What is infertility?
Although the terms sterility and infertility are often used synonymously, they actually mean different things. Infertility is the inability to carry out a pregnancy, as occurs in cases of recurrent abortions. Sterility is an absolute inability to become pregnant.
Infertility affects more than 20% of couples of reproductive age. One quarter of cases is considered to be due to a male factor, another quarter due to female factors, in one quarter the infertility is due to both partners. There remains a significant proportion of cases, where no reason for the infertility can be identified, unexplained infertility.
The best biological age for a woman to have children is between 20 and 30, however, today many women are having children between 30 and 40 years of age.
Each woman is born with a determined number of oocytes (1-2 million). The number is then continuously decreasing through atresia so to that at menarche about a quarter of these oocytes remain. At 35 years of age, approximately 10% of the eggs remain. The older the remaining eggs are, the worse their quality is.
Several studies from the 1990’s onward have suggested that semen quality in men is deteriorating. Several reasons may be causing the decrease of number of sperm in semen. Environmental changes have been offered as one explanation. The spermatogenic capacity is largely determined already during the pregnancy. Whereas the quality of semen appears to be deteriorating the actual decrease in male fertility is much more difficult to evaluate.
As a rule of thumb, if a couple is unable to achieve a pregnancy with 12 months of regular sexual intercourse principle, an evaluation by a gynecologist (or better yet an infertility specialist) it is recommended. Obviously, if a pre-existing condition is known to affect the fertility (endometriosis, fibroids, advanced age), the appropriate evaluation should be done with little delay, so that no valuable time is lost.
It is advisable to always consult a gynecologist who specializes in this topic. Infertility is one of the fields in medicine that has advanced the dramatically in recent years. Even the initial assessment of the couple is faster and more effective if it is carried out by a team of doctors dedicated exclusively to infertility issues.
