We may experience period pain, irregular bleeding, genital infections, all kinds of gynaecological problems, and sometimes wonder why on earth we were made this way. There is a reason. Women can have babies. Well, most of them can. Unfortunately, some of them who want to can’t, and some of them who don’t want to do.
Fertility could be seen as the pay-off for all the trouble the uterus and its companions sometimes cause. Having witnessed the excitement and joy of new parents at the birth of a long-awaited baby, the negative aspects of uterus ownership pale into insignificance. However, making babies is not always straightforward. As with most finely tuned and delicate mechanisms, fertility has the potential to get in a real mess.
About 10 to 15 per cent of couples will suffer from infertility. In today’s environment of medical expertise and technology this is not as easily accepted as it was in our grandparents’ day. In the past an infertile couple either had no children, or adopted them. Now we have the technology to find out why some people are infertile, and often can attempt to correct the fault. Despite the great advances made in this area, some couples will still be unable to reproduce, no matter how many tests and procedures they are willing to endure.
On average the expected pregnancy rate in a fertile couple after one year of unprotected intercourse (using no contraception) is about 85 per cent. After two years it approaches 90 per cent. So young couples rushing off to the doctor, wondering why they are not pregnant after two months of unbridled passion, will most likely be told to go home and keep trying. If after one to two years of concerted effort there is still no product, it may be considered reasonable to investigate. There may be reasons for investigating an ‘older woman’, for example someone over 36 years, more promptly. Natural fertility tends to decline gradually with age. There may also be increased problems associated with having babies at an ‘older’ age. (Although most 36-year-old women may shudder to think of themselves as ‘old’, the fact is that in terms of reproduction, they are getting on in years.)
Infertility may be ‘primary’, that is, never been pregnant, or ‘secondary’, which means that a woman has been pregnant before, but has developed a problem since.
There are many steps that can go wrong along the way to baby production. There can be problems with hormones, ovulation, sperm, anatomy, transport of the egg or sperm or embryo, implantation, and many more. Any of the many delicately balanced mechanisms in either the male or the female may be faulty, and both partners need to be investigated.
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