Many couples, when deciding to start trying for a child, expect a quick result. When pregnancy tests do not show the coveted two lines for several months, the first concerns arise. This is not always a cause for concern. Most women will get pregnant within the first year of trying, having regular intercourse and not using contraceptives. However, if the waiting period for pregnancy is prolonged, it is worth checking what is causing the problems. We asked an expert, Dr. Joanna Figula, deputy medical director at ARTVIMED Clinic in Cracow, about the most common fertility disorders.
Decreased ovarian reserve
In women, one of the most important factors affecting fertility is age. Therefore, the earlier we start thinking about offspring – the better. As time passes, the number of normal ova decreases, and their availability is crucial to the possibility of pregnancy. Therefore, women who are concerned about their fertility in the first stage are advised to test the level of the hormone AMH. The result, combined with ultrasound evaluation, allows to determine the level of ovarian reserve, that is, to answer the question of a woman’s reproductive potential. Statistically, a girl coming into the world has about 2 million primary ovarian follicles, when she begins to mature – there are already about. 200-400 thousand – this is the ovarian reserve. During a woman’s lifetime, less than 400 primary follicles will transform into a mature egg cell. It follows that ovarian reserve decreases with age, and with it also the chances of conceiving a child.
Hormonal disorders
The length and regularity of menstrual periods is another aspect to look for disorders. A normal menstrual cycle should last between 21 and 35 days. During this time, many mechanisms are activated that affect the possibility of conceiving a child. Deviations from the norm observed by a woman, including, in particular, a significant shortening or lengthening of the cycle, large irregularities, intra-cyclic spotting, may signal a problem. Usually, they are due to abnormal hormonal balance, and thus are associated with disturbances in the process of ovulation and the normal growth of the endometrium. There can be many reasons for this situation: thyroid disease, PCOS, luteal phase disorders (very rare), obesity and related diseases, and even taking certain medications. In any case, it is worthwhile to consult a specialist and perform tests.
Endometriosis
Severe pains during menstruation and during intercourse should also give you food for thought. They may indicate the development of pelvic flooding conditions or endometriosis, which is a hormonal-immune disease. It affects up to 10% of the population of women of reproductive age and very often goes undiagnosed for many years. It involves abnormal growth of the endometrium and its presence in the abdominal cavity. Endometrial cells produce mediators (chemicals) that significantly adversely affect the process of ovulation, fertilization and the subsequent implantation of the embryo in the uterine cavity.
Complications after procedures and diseases
Some diseases and medical procedures can consequently lead to reduced fertility. Surgical procedures performed in the abdominal cavity of women can lead to the formation of adhesions, for example, in the area of the fallopian tubes. Such changes can prevent the egg and sperm from joining. To make a diagnosis, it may be necessary to perform an ultrasound with contrast and, if in doubt, a diagnostic laparoscopy. In cases of severe abnormalities (such as obstruction of the fallopian tubes), the doctor may refer for in vitro fertilization surgery. In men, abnormalities occur due to a difficult course of diseases such as mumps while still young.
Fertility disorders related to body weight and lifestyle
Many couples underestimate the impact of lifestyle and overall body condition on fertility. Meanwhile, it is quite common to be overweight and obese, as well as underweight, which can significantly reduce the chances of getting pregnant quickly. In numerous cases, abnormal body weight is accompanied by hormonal disorders. The most common method of determining normal body weight is to calculate the BMI, based on the proportion of a person’s weight to height. It is considered that the appropriate value of BMI varies between 18.5 and 24.5. A growing number of serious scientific works prove that reduced fertility is also related to an unhygienic lifestyle, lack of physical activity, use of stimulants, chronic stress. This applies equally to women and men. Proper habits should definitely be taken care of during the period of striving, or even a few months beforehand.
The male factor in infertility
In more than 35% of cases, the cause of problems in getting pregnant is the so-called male factor. For various reasons, temporarily or permanently, the partner’s semen has abnormal parameters (including the number of sperm, their motility and normal structure, the volume of the ejaculate). The problem can be related to the abnormal lifestyle mentioned above, obesity, systemic diseases, exposure to toxic agents, but also, for example, childhood diseases such as mumps (salivary gland inflammation), which as a complication can cause testicular inflammation, leading in some cases to permanent infertility. Typically, abnormalities also appear in oncology patients undergoing radio- or chemotherapy. It is worthwhile to perform a semen test to determine the quality and quantity of sperm, and thus assess fertility. If necessary, medicine knows solutions to achieve pregnancy.
One of the reasons for difficulties in getting pregnant can also be an abnormal reaction of the woman’s immune system to her partner’s semen. The antibodies produced then destroy sperm and prevent fertilization. This is then referred to as “hostile mucus syndrome. To confirm the diagnosis, it is usually recommended to perform a test after intercourse – such tests are implemented in infertility clinics.
Diagnosis is key
For the success of further proceedings, whether spontaneous or medically assisted efforts, the most important thing is the correct diagnosis of the causes of the difficulties in conceiving a child. It may be worthwhile to continue natural attempts, but in some cases properly tailored treatment will be indicated. For this reason, if pregnancy does not occur for a long time, it is worth considering testing – in a woman, the first step is hormonal diagnosis (including AMH) and ultrasound with assessment of the reproductive organs (including the number of antral follicles, AFC), while in a man, a semen test. Based on this, the doctor will be able to determine whether additional tests are needed and what steps should be taken for the couple to live to see their desired offspring.