We have come across certain patients who have never had the opportunity of learning about the very basics of where babies come from.
Put very simply, life and eventually a baby is formed by the joining of the male seed (called spermatozoa) and the female seed (called an egg or ovum).
It is absolutely essential that you and your partner understand what the normal chances of conceiving really are, and equally important, how long it can take for a normal couple to conceive.
Definition of infertility
Infertility is defined as the failure of a couple to conceive after having regular sexual intercourse for a period of one year, this is reduced for female patient's 35 years and older to 6 months.
The first thing to realise from this definition is that it is dependent upon time, and secondly, that it is a relative description, not an absolute one. For example, even if a young couple conceives in the thirteenth month of trying, they will by definition, have been labelled infertile, even though they are now pregnant!
In simple terms, all that this definition says is that a specific (normal) percentage of people will have conceived within one year. However, this percentage of normal varies with the female partner's age, as can be seen from Figure 2.1.
Figure 2.1
Age range
(Years)
% Pregnant
per year
20-25
84%
26-30
74%
31-35
69%
36-40
59%
As you can see from Figure 2.1, approximately 73 - 74% of couples where the female is in the age range 20 - 30 years will have achieved conception after trying for one year. To take it one step further, about one-third of normal couples will conceive during their first three months of trying, and the remaining two-thirds during the next nine months.
What, then, is the importance of this definition of infertility? It acts purely as a guide, and the message it conveys is that if a couple who are apparently normal have not conceived after trying for one year (or 6 months if the female is 35 or older), then they should seek medical advice.
Normal women, especially over the age of 35 are faced with 2 problems. Further increases in female age, is associated with a more significant drop in their natural fertility and to compound this issue, there is an increased risk of miscarriage and congenital abnormalities. There is also a need for genetic counselling as risks of certain abnormalities, e.g. Down syndrome, increase with age. Yet age alone should not be a barrier to fertility. The one factor we are unable to assess is how long a woman will remain fertile, i.e. until her supply of eggs (ova) are used up. Thus a more aggressive approach to infertility is needed in an older woman.
