What is the optimum age for a woman to conceive and why?
Women have the best chance of spontaneous conception between the ages of 20 and 25 as studies have shown that women in this age group have the maximum fertility rates.
How long does it take for a woman in her 20's, who has regular intercourse, to conceive? Is this period of time longer for women above 35?
As mentioned above, the fertility rates decline as a woman gets older. Therefore, the time to pregnancy is longer for older women. It is not possible to give an average time to pregnancy for any woman or age group but on an average, about 70% of women between the ages of 20-25 years get pregnant within 3 months of trying as opposed to only 40% in the 30-35 year age group. At 6 months these figures are 85% and 60% respectively and at the end of one year, these figures are 95% and 80% respectively.
When should a couple see a specialist if they still cannot conceive?
A couple should seek medical advice if they are unable to conceive within 1 year of unprotected regular intercourse. However, women who are more than 35 years of age should see a doctor if she does not get pregnant within 6 months because of their declining fertility rates. Ideally all women should have a pre-pregnancy check-up to ensure that there are no underlying problems that can impair their fertility. A pre-pregnancy check-up is highly recommended for women who are older than 35, women who do not have regular periods or who have had sexually transmitted or other pelvic infections or any pelvic surgery.
Does having multiple sex partners and an increased risk of infection affect your fertility? Is it possible to reserve the damage caused by the infection?
Multiple sexual partners can increase the risk of a woman having sexually transmitted infections. Not all of these infections produce symptoms so they may go unnoticed and untreated. These infections can damage the fallopian tubes resulting in tubal blockage and infertility or may affect the proper fucntioning of the tubes resulting in ectopic pregnancies.
Does taking birth control pills over a prolonged period of time affect your fertility? How long does it take for normal ovulation to resume?
Recent studies have suggested that contraceptive methods like some birth control pills for prolonged periods of time (more than 2 years) may have a transient delay in subsequent fertility and the time to conception. There may be a delay of about 3-4 months in the time to conception. This is probably due to a slight delay in resumption of normal ovulation. However there is no long-standing impact on fertility.
How do cysts and fibroids, irregular ovulation, blocked fallopian tubes and conditions like PCOS: Polycyctic ovarion Syndrom and endometriosis affect fertility?
Fibroids do not necessarily cause infertility. Large fibroids and those that cause distortion of the cavity of the womb cause tubal blockages or interference with the implantation of the embryo in the womb which results in infertility.
Release of the egg from the ovary (ovulation) is essential for conception as there can be no pregnancy without the egg. Polycystic ovarian disease is the most common cause of irregular ovulation. Patients with PCOS have a hormonal imbalance preventing the regular release of the egg from the ovary.
Fallopian tubes pick up the egg after it has been released from the ovary and it is in the tubes that the egg and sperm meet. Hence the tubes play an essential role in conception. If both the tubes are blocked, there can be no conception as the egg and sperm cannot meet.
The endometrium is the tissue that lines the inside of the womb (uterus). Endometriosis is a condition where the endometrium is also found in other areas of the body usually the ovaries or other areas in the pelvis (around the womb). It is not exactly known how endometriosis causes infertility, but there are several possible mechanisms.
- It may interfere with the function of the fallopian tubes
- It may distort the normal relationship of the ovary and tube resulting in an inability of the tube to pick-up the egg.
- It has been suggested that patients with endometriosis have certain chemicals present in their abdomen that can damage the egg.
- Endometriosis causes painful intercourse which may reduce the frequency of intercourse resulting in delays in conception.
A thorough gynaecological examination, blood tests and ultrasound scans can help diagnose these conditions.
What other medical conditions affect fertility? (e.g Thyroid problems)? How should these conditions be treated and can the patient still conceive?
Thyroid hormones affect ovulation and those with thyroid problems may have irregular periods and hence problems in conception. Thyroid problems can also result in miscarriages or pregnancy complications such as premature labour or growth retardation of the baby. Hence it is important to treat thyroid conditions and normalise the thyroid hormones prior to conception and throughout pregnancy. Medications that are safe in pregnancy can be used and monitoring of thyroid levels needs to be done regularly to ensure normal levels.
Is infertility hereditary?
Infertility may be passed on to their progeny in a small proportion of men and women. Among males, genetic conditions like Klinefelter syndrome or microdeletion in AFZ (azoospermia factor C) may be hereditary. Other conditions like cystic fibrosis may also cause infertility. While in the past these men were permanently infertile, with the advancement in artificial reproductive techniques, men with azoospermia may now become fathers. However, the infertility may still be passed on to the next generation. Among females, polycystic ovarian syndrome, which is an important cause of infertility, may be genetically inherited in some families.
Is it advisable for a patient to freeze her eggs if she doesn't wish to conceive yet? Why? Does your clinic offer this option?
While it is possible to freeze a woman's eggs for future use, very few pregnancies have been reported using this technique. This is usually because eggs are quite fragile and many do not survive the freezing process. Hence freezing of eggs to preserve fertility, if a woman wants to delay conception, is not used in clinical practice as yet.
Do prolonged periods of stress affect conception?
Psychological stress may reduce female reproductive performance There is, however, a lack of clear consensus as to the definition and measurement of ‘psychological stress' which makes the nature and strength of any association between stress and conception questionable.
How do habits like smoking and drinking affect fertility? What if you're just a light drinker or social smoker?
In males, smoking negatively affects sperm production. It results in a fall in sperm quantity as well as quality. In females, smoking results in a delay in conception. Constituents of cigarette smoke have been found to damage the eggs or reduce fertilisation and even cause miscarriages and other pregnancy complications. There is emerging evidence of the adverse effects of passive smoking on reproduction hence all forms of smoking are detrimental to fertility.
Does sperm allergy affect a woman's chances of conceiving? What are the solutions?
Antisperm antibodies which cause sperm allergy are a poor predictor of conception in natural cycles and hence should not be routinely tested in clinical practice.
Does high temperatures (e.g sitting in a sauna, working in a kitchen) affect fertility?
Increased scrotal temperature is closely associated with reduced semen quality in healthy populations. Wearing tight-fitting underwear, sedentary work position and occupational heat exposure can increase the testicular temperature and have shown to be associated with abnormal semen quality. However, the effect of impaired semen quality on pregnancy rates has not been established. There are no studies on the effect of sauna / kitchen work on female fertility.