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When you are struggling to have a baby

By Faeza
30 June 2016

STATISTICS say one in seven couples have problems conceiving a baby. While some may eventually have children and make their dreams come true, others can end up depressed and their relationships strained. It is important to understand the causes and treatments that are available for infertility. Embryologist, Cecile Booyse and Gynaecologist and Obstetrician Doctor Helen Lyndeque speak to Move! about the causes of infertility.

WHAT IS INFERTILITY?

According to women’s reproduction health experts, infertility means not being able to get pregnant after trying for a long time. They further state that if a woman keeps having miscarriages it is also called infertility. About 15 percent of South African couples experience fertility problems. Dr Booyse says infertility is the term used for women who are unable to get pregnant and for men who are unable to impregnate a woman

after trying for at least one year. She also states that usually 60 percent of couples will be pregnant after trying for about a year. “Women who are able to get pregnant, but who cannot carry a pregnancy to term may also be considered infertile,” she says.

CAUSES OF INFERTILITY

According to Dr Booyse, the causes of infertility include a wide range of physical as well as emotional factors. She argues that there are several main causes of infertility. “Male factors include retrograde ejaculation, impotence, hormone deficiency, environmental pollutants, scarring from sexually transmitted disease, or decreased sperm count. In women the problem could stem from blocked fallopian tubes, endometriosis, ovulation

dysfunction, or failure to ovulate and fibroids,” she says. Dr Booyse says that a woman’s

peak fertility occurs in her early 20s. “When a woman is older than 35 (and particularly over 40), her likelihood of getting pregnant drops to less than 10 percent per month,” she says. Dr Lyndeque adds that other factors that contribute to infertility are having multiple sexual partners, sexually transmitted diseases, someone with a history of pelvic inflammatory disease. “Among men, a history of orchitis or epididymitis and mumps,

varicocele as well as eating disorders contribute to infertility,” he says. He also argues that anovulatory menstrual cycles, endometriosis, defects of the uterus (myomas) or cervical obstruction and long-term chronic diseases such as diabetes are other factors."

TESTS AND TREATMENTS

Dr Booyse says that if you have been trying to conceive for at least one year with no luck, you should consult a specialist. “A complete history and physical examination of both partners is essential," he says. "Tests may include semen analysis to determine volume and

viscosity of semen and sperm count, motility, swimming speed, and shape (morphology). Also, measuring serum progesterone (a blood test) on day 22 to 24 of the cycle, conducting

a serum hormonal levels (blood tests) for either or both partners as well as conducting hysterosalpingography, an X-ray procedure that looks at the route of the sperm from the cervix through to the uterus and fallopian tubes can be used to investigate the problem."

Dr Lyndeque says there are a variety of ways to treat infertility, including medication, surgery, ntrauterine insemination or artificial insemination, assisted reproductive technology (ART), such as in vitro fertilisation. “Health care providers often treat infertility with medication or surgical repair of the reproductive organs,” he explains. In addition, Dr Lyndeque argues that lifestyle changes may also help alleviate infertility, such as reducing stress, diet modification, discontinuing the use of drugs, alcohol and smoking, or reducing the temperature around the testes. Too much caffeine intake can also worsen the situation.

PROGNOSIS

According to Dr Lyndeque, a cause for the infertility can be determined in about 85 to 90 percent of infertile couples cases. “Appropriate therapy, not including advanced techniques such as in vitro fertilisation, allows pregnancy to occur in 50 to 60

percent of previously infertile couples," he says. "Without any treatment intervention, 15 to 20 percent of couples previously diagnosed as infertile will eventually become pregnant,” adds the embryologist. In addition, Dr Booyse argues that when the woman does not have regular periods, it could mean that she is not ovulating.

“A doctor can be consulted when a woman has lost a baby three or more times through miscarriage, if the woman has had pelvic infections or the man has had mumps or a

prostate infection, as well as when a woman could not get pregnant with another partner,” she argues. Dr Lyndeque explains that most types of male infertility are not preventable. “However, avoiding drug and tobacco use and excessive alcohol consumption, which may contribute to male infertility, may help," he says. Furthermore, Dr Lyndeque cites high temperatures as something that can also affect sperm production and motility. "Although this effect is usually temporary, it is better to  avoid hot tubs and steam baths,” he explains.