Understanding Infertility

What is Infertility?

Infertility is when a couple is unable to conceive after a year of regular, unprotected intercourse. It’s a challenge that affects many couples and can touch every aspect of their lives.

The World Health Organisation (WHO) recognises infertility as a public health issue that impacts not just individuals and couples but also communities and societies. Various factors contribute to infertility, including:

• Medical conditions: such as polycystic ovary syndrome (PCOS) and endometriosis in women, or low sperm count or quality in men.
• Lifestyle choices: like smoking and excessive alcohol consumption.
• Environmental factors: and age.

Reproductive medicine has made incredible progress, with treatments like in vitro fertilisation (IVF) and other forms of assisted reproductive technology (ART) offering hope to many. However, these treatments can be expensive, and their availability may vary depending on where you live and the legal or ethical guidelines in place. This can affect how common and successful these treatments are across different regions.

The Basics of Human Reproduction

Understanding fertility starts with knowing how human reproduction works. For conception to happen, both partners need to be in good health.

For women, this means producing healthy egg cells (oocytes) that can travel through the fallopian tubes where they may meet sperm for fertilisation. For men, fertility depends on the quantity and quality of sperm. Healthy sperm need to be in the right shape, able to move well, and in sufficient numbers to fertilise an egg.

A woman’s reproductive system also needs to be ready. This includes not just healthy ovaries but also open fallopian tubes, a well-prepared uterine lining for the embryo to implant, and a balanced hormonal environment to support these processes. All these factors come together to create the best chance for fertilisation and early embryo development.

Timing for Conception

Conception is all about timing. It happens when an egg is released from the ovary during ovulation and meets sperm in the fallopian tube. This is the window when pregnancy is most likely. Having intercourse around this time increases the chances of fertilisation.

The fertile window typically spans a couple of days before and after ovulation. During this time, the body makes it easier for sperm to reach the egg by producing thinner, more slippery cervical mucus and adjusting the cervix’s position. Sperm can survive in the female reproductive system for up to five days, so even if intercourse doesn’t happen exactly at ovulation, it’s still possible for fertilisation to occur.

The egg, once released, only lives for about 24 hours. If it isn’t fertilised within this time, it disintegrates. Understanding this cycle is important for couples trying to conceive and is also crucial when considering assisted reproductive technologies, where timing is carefully managed.

The Role of Hormones in Fertility

Hormones are the body’s messengers that control reproductive functions for both men and women. They manage everything from egg development to the timing of ovulation.

In women, a complex balance of hormones triggers the growth and release of an egg each cycle. If this balance is off, it can lead to problems with ovulation, which is a common cause of infertility. Conditions like thyroid disorders, high levels of prolactin, or polycystic ovary syndrome (PCOS) can disrupt this hormonal balance.

For men, hormones like testosterone are essential for producing sperm and maintaining libido. If these hormones are out of balance, it can affect sperm count, movement, and shape, making it harder to conceive.

Treatments often involve medications that help restore hormonal balance and support normal reproductive functions. For women, this might mean drugs that stimulate the ovaries to produce and release eggs. These treatments are closely monitored to ensure they work in harmony with the body’s natural rhythms.

Understanding and managing hormonal health is key to treating infertility. By addressing these issues, doctors can help many couples move closer to their dream of starting a family.

Understanding Oocyte and Sperm Production

In Women

The process of egg (oocyte) production starts in the brain, where the hypothalamus signals the pituitary gland to release hormones that stimulate the ovaries. These hormones help follicles in the ovaries grow, each containing an immature egg.

As the follicles develop, they produce oestrogen, which prepares the uterus for pregnancy. When oestrogen levels reach a certain point, a surge in luteinising hormone (LH) triggers ovulation, where the egg is released from the dominant follicle and moves into the fallopian tube, where it waits to be fertilised.

In Men

Sperm production, or spermatogenesis, also begins in the brain, where the hypothalamus signals the pituitary gland to release hormones that stimulate the testes to produce sperm and testosterone.

Sperm mature in the epididymis and are stored until ejaculation. During ejaculation, sperm are mixed with seminal fluid to form semen, which travels through the male reproductive system and is deposited in the female reproductive tract during intercourse. The goal is for the sperm to reach and fertilise the egg.

The Menstrual Cycle and Ovulation

The menstrual cycle is a series of changes that prepare a woman’s body for pregnancy each month. It typically lasts about 28 days, though it can vary. The cycle has several phases:

• Menstrual Phase (Days 1-5): The cycle begins with menstruation, where the uterus sheds its lining from the previous cycle.
• Follicular Phase (Days 6-14): After menstruation, hormones stimulate the growth of follicles in the ovaries, and one dominant follicle continues to develop, producing oestrogen to prepare the uterine lining.
• Ovulatory Phase (Around Day 14): A surge in LH triggers ovulation, where the mature egg is released from the ovary.
• Luteal Phase (Days 15-28): After ovulation, the empty follicle produces progesterone to further prepare the uterus for a potential pregnancy. If fertilisation doesn’t occur, hormone levels drop, and the cycle begins again.

Infertility Considerations

Infertility can be caused by a variety of factors and affects both men and women. It’s defined as the inability to get pregnant after one year of unprotected sex. Women who can get pregnant but have trouble staying pregnant may also be considered infertile.

Diagnosing Infertility

Diagnosing infertility involves a range of tests to understand what might be causing the issue:

For Women:

• Hormone Tests: Measure levels of hormones important for ovulation and ovarian health.
• Ultrasound: Checks the ovaries and uterus, looking for issues like fibroids or cysts.
• Hysterosalpingography (HSG): An X-ray test that checks if the fallopian tubes are open and if the uterine cavity is normal.
• Hysteroscopy: Uses a small telescope to look inside the uterus for abnormalities.
• Endometrial Biopsy: Tests a sample of the uterine lining for issues that might affect implantation or increase miscarriage risk.

For Men:

• Semen Analysis: Examines sperm count, movement, and shape to assess fertility.
• Sperm Antibody Test: Checks for antibodies that might affect sperm function.
• Sperm DNA Fragmentation Test: Evaluates the integrity of sperm DNA, which can affect embryo development and pregnancy success.

Understanding Fertility

Fertility clinics like Ferticentro offer treatments and support for individuals facing infertility. They provide advanced reproductive technologies such as IVF, Intrauterine Insemination (IUI), and fertility medications. They also offer counselling and support to help manage the emotional challenges of infertility.

Understanding the menstrual cycle and fertility is important for those trying to conceive or using it as a natural family planning method. For those facing difficulties, a deep understanding of these processes can help identify issues and guide treatment options.