lifestyle changes like stopping smoking, weight
control both for the male and the female, in many cases is all that's required to get pregnant.
As I said before, fertility also has a huge chance factor. And therefore, giving it time,
particularly if one is young is it's also quite usual and should be tried.
Even though IVF can help with most fertility problems, most couples actually do not need IVF.
There are many other treatments available where there is a cause that can be treated.
As for example, if there is a fibroid, which is a localised swelling of the muscles of the womb,
or a polyp that's distorting the cavity can easily be removed through keyhole surgery as a day case.
Endometriosis sometimes can affect fertility, scarring inside the tummy
from a previous infection or a surgery can affect.
And these all can be treated through keyhole surgeries as day cases.
Occasionally, the tube can be blocked and can be swollen.
And even if one then needs IVF for fertility, the tube ideally (or the tubes if both are damaged)
should be removed though keyhole surgery or clipped before going for IVF to increase the success rate.
In minor cases of ovulation problem where the eggs are not
being released in time, simple medications with very simple monitoring
that can be done in simple outpatient settings may be all that's necessary for fertility.
However, if none of these work or if there's a strong male factor problem or somebody is over 35 years of age,
then probably IVF and the various modes of assisted reproduction is a better option
and there are many available.
And in most cases, most women and most couples would conceive with IVF if needed.