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The
time period is arbitrary. It relates to the natural
rates of conception, i.e. 80% of couples will be pregnant
after 12 cycles. Of those who have not conceived after
12 cycles, about 50% will conceive during the second
year of attempted conception. After this second year
of attempted conception, the chances of conception in
those couples remaining are about 50% in the following
four years.
Women with primary infertility are twice as likely to
obtain treatment as those with secondary infertility.
A male factor is responsible for a couple’s infertility
in about 25% of cases. In the last 50 years there has
been a documented fall in sperm concentration.
About half of couples with infertility eventually conceive.
Young age, a relatively short period of infertility,
and the absence of factors such as bilateral tubal obstruction,
azoospermia and prolonged amenorrhoea increase the chances
of success.
Three per cent of couples with unexplained infertility
conceive each month independently of treatment.
Investigations
may include:
* History and examination of both partners
* Semen analysis
* Assessment of ovulation; other methods include basal
body temperature, endometrial biopsy
* Other hormonal tests — LH, FSH, TFT’s,
testosterone, DHEA, sex hormone binding globulin, PRL
— performed on day 2, 3 or 4 of the cycle
* Assessment of cervical compatibility — post-coital
test, mucus invasion test
*Assessment of tubal patency, laparoscopy
*Assessment of pelvic adhesions, endometriosis - laparoscopy
* Rubella status — this should be checked prior
to the commencement of any treatment; if a patient is
non-immune then they should be vaccinated and advised
to avoid pregnancy for 3 months.
* People who are concerned about their fertility should
be informed that about 84% of couples in the general
population will conceive within one year if they do
not use contraception and have regular sexual intercourse.
Of those who do not conceive in the first year, about
half will do so in the second year.
Many of the causes of infertility are unpreventable.
But, sometimes you can take preventive measures to optimize
your fertility. Some of these methods for prevention
include:
* Quit smoking.
* Avoid exposure to chemicals and environmental toxins.
* Limit sexual partners and practise safe sex to avoid
STDs.
* Keep your body weight in check, manage your weight
if you are obese or severely underweight.
* Keep in shape.
* Get treatment for any conditions that may affect fertility
such as diabetes, endometriosis, asthma, and polycystic
ovarian syndrome.
* Avoid the use of all illegal substances/drugs
You
can increase your ability to conceive by having sex
during the fertile time in your cycle, ovulation, by
not using protection, and by keeping in top shape during
conception, including exercise and healthy nutrition.
This goes for both you and your partner.
Treatment
Artificial insemination, also known as intrauterine
insemination, is the process of injecting a woman with
carefully prepared sperm from her partner, or sperm
from a donor. Artificial insemination is used in cases
of unexplained infertility, or when a male has minimal
amounts of sperm present in his semen, or has other
sperm difficulties such as motility issues, or genetic
problems. Artificial insemination is used in conjunction
with ovulation drugs to optimize the chance for fertilization.
It should only be recommended after full tests have
been performed on the woman to check for any structural
problems, infection or hormonal imbalances that may
affect fertilization and pregnancy.
Insemination involves monitoring ovulation through a
test kit, ultrasound, or blood tests, to identify the
best time to inject the ovulation drugs. The sperm may
be applied directly into the uterus or to the cervical
opening and released with a catheter passed through
a speculum at ovulation. The procedure involved in insemination
is relatively quick and painless. It is performed in
the doctor’s office, without anaesthesia, and
you are free to leave after it is performed.
If the insemination involves donor sperm, the sample
is tested for any diseases and prepared at the sperm
bank before it is sent to the doctor’s office
for insemination. You should be aware that often couples
who decide on donor insemination have conflicting emotions
about issues such as choosing a donor and whether to
tell the child conceived by the insemination.
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