By Dr. Liza Ling Ping, Consultant O&G and Fertility Specialist
Marriage is a joyous occasion that unites a couple, with the well wishes from family and friends! The celebration may carry on for few days, and for the couple honeymoon begins. Weeks and months later, the good news like `Honey, I am pregnant!’ is one to celebrate again. However for some couples, it can be frustrating and depressive to find a pregnancy test positive elusive, despite trying very hard.
The chances of getting pregnant quickly does depend on age. Women are most fertile between the ages of 20 and 24. Around the age of 30, fertility starts to decline for women and will decline more steeply from 35 years of age onwards. By age 40, the chance of getting pregnant is less than 5% per menstrual cycle. For men, the decline in fertility is more gradual compared to women. Most men will remain fertile into their 50s and beyond. However, the number of men with sperm problems also increase with age.
The best chance of getting pregnant is regular intercourse. Over 80% of couples will conceive within the first year of regular intercourse and no contraception practice. Regular intercourse means making love every 2 to 3 days throughout your cycle. If by doing so, you are still not successful in conceiving after a year, it is recommended that you should seek help from your doctor. But if you are over 35 years old, it is important to ask for help sooner.
Infertility was once thought as just a women’s problem, it can also be attributed to men’s problem. Infertility affects both men and women equally. There are many contributing factors to infertility and 25% of infertile couples may have more than one contributing factors. Approximately 40% of infertile couples the sole cause arises from the male partner.
The common causes of female infertility are ovulation problems and blocked fallopian tubes usually due to infections. Other causes such as endometriosis, uterine fibroids and endometrial polyps may also affect female fertility. Low sperm count, less progressive sperm movements and high abnormal sperm numbers contributes to male infertility. Smoking and overweight are other contributing factors affecting both male and female fertility.
There are many fertility treatment options available and it is best to discuss with your doctor the most suitable and favourable outcome for you. However, there are some couple who will need to be referred to center specializing in assisted reproductive techniques to help them conceive. For ovulation problems, fertility drugs such as clomiphene citrate or gonadotrophin injections can help induce and trigger release of more eggs per menstrual cycle. Intrauterine insemination (IUI) can be offered with fertility drugs to increase the chance of pregnancy by injecting your partner’s sperm or donor’s sperm into your uterus through a thin flexible tube. IUI is feasible only in situation where at least one of the fallopian tubes is patent.
If a woman has both tubes blocked or diseased (e.g: dilated with fluid-hydrosalphinx) or a man has very poor sperm quality, invitro-fertilization (IVF) or intracytoplamic sperm injection (ICSI) are more suitable treatment options and for many couples, gives them the best chance of having a baby.
What is IVF? IVF involves fertilizing egg/eggs outside the body, using your own eggs and sperms, or using donated eggs or sperms. If there is any concern on sperm quality, ICSI is carried out for fertilization process, where one sperm is injected into one egg. The procedures for IVF are quite complicated and are performed by highly trained personnel and fertility specialists.
To make it simple, the following are IVF processes to getting pregnant.
In this step, you will be given fertility hormones known as gonadotrophin that will increase the number of eggs produced. Your fertility specialist will monitor your follicle growth progress through series of vaginal ultrasound scans and some blood test.
Once follicles have achieved a certain size, the next step is to collect your eggs using ultrasound guidance while you are sedated. A thin needle is attached to the ultrasound probe and inserted through the upper vagina to collect the eggs from follicles on each ovary.
For men, you will be asked to provide a sperm sample after the retrieval of your partner’s eggs.
The following step is fertilizing the egg, by mixing the most active sperms with the eggs and cultured in an incubator. These are performed in the laboratory. The eggs that are successfully fertilized will now form embryos. The embryologist will monitor the development of the embryos and the best will be chosen for transfer. Any surplus usable embryos can be frozen for future use.
This is the final step using ultrasound guidance performed via abdomen. This is normally a pain-free procedure which does not require sedation. A speculum is inserted into the vagina, similar to having a cervical smear taken, to visualize the cervix. The embryo(s) are transferred through a small special tube which is passed through the cervix into the uterine cavity.
Two weeks later, a blood test will be carried out to see if you are pregnant.
Many couples face problem in conceiving and are too shy or ashamed to seek help because of the stigma that is attached as being barren. With the current advancement in medical knowledge and technology, there are many treatment options available to help you conceive. Do consult your doctor early if you have problem conceiving.