Fertility and Infertility

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Dr Ochi Igboko

If you are considering having a baby, you probably have wondered how long it will take to get pregnant, when to have sex, and how often. What to do if you can’t get pregnant. Find the answers to your questions here.

The Odds of Getting Pregnant.

It is a common question: What are the odds that I will get pregnant this month? For most couples trying to conceive, the odds that a woman will become pregnant are 15% to 25% in any particular month. But there are some factors that can affect your chance of getting pregnant:

Your Pre-Pregnancy Checklist:

  • Age. After you reach age 30, your chances of conceiving in any given month diminish, and they decrease as you age, dropping steeply in your 40s.
  • Irregular menstrual cycles. Having an irregular cycle makes it tricky to calculate when you are ovulating, thus making it difficult to know the ideal time to have sex.
  • Frequency of sex. The less often you have sex, the less likely you are to get pregnant.
  • Amount of time you’ve been trying to conceive. If you haven’t gotten pregnant after one year of trying to conceive, your chances of becoming pregnant may be lower. Talk to your doctor about tests for female and male infertility.
  • Illnesses or medical conditions can affect pregnancy.
  • Understanding Menstrual Cycles

    Knowing more about menstrual cycles may help. A woman’s cycle begins on the first day that she notice bright red blood– not just spotting — and it ends on the day before the next cycle begins. A cycle can take 21 to 35 days — or more. If her cycle varies in length by a few days from one month to the next, that’s considered irregular — and common. Many women don’t have regular cycles. It doesn’t necessarily mean anything is wrong.

    Having Sex, Getting Pregnant

    Here’s another common question from couples trying to conceive: How often should we have sex? In short, the answer is frequently. A lot of couples trying to conceive spend a lot of energy timing sex, with mathematical precision, to calculate when a woman is prime for ovulation. Theoretically, the approach makes sense. Recent studies have shown the window of opportunity for a sperm to fertilize an egg is pretty small: Essentially, it’s only the four to five days leading up to ovulation and the day of ovulation itself. Your best chances are on the day before and the day of ovulation. So, the key would seem to be to have sex frequently in that five- to six-day window.

    But while timing your lovemaking exclusively to those few days makes logical sense, it also has some drawbacks — primarily because your body doesn’t always behave with clockwork regularity. Even if your cycle is regular, ovulation can occur at any time during the cycle. If you are having sex on the day you think you are ovulating, and you are off by a few days, you may be out of luck. So the expert advice is to hedge your bets: Have sex at least two to three times every week. Studies have shown that as long as your partner has a normal sperm count, having sex every day of the month further increases your chances.

    Infertility – Treatment Options

    It is a myth that relaxing or ‘giving it time’ will overcome infertility. Fertility problems are medical in nature and can often be treated.
    Worldwide more than 3 million children have been born through in-vitro fertilization (IVF). Other treatments are successful too. At least half of couples who seek help will get pregnant.

    When should I seek help?

    Most couples should see a doctor after a year of trying to conceive. If a woman is over 35 years or has an irregular menstrual cycle, and has been trying for six months, it is better to see a doctor as soon as possible. Her partner should too.

    Common Problems in Men

    These include

    • Low sperm count
    • Poor sperm movement
    • Malshaped sperm
    • Blocked sperm duct
    • Erectile dysfunction

    Top Problems in Women

    • Ovaries do not release eggs regularly (hormonal imbalance)
    • Blocked fallopian tubes
    • Problems in the cervix or uterus

    Ovulation Problems

    If your doctor finds you do not ovulate normally, medication can help. The most common choice is clomiphene. About half of women who take it will get pregnant, averagely within three cycles. Beware that you are more likely to get pregnant with twins (or more) because it makes the ovaries release more than one egg at a time. Injectable hormones—if you don’t get pregnant after taking clomiphene for 3-6 months, your doctor may recommend fertility hormone shots to stimulate ovulation. About half of women who ovulate get pregnant pregnant after taking them. These medication can also make you carry twins or more.

    Blocked Fallopian Tubes

    In some women, scars prevent eggs from travelling down the fallopian tubes. It can happen if you have endometriosis or if you have had pelvic infections or surgeries in the past.Doctors can attempt to take out the scar tissue with surgery which will boost your chances of getting pregnant.

    Intra Uternie Insemination (IUI)

    This is an alternative to IVF. It is a popular procedure for many fertility problems. Doctors place the man’s sperm into the woman’s uterus, but not into the egg directly, while she ovulates. You may also need to take drugs to prompt your body to ovulate. IUI is less expensive and simpler than IVF, but pregnancy rates are much lower.

    Sperm Donations

    Fertile women can choose IUI using sperm from a donor. It may take several tries, but pregnancy rates are over 80%. You and your husband may need to see a counsellor first to make sure you are both ready to raise a child who is not biologically related to the father.

    In Vitro Fertilization (IVF)

    This option offers hope when other infertility treatments fail. It directly combines the egg and sperm in a lab. Doctors then place the growing embryos in the uterus. IVF can be unpleasant and expensive. Pregnancy rates per IVF cycle ranged from 10% for women aged 43-44 to 47% for women under 35.

    What is ICSI?

    Doctors can inject the sperm directly into the egg in a lab. This technique called ICSI (intracytoplasmic sperm injection), helps when a man’s sperm count is very low or his sperm don’t move well. When the fertilized egg is ready, it is implanted into the woman’s uterus through the normal IVF process.

    IVF with a Donor Egg

    Women who are over 40, have poor egg quality, or have not had success with previous cycles may consider an egg donor. This involves combining the man’s sperm with another woman’s donated eggs. If the procedure works, the woman becomes pregnant with a child who is biologically related to her partner but not herself.

    IVF Risks

    To increase the chances of success, it is common to transfer two or more embryos at a time. This means the woman may get pregnant with twins, triplets or even quadruplets. Carrying multiple babies increases the risk of miscarriage, anaemia, high blood pressure, and other complications during pregnancy. It also makes premature birth more likely.

    Donor Embryos

    If you have not had success with IVF or want a less expensive option, you might consider using donor embryos. These come from couples who have finished the process. The transfer costs less than the standard or donor egg IVF. If successful, the woman will get pregnant though the baby will not be biologically related to her or her partner.

    Surrogacy

    When a woman cannot carry her own pregnancy to term, some work with another woman who agrees to be a gestational surrogate. The doctor will use IVF to make embryos using a woman’s egg and her partner’s sperm. The surrogate is the one who goes through the pregnancy after the IVF. But her DNA is not involved. The baby will be the biological child of both husband and wife.

    Tips to Choose a Fertility Clinic

    Virtually all the procedures mentioned above are available in big cities in Nigeria. Ask plenty of questions about their procedures and costs. Make sure they offer the latest technologies and involve patients in decisions.

    Natural Remedies

    A few lifestyle changes can make a difference. If you smoke, quit. Smoking lowers fertility for men and women and dims pregnancy rates. In one study, men who stopped smoking saw their sperm count climb 800%. Also check your diet. Is it as healthy as possible? Some vitamins and minerals may improve the odds.

    Moving On

    If treatment becomes too heavy a burden-physically, emotionally, financially-it may be time to consider alternatives. An infertility counsellor will help you and your partner explore the options. Adoption is an option that should be considered.

About author

Dr Ochi Igboko

Consultant Anesthesiologist & Critical Care Physician. Email: drigboko@yahoo.com

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