By Eduardo Gonzales, MD
I married late. I was 35 years old when my husband and I got married three years ago. I haven’t been pregnant yet despite the fact that my husband and I have never practiced any form of contraception. Is it time to consult a doctor? Is it true that among infertile couples, the problem is most likely with the wife? —email@example.com
After three years of trying to become pregnant without any success, is it time to see a doctor? Definitely. In fact, you should have seen a doctor two years ago. Couples in which the wife fails to conceive after a year of regular unprotected sex are considered infertile and should seek consultation if they want to increase their chances of having a baby. Moreover, because a woman’s chances of having a baby decrease rapidly every year after the age of 30, women who marry at 35 years or older, as in your case, are advised by most experts to seek consultation as early as after six months of unprotected sex. In any case, the earlier an infertile couple seeks consultation, the higher are the chances that they will ultimately have a child. Hence for infertile couples, time is of the essence. You should therefore consider making an appointment with a reproductive endocrinologist—a doctor who specializes in managing infertility—as soon as possible.
Is infertility just a woman’s problem?
Infertility in couples is accounted for by conditions affecting the wife in only about a third of cases. Male infertility factors account for another third. In the rest, the cause is either a combination of male and female factors, or unknown. Simply put, you and your husband have equal odds of being the cause of your failure to conceive.
Hence, when you seek medical consultation, your husband should go with you, not only because he could be the reason for your inability to get pregnant, but also because going through the assessment process together will definitely improve your marital bond.
It is rather easy to determine infertility in men. All it takes is an interview, physical examination, and a single laboratory examination—semen analysis.
There are numerous possible causes of male infertility, but many of them are correctible. One easily correctible cause is excess heat in the area of the testes—the sperm cells germinate in the testes at a temperature that is slightly lower than core body temperature, which is why the testes hang out of the body, hence anything that will unduly warm the testes will lead to low sperm count such as improper clothing (e.g. supporters, etc.), cryptorchidism (undescended testes), and varicocoeles (enlarged veins) in the scrotum. Other possible cause of male infertility are psychological stress, poor nutrition, infection, concomitant illness such as diabetes mellitus, abnormalities of the testes and the ducts that convey the sperm from the testes to the outside, erectile dysfunction, and hormonal problems.
Over 50 percent of infertile men can be treated successfully. Treatment depends on the cause of infertility and range from surgery or medications to lifestyle changes.
In contrast to male infertility, there is no single test that can tell whether a woman is infertile or not, which explains why the cause of female infertility can be difficult to diagnose. Ovulation disorders account for about 25 percent of infertility in women. The cause of an ovulation disorder is many times hard to establish because it can be due to a condition affecting any or all of the following organs: hypothalamus, pituitary gland, and ovaries. Other possible causes of female infertility are damage to, or structural defects of, the fallopian tubes or cervix, endometriosis (i.e., presence of uterine tissue outside the uterus), and abnormalities of the uterus, which can be anatomic in nature or due to the presence of tumors or scarring.
Often, a woman has to undergo a host of tests—many of which are rather expensive—before her infertility and its cause could be ascertained.
A variety of treatments are available for infertile women. Most treatment options are designed to restore fertility by means of medication or surgery, but a few are designed to assist in reproduction by employing sophisticated techniques such as in-vitro fertilization.
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