What does infertility mean?
So how do we define infertility? How long should it take to get pregnant? For the reasons highlighted above it is perhaps best to avoid using a time-scale as the sole factor to define fertility problems. It would be more relevant for you to consider with your GP your particular circumstances. In research studies often a cut- off time of attempting to conceive for a year or two is used to define infertility.
How common is infertility?
Research shows that about 14 per cent of women experience infertility: failure to conceive within two years. However, this statistic might be slightly misleading since around half of these women subsequently go on to have a child. Perhaps what is surprising, given the current climate of much media attention being given to the subject of fertility and fertility treatment, research has shown that only half of these women seek any medical advice. Interesting too is the fact that, of those who went on to conceive, just as many had not had any medical advice as those who had. Perhaps this is a further reason not to rush into seeking medical help. Other research has shown that the pattern of seeking help is changing very rapidly. In the past 25 years far more women and men are now seeking help for fertility-related issues.
What causes infertility?
A discussion of the causes of infertility is really beyond the scope of this book. Avast array of different aspects of the process of conception can be to blame: for women there may be problems with ovulation, a previous ectopic pregnancy or an infection may have damaged the fallopian tube. For men, a range of issues to do with the quantity and motility of the sperm may be relevant. These types of problems are termed primary fertility problems. However, it is interesting to highlight that some of the reasons for not conceiving are not simply a 'technical' fault of the reproductive system or primary infertility, some of the reasons stem from a complicated mixture of physical and psychological reasons.These problems are termed secondary infertility.
Primary problems lend themselves to investigation but sometimes no physical problems can be identified and a sizeable group of people have what is termed 'unexplained' infertility. Clearly, the psychological costs of such a diagnosis are high. Sometimes the causes of infertility can be directly due to other problems, illnesses or drug treatments. Sometimes you will have been directly informed of these risks, e.g. that a particular type of medication causes impotence. However, other problems may be hidden: a previous history of anorexia nervosa can lead to fertility problems but if the eating problems were never recognised in the past, then this reason may not be apparent. Other more subtle influences on fertility are drinking and smoking which are clearly factors that can be changed.
Often the inability to conceive is related to sexual difficulties. There are probably no problems relating to actual conception but the relationship is either not consummated or intercourse is rare. These clearly are problems of conception but the solutions are very different.
Ali and Maria's story
Ali and Maria came to see me for help with relationship problems. They had been married for nearly a year but the relationship did not appear to be consummated. Maria had been studying in England when she met Ali and had come from Greece to live permanently here when they married.. Ali was Algerian and the couple communicated in English although it was not their first language. Communication was undoubtedly difficult and the couple seemed unable to make the other understand how they felt. Ali desperately wanted children and was sure that Maria did too. Consequently Ali was perplexed by their inability to have a full sexual relationship. Maria, however, appeared much more ambivalent about everything. In marrying Ali she had left her family and her home and had given up her studying to work in a restaurant. Ali ran the restaurant and organised when Maria would be working. When Ali was working, she mostly sat at home alone in their flat and had made few friends. She said she had planned to be a teacher and was not worried about when children came along since she was still very young.
Sadly, Ali and Maria's marriage did not survive these problems. Maria returned home to her mother for a holiday and failed to return. Ali began to look into having the marriage annulled.
The solutions to these types of 'fertility' problems are complicated and need a different type of assessment by someone specialising in sexual problems. There may be underlying issues such as childhood sexual abuse or intense anxiety concerning sexuality Very often issues are to do with power and control within relationships. For Maria, avoiding sex meant avoiding children in a situation where she felt unable to articulate her own views and needs.
Christine and Kevin's story
Christine and Kevin had been happily married for five years and were in a secure position financially and both wanted to have a family. Christine said that both sets of parents were eagerly awaiting the announcement of a pregnancy. In fact, Christine's mother had tentatively asked her if there were 'any problems' and said that 'at 33 she shouldn't waste too much time'. Christine came for help because she had never managed to have intercourse with her husband. She said that they were both fully happy with their sexual relationship as it was but they did want to have children. Christine was also actively perusing fertility treatment through the private sector, as she didn't really feel her sexual difficulties were likely to change.
What help is available?
If you are desperate to be pregnant, are in your late thirties and have been trying for many months, then you may feel that you have 'no time to lose' in terms of investigating whether or not there is a problem. However, there are costs to entering the realms of testing. Any type of testing brings with it the risk of 'false positives', that is, a problem may be identified, for example, a man may be told he has a low sperm count, which may in fact not prove to be significant at all. However, being told that you have a 'low sperm count' may have powerful effects on your self-esteem, on your relationship, and particularly on your sexual relationship. Taking any form of testing turns the situation into a 'problem' and may exert unwanted pressure on your sexual relationship. These factors need to be balanced against the realities of your personal situation: your age and your medical history, for example.
Your GP is undoubtedly the best person to approach in the first instance. Although there is a vast array of services available privately, an initial contact with your GP should help you to identify whether you need to embark upon any further testing and intervention. Once the process is set in motion there is a wide array of treatments available depending on what the specific problems are.
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