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Infertility Facts
Infertility is defined as 12 months of unsuccessful conception for women under 35. For women over 35, this decreases to six months of unsuccessful conception.
Women with irregular cycles, suggesting a problem with ovulation, can consider evaluation and treatment as soon as this problem is identified.
Of the approximately 60 million women of reproductive age in 1995, about 1.2 million, or 2%, had had an infertility-related medical appointment within the previous year and an additional 13% had received infertility services at some time in their lives. (Infertility services include medical tests to diagnose infertility, medical advice and treatments to help a woman become pregnant, and services other than routine prenatal care to prevent miscarriage.)
Infertility is not associated with any specific race or ethnicity.
FACTS EVERY COUPLE SHOULD KNOW
Infertility affects both men and women. Infertility results from a male factor in about 35% of cases, and a female factor in 50%.
About 10% of infertility problems remain unexplained even after complete medical evaluations.
While infertility can be a devastating experience for you and your partner, the good news is that it can be treated.
A number of medical conditions can be treated with Assisted Reproductive Technology (ART). City Fertility Centre can provide treatment for a number of infertility conditions.
HOW DOES CONCEPTION NATURALLY OCCUR?
For a couple to conceive a number of processes must take place successfully in both the man and the woman; and, at exactly the right time. The following briefly outlines the steps necessary for conception to take place:
- During the menstrual cycle, a woman’s hormones regulate the growth, maturation and release of an egg from her ovary. Each month the pituitary gland located in a woman’s brain sends a hormonal signal to her ovaries to prepare an egg for ovulation. These hormones are known as follicle-stimulating hormone (FSH) and luteinizing hormone (LH).
- The pituitary gland is, in turn, controlled by an area of the woman’s brain known as the hypothalamus, which sends out a hormone known as GnRH, or gonadotropin-releasing hormone. GnRH “tells” the pituitary gland when to release FSH and LH.
- An increase in FSH stimulates the growth of the developing follicles (and eggs) in the ovary.
- A large increase in LH signals the ovary to release an egg—this is known as ovulation. Normally, only one of a woman’s two ovaries produces an egg during the woman’s menstrual cycle.
- The released egg then moves from the ovary into the fallopian tube. The egg remains viable for about 24 hours.
- For fertilization to occur a sperm must locate and penetrate the awaiting egg while it is in the fallopian tube.
- If fertilization occurs, the fertilized egg, or embryo, continues to travel down the fallopian tube into the uterus, where it will attach, or implant, into the lining of the uterus.
In order for a couple to conceive, both the male and female reproductive systems must be functioning properly.
In the female this means:
- Ovulation occurs and leads to the production of a viable egg.
- The fallopian tubes are open and functioning properly to allow the egg and sperm to meet.
- The fertilized egg is able to move into the uterus and is not blocked from implanting in the wall of the uterus.
- The sperm are able to travel through the woman’s vagina, cervix, uterus, and fallopian tubes without being blocked in their attempt to locate the egg.
In the male this means:
- The testes produce viable, or normal sperm, as well as testosterone, the male hormone.
- Ability to achieve an erection and engage in sexual intercourse.
- Normal ejaculation occurs with semen going through the man’s urethra into the vagina.
- The sperm that are produced are properly shaped, able to move rapidly, and can accurately move to the fallopian tubes to locate and fertilize the egg.
THE RELATIONSHIP BETWEEN AGE AND FERTILITY
Delayed child bearing is becoming increasingly common in western societies for several reasons: many couples prefer to rear their children only after establishing a stable relationship and financial security, also, there are increasing numbers of late and second marriages.
Conception rates for normal healthy couples are, at best, 20-25% per menstrual cycle. Once a woman reaches the age of 35, her fertility begins to decline. By age 40, it is estimated that her conception rate is in the range of 8-10% per month and at age 43, the pregnancy rate is thought to be as low as 1-3% per month.
Although pregnancies in women approaching 50 and beyond are occasionally reported, there is a decrease in fertility (the ability to achieve a pregnancy) with advancing age. The decline is gradual over the reproductive life span of the woman.
The risk of miscarriage is also increased with ageing e.g. the risk of miscarriage at age 25-29 years is 10% while the risk at age 40-44 is 34%. Furthermore, advanced maternal age is associated within increased risk of chromosomally abnormal offspring.
| Risk of Miscarriage with Increased Age |
| Maternal Age(years) |
Miscarriage(%)
|
| 15-19 |
9.9 |
| 20-24 |
9.5 |
| 25-29 |
10 |
| 30-34 |
11.7 |
| 35-39 |
17.7 |
| 40-44 |
33.8 |
45 and over
|
53.2 |
WHY DOES FERTILITY DECLINE WITH INCREASING AGE?
Ageing of the ovaries is the most prominent factor and is part of the normal ageing changes that affect all organs and tissues. Most women have about 300,000 eggs in their ovaries at puberty. For each egg that matures and is released (ovulated) during the menstrual cycle, at least 500 eggs do not mature and are absorbed by the body. By the time the woman reaches menopause which usually occurs between 50-55 years, there are only several thousands eggs remaining. As the woman ages, the remaining eggs in her ovaries also age, making them less capable of fertilization and their embryos less capable of implanting.
- Fertilization is associated with a higher risk of genetic abnormalities e.g. chromosomal abnormalities such as Down syndrome with increasing age. The risk of a chromosomal abnormality in a woman age 20 years is 1/500 while the risk in woman age 45 is 1/20.
- Gynaecological problems such as pelvic infection, tubal damage, endometriosis, fibroids, ovulation problems etc tends also to increase with age. As the woman gets older, she has more time to develop these conditions, which will adversely affect her fertility.
- Sexual function is also decreased with ageing e.g. libido, frequency of intercourse etc.
- The effect of ageing in endometrial receptivity (ability of the endometrium to receive the embryo) is controversial. There is increasing evidence that the receptivity decreases with age.
- Ageing does not just affect women, but also men to a much lesser degree. It affects sperm and coital frequency. There is no maximum age at which men are not capable of conceiving a child.
- Advanced maternal age increases the risk of autosomal dominant diseases such as Marfan's syndrome, neurofibromatosis and achondroplasia.
INVESTIGATIONS OF INFERTILITY IN OLDER WOMEN
- It is advisable to seek the advice of your doctor/ specialist sooner than later so investigations and treatment can be started without undue delay.
- Several tests may be useful in assessing the fertility potential in older woman e.g. blood tests to examine the levels of the hormones FSH, LH, estradiol and inhibin on day 3 of your menstruation.
- You will be more likely to be counselled about the risk of miscarriage and chromosomal abnormalities in relation to your age. In addition to the potential complications of pregnancy such as high blood pressure, bleeding and diabetes.
In addition to a reduction in pregnancy rates associated with increasing female age, there is also a significant increase in the risk of miscarriage and chromosomal (genetic) abnormalities.
| Risk of Chromosomal Abnormality In Newborns By Maternal Age |
Maternal Age
(years) |
Risk for
Down Syndrome |
Total Risk for
Chromosomal Abnormalities |
| 20 |
1/1,667 |
1/526 |
| 25 |
1/1,250 |
1/476 |
| 30 |
1/952 |
1/385 |
| 35 |
1/378 |
1/192 |
| 40 |
1/106 |
1/66 |
| 41 |
1/66 |
1/53 |
| 42 |
1/63 |
1/42 |
43
|
1/49 |
1/33 |
| 44 |
1/38 |
1/26 |
| 45 |
1/30 |
1/21 |
| 46 |
1/23 |
1/16 |
| 47 |
1/18 |
1/13 |
| 48 |
1/14 |
1/10 |
| 49 |
1/11 |
1/8 |
"Reproductive Potential in Older Women"
by P.R. Gindoff and R. Jewelewicz. Fertility & Sterility. 46:989;1986
EXERCISE WEIGHT AND FERTILITY
Couples with infertility often wonder if lifestyle habits might compromise their fertility. Two important lifestyle factors, weight and exercise, can affect fertility.
Low weight or weight loss can lead to a decrease in an important hormonal "message" that the brain sends to the ovaries in women and testes in men. This hormone, gonadotropin releasing hormone (GnRH), is produced in the part of the brain called the hypothalamus. The release of GNRH leads to the release of the hormonal messengers LH and FSH (the gonadotropins) by the pituitary gland. LH and FSH are critical for the development of eggs in the ovaries and sperm in the testes. The degree to which weight loss affects fertility will vary. In mild cases, the ovaries may still -produce and release eggs, but the lining of the uterus may not be ready to receive a fertilized egg because of inadequate ovarian hormone production. In more severe cases, ovulation does not occur, and menstrual cycles are irregular or absent. In men, low weight or weight loss may lead to decreased sperm function or sperm count. If low weight or weight loss has been identified as the cause of one's infertility, the preferred treatment would be to stop losing weight or even to gain weight if needed.
Being overweight or obese can affect the hormonal signals to the ovaries or testes. Increased weight can also increase insulin levels in women, which may cause the ovaries to overproduce male hormones and stop releasing eggs. Weight loss is the best plan of action, but drugs such as clomiphene citrate or gonadotropins can be used in overweight patients. It is important to make sure that glucose (blood sugar) levels in overweight patients are normal prior to attempting pregnancy and that specific metabolic causes of obesity are not present.
Proper exercise and diet are important for maintaining good health and proper weight. Extreme exercise can, however, lead to reduced sperm production in men and the cessation of ovulation in women by decreasing the brain message to the ovaries and testes. However, the amount of exercise must be very extensive; normal exercise will not affect fertility in most couples. It is impossible to know how much exercise for any one person is too much. Generally, running more than 1O miles per week is considered too much when trying to conceive. The most effective way to treat reproductive problems associated with excessive exercise is to decrease or modify the amount of exercise.
CONFIDENTIALITY
Please be assured that all services are provided in a completely discreet and confidential environment.
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