By definition, failure to achieve pregnancy despite having sexual intercourse 2-3 times a week without any contraception for at least one year is called “infertility”. The incidence of infertility does not differ greatly between societies. About fifteen per cent of couples worldwide have to resort to assisted reproductive techniques due to infertility problems. While there may be reasons to explain the reason for not being able to conceive in large part of these couples, no pathology can be detected in approximately 10-12 per cent of them. These cases are called unexplained infertility.
In order to understand the causes of infertility and plan its treatment, it is necessary to understand how the reproductive cycle works in men and women and the mechanism of pregnancy.
“When do you plan to have children?” is the most common question many newly married couples face. In fact, this question is one of the first questions that newly married couples ask themselves. Many young couples dream of conceiving on their honeymoon, especially in couples with a traditional family structure where the woman does not work. In rural areas, where the child is important for the family’s livelihood and work, there are too many men and women to marry to have children. In societies like ours, where having a child is seen as a privilege and prestige, infertility is almost of vital importance. Another group consists of individuals who could not find time to get married due to the difficulties of working life but are considering getting married and having children as soon as they get older. The common mistake of all these individuals is that they think they can get pregnant whenever they want, maybe even on their honeymoon. In many movies and novels, the hero can conceive with a single relationship or a baby at any time, but in real life, this is not the case. When we consider a completely normal couple with no health problems, the probability of conceiving is only 25% during a single menstrual period, even if they have intercourse every day. This condition, which shows the couple’s fertility potential, is called “fecundity”. As an organism, a human is not a living thing with a very high reproductive potential. There are many reasons for this. Some eggs are not fertilized, and some cannot develop during the embryonic period even if they are fertilized. Pregnancy is a matter of luck in a sense. It is possible to compare this to Russian roulette roughly. It is impossible to predict which couple may or may not conceive in advance! The chance of achieving pregnancy, which is 25% in a single relationship, increases to 85% at the end of a year. In other words, 85 out of every 100 couples will be pregnant at the end of one year. The remaining 15 couples are faced with infertility. According to some authors, if there is no pregnancy at the end of the first year, it is not correct to say that the couple is infertile. For this, it is necessary to wait two years. Indeed, the pregnancy rate, which is 85% at the end of the first year, is around 92% at the end of the second year.
Many factors influence the chance of getting pregnant in a single menstrual cycle. Let’s examine these factors.
Woman’s Age: As the biological clock progresses, the woman’s chance of conceiving gradually decreases. The most important reason for this is the decrease in the number and quality of eggs in the ovaries with age. While the difference between the odds of conceiving a 20-year-old woman and a 21-year-old is not huge, this difference becomes more significant in the 30s.
Frequency of Sexual Intercourse: It is not correct to classify the frequency of sexual intercourse as normal or abnormal. What matters is the adequacy of the number of relationships, not the number or number of them. The optimum number for this is three intercourse per week.
Timing: Besides the frequency of sexual intercourse, the timing of the intercourse is also important. The intercourse to be entered on the days of ovulation will increase the probability of pregnancy.
Duration: How long the couple has wanted a child is an important point. The longer the lapse of time for couples trying to conceive, the less likely they are to achieve a successful pregnancy without medical assistance.
Pathology: The presence of pathology that may cause infertility also reduces the chance of pregnancy. The best examples of these are previous surgeries or endometriosis.
If a couple has a fertility problem, how does it affect the pregnancy? Being pregnant is under the influence of many factors. For example, in a couple consisting of a man with half the sperm count and a normal woman, the chance of pregnancy is reduced by half. This is not the case for every factor that affects pregnancy. For example, in cases where both tubes are blocked, the chance of pregnancy is almost non-existent. Similarly, it would be a great surprise for men who do not have sperm production in their testicles or whose ducts that carry sperm from the testicles to the outside world do not function to have children naturally. From this point of view, both men and women should be examined in detail in couples who apply to the doctor with the desire to have children. When there is a problem in both couples, the chance of pregnancy decreases not by the sum of these but by their multiplication. Suppose the human lifespan could be increased to 300-400 years, and egg production from the woman and sperm from the man could be produced during this period. In that case, almost all unexplained infertility cases could become pregnant. This is a phenomenon that demonstrates the importance of time in infertility. In cases of infertility, the possibility of pregnancy should be increased; this is only possible with medical treatment.
When to Worry, When to Go to The Doctor?
If you have had regular sexual intercourse every 2-3 days on the days that coincide with ovulation for more than a year and you have not been able to get pregnant even though you have not applied any contraception, you are in the infertile class. This does not mean that you can never conceive normally, but the chances are reduced statistically. Now you need medical help. There is no fixed time for this assistance. You should see a gynaecologist when not having a baby starts to worry you. Many couples see infertility as something to be ashamed of and feel lonely. However, the situation is not that bad. Many couples worldwide have the same problem; a significant portion of them can get pregnant with very simple treatments. Herein lies that infertility, which restricts couples, is always an important problem but not an emergency. People generally delay going to the doctor by hiding behind any excuse and always saying next month. However, it is possible to make up for everything in life except time.
In some cases, it is unnecessary to wait one year before applying to the doctor.
- Very frequent or infrequent periods,
- History of previous pelvic infection,
- More than two miscarriages,
- Women of advanced age,
- Small testicles in men,
- History of prostate infection.
If there is, it would be wise to seek professional help or advice immediately.
Before consulting a doctor, keep in mind that you can increase your reproductive potential with simple precautions. One of the most important of these measures is to provide a balance between body weight, diet and exercise. Proper diet and exercise are extremely important for optimal reproductive function. Underweight or obese women may have difficulties conceiving. Most of the female hormone estrogen is produced in the ovaries. However, adipose tissue is also a source of estrogen that cannot be underestimated. Fertilization is a complex event in which sensitive hormonal balances play a role. A stable hormonal status is necessary for this event to result in success. Therefore, it is not surprising that being under or overweight can cause infertility. Body weight 10-15% below or above normal can radically affect the reproductive system. The best example is the irregular menstrual bleeding in extremely thin people with nutritional disorders. These irregular bleedings usually accompany anovulation, that is, the absence of ovulation. Many women who engage in heavy sports, such as marathon runners and swimmers, have menstrual irregularities and thus infertility problems.
Another factor affecting fertility is smoking and alcohol. While smoking reduces the sperm count in men, it also impairs egg quality in women. Similarly, alcohol is a substance that has been found to play a negative role in sperm count.
Drugs used for different diseases also affect fertility. It is known that ulcer and blood pressure drugs affect sperm counts. Reducing caffeine intake increases the chances of conception.
The frequency of sexual intercourse is one of the most important factors affecting reproductive ability. The more frequent intercourse, the higher the chance of pregnancy. What is meant here is not an everyday relationship. This reduces the number and quality of sperm. The ideal is to have intercourse every other day on days close to ovulation. Today, a decrease in sexual motivation and desire is a common complaint of most couples due to the fact that both men and women are in working life, professional stresses and concerns. For these reasons, the relationship is mostly on weekends. Naturally, these couples will be delayed in achieving pregnancy, and most likely, the couple will have to consult a physician due to infertility.
The timing of the relationship, as well as the frequency, is extremely important. Except for humans, almost all living things know the spawning period. During this period, which is called the estrus period, their sexual desire increases and they mate. In fact, this feature of cats is the subject of many jokes. In humans, however, the situation is different. There is no obvious estrus in women, and many women do not notice their ovulation period. The woman’s menstrual cycle is determined with various methods, and the ovulation period can be determined. For this reason, every other day, intercourse is recommended during the period when the probability of conception is high, which is called the fertile period.
The final point regarding the link between sexual intercourse and fertility is to have intercourse appropriately. There are many different types of animals in nature, and each of them has developed different mechanisms to continue its lineage. For example, pigs are very stingy with sperm. The male’s penis is spiral-shaped and is screwed into the female’s vagina. In this way, not a single sperm is wasted. Such mechanisms do not exist in humans. In reality, there is no need for such techniques. It is perfectly normal for semen to escape from the vagina after intercourse. While many women interpret this as a negative factor in pregnancy chances, this is not true. The semen coming out is an indication that the relationship is done properly. It is the position where the man is on top, which is recommended for couples who want a child. Other suggestions are that the woman should lie on her back for at least 5 minutes after intercourse and avoid vaginal cleaning. Artificial substances used to provide lubrication during intercourse are not recommended as they can have a fatal effect on sperm. If necessary, liquid paraffin should be preferred instead of petroleum-based ones.
One of the reasons why infertility is more common than in the past is that women are more involved in working life. Most women are waiting for a rise in their job to have children, so they are getting older. Again, many employers, including very large holdings, impose a period of non-pregnancy restriction on female personnel they will hire. As time passes, the woman’s reproductive potential decreases; therefore, infertility is more common. There is no such thing as the best time to have a baby. A woman’s reproductive potential is at its peak between 20-30. This potential, which decreases after age 30, shows a sharp and rapid decline after age 35. The best time to have a baby is a highly personal decision. However, couples delaying or considering having a child for various reasons have another problem: social pressures. In almost every society, family elders tend to put pressure on having grandchildren as soon as possible. Articles in the media suggesting that couples have a baby as soon as possible are also a factor of pressure. With the effect of all these factors, newly married couples or couples who have been protected with effective long-term methods can visit a doctor just because the woman has reached the age of 30. However, they have not yet entered the infertility class.
Is Reproductive Potential Decreasing?
This question is one of the questions that both the physicians who are interested in and the couples who are directly related to the event seek the answer to. The answer is not definitive, but probably the proposition is true. The increase in the age of marriage for women, the increase in the rates of sexually transmitted diseases with sexual freedom, and the global decrease in sperm count in men, although the reason is unknown, may be the reason for this situation. The decrease in sperm counts is an interesting global observation. Indeed, in the last 15-20 years, a decreasing trend in sperm counts has been observed worldwide. It is unclear whether this is due to environmental pollution or the stress of modern life. What is pleasing is the developments in assisted reproductive techniques and the resulting increased success rates, despite all the negativities on the reproductive potential. It is also remarkable progress that modern people have removed infertility from being taboo and consciously evaluated treatment alternatives.
You can visit our IVF Turkey page to get detailed information about IVF treatment and how the processes work in Turkey.
REFERENCES:
https://pubmed.ncbi.nlm.nih.gov/25769434/
https://pubmed.ncbi.nlm.nih.gov/23768623/
https://pubmed.ncbi.nlm.nih.gov/26986742/
