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Infertility: What are the causes?

Mr Amit Shah,Mr Anil Gudi and Prof Roy homburg

How long does it take to conceive for normal healthy couples of fertile age who are having regular intercourse? About 50-60% will be pregnant within 6 months, 85% at 12 months and 94% at 24 months, without requiring any treatment. For pregnancy to occur, one sperm must meet and penetrate (fertilise) a healthy egg which then continues its journey through the tube to the cavity of the uterus where it is absorbed into the lining of the uterus and starts to grow from an embryo to a foetus.

For this to happen the sperm must be active and in sufficient numbers, the egg capable of being fertilised, the pathway of the egg from the ovary into the tube and onward must be open and normal and the same applies for the sperm coming in the opposite direction. In addition, the timing must also be right; if there are no sperm around the time of ovulation or plenty of sperm but well before or after the release of the egg from the ovary, these timings will not produce a pregnancy.

From this, we can divide the causes of infertility into three very general groups: a sperm problem, a problem with ovulation and a “mechanical” problem. The commonest of these is probably a deficient sperm count, often accompanied by decreased mobility and abnormal looking sperm. Absent or infrequent ovulation will obviously not produce an available egg and mechanical reasons include blocked tubes, usually following infection or an operation in the pelvic region. The biological age of the eggs in the ovary is critical and advancing maternal age (from about 37 years onwards) sees a downward slope in the chances of conceiving.

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