General Info : Infertility
REPRODUCTIVE HEALTH
According to WHO (2006), Reproductive Health is described as a
      a state of complete physical, mental and social well-being, and not merely the absence of disease or 
       infirmity, in all matters relating to the reproductive system and its functions and processes through out
        lifespan.

Studies have shown that on a global scale, reproductive health is still difficult to attain with 20% of women and 16% of men having reproductive and sexual related ill-health (WHO, 2008). One of the major reproductive problems is INFERTILITY. 

RETHINKING - (IN)FERTILITY
Planning and preparing to have children can be an exciting process.  Individuals or couple often have some thoughts, images and expectations about what their family will be like, the number of children they will like to have and how they will like to raise the children.  
                         Fertility is, therefore, seen as a given!
While this assumption may come true for many people, a number of others tend to experience life without this 'GIVEN'. This percentage of people discover that life do put huddles in life journeys and expectations and that these huddles often threaten to change the course of fulfilling the assumed fundamental and natural process of life (i.e. having children). One of such life huddles is infertility. It is therefore important that we start rethinking the concepts of fertility and infertility.

WHAT IS INFERTILITY
Infertility is described as: 
     the inability to conceive after 2 years of unprotected vaginal sexual intercourse by a woman of 
        reproductive age. 
Infertility is one of the few life conditions that have the propensity to cast the shade of doubt and helplessness into all areas of human function. Though infertility has this over-powering impact on the people affected, it is not always at the fore front of health anxieties until the diagnosis is made or the couple attempt to have children and fail to conceive. 

The diagnosis of infertility often comes as a shock and downward spiralling challenge. Unlike other challenging life events, which may have a clear resolution, infertility is uniquely distressing because it can last for many years and the outcome is uncertain. Because fertility is commonly seen as a given, people tend not to pay attention to the things that can help or hinder their fertility ability. 

Types of Infertility
There are two forms of male or female infertility (sterility): 
  • Primary and 
  • Secondary. 
1. The primary infertility affects germ cell structure or physiology, causing arrest of germ cell development and ultimately cell death. The individuals affected by primary infertility will therefore not be able to produce sufficient viable sex cells for fertilisation thereby having difficulty in effecting conception at all.
  • Primary female infertility includes 
    • premature ovarian failure (POF),
    • polycystic ovary syndrome (PCOS), 
    • endometriosis, and 
    • leiomyoma (Fibroids). 
  • Primary male infertility disrupts spermatogenesis (sperm production) and is associated with abnormal semen such as: 
    • low or no sperm count, 
    • abnormal morphology (abnormal size and shape of the sperm cells. eg.  too big or too small head), or 
    • abnormal motility (sluggish movement, hence dying before they reach the egg). 
    • low or watery semen volume
    • abnormal vitality (percent alive)
2. Secondary infertility arises due to systemic or syndromic genetic defects. This means that the individuals affected by secondary infertility would have achieved conception before the defect occurred. The defect could be:
  • developmental, 
  • endocrine, and 
  • metabolic defects. 
Genetic syndromes that can manifest primary or secondary male or female infertility are:
    • Fragile X syndrome, 
    • Kartagener's syndrome, 
    • Myotonic dystrophy, 
    • Noonan syndrome, 
    • Fanconi anaemia, 
    • Sickle cell anaemia, 
    • β-thalassemia, etc
CHANCES OF CONCEPTION 
With regards to conception both naturally and assisted, age (of the woman) is found to be one of the crucial factors in determining the pregnancy success rate. 

For women under 40 years, statistics show that:
 Over 80% of couples in the general population will conceive within 1 year, if they do not use contraception and have regular sexual intercourse. Of those who do not conceive in the first year, about 50% of them will do so in the second year (cumulative pregnancy rate over 90%). This means that it is only about 10% of women under 40 years that will not conceive in the first two years of their having unprotected sexual intercourse. If they wish to have children, they will have to seek assisted conception route.

For people using assisted method such as artificial insemination to conceive, over 50% of the women will conceive within 6 cycles of intrauterine insemination (IUI). For those who do not conceive within 6 cycles of intrauterine insemination, about half of them will do so with a further 6 cycles (resulting to a cumulative pregnancy rate of over 75%). This means that only 2.5% of women will not conceive both naturally and assisted. This may be as a result of other medical problems which will need to be investigated and possibly diagnosed.

For women over 40 years, the statistics, however, starts to get complex because tend to make room for other factors to impact negatively on the fertility of the women. It, therefore, means that the earlier couples know their fertility status and work towards pregnancy, the better for them!

The Window of Fertility
The fertility window in a woman’s menstrual cycle is shown to be approximately 6 days within which pregnancy is possible. The 6 days consists of five days before ovulation through to the day of ovulation. This is because the lifespan of sperm is 5 days and the lifespan of the ovum is 24 hours (1 day). 

The fertility graph shows the percentage change of getting pregnant from six days before ovulation (-6) to the day of ovulation (0). If a woman has sexual intercourse six or more days before she ovulates, the chance she will get pregnant is virtually 0%. If she has sexual intercourse five days before she ovulates, her probability of pregnancy is about 10%.

The probability of pregnancy rises steadily until the two days before and including the day of ovulation where the chance doubles. These days are termed the most fertile days with 27-33% chance of becoming pregnant.

At the end of the ‘fertile window’, the probability of pregnancy declines rapidly and by 12-24 hours after she ovulates, the chance of getting pregnant during that cycle falls to 0%.

For those women who are not aware of their ‘fertile window’ or when they ovulate, sexual intercourse is recommended every 2 to 3 days to help optimise their chance of conceiving.
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