SEX WITHOUT PROBLEMS

Infertility

Most of us take our fertility for granted. We grew up with the understanding that we would have children of our own, easily and without major complications. For between 80% and 90% of couples that is the case. They achieve pregnancy anytime up to a year after stopping contraception.

For the others who are not so lucky and find they are infertile, this knowledge can have a profound effect on their lives. It effects relationships, involves an emotional and physical roller coaster and creates frustration. The family is the cornerstone of every culture. Couples faced with infertility and the absence of children in their lives are faced with major decisions.

What is The Need for Fertilisation?

For conception to occur naturally a woman has to release an egg (ovum) from her ovary. The egg then travels into the fallopian tube where it meets the sperm deposited by a man into the vagina during intercourse. For fertilisation to take place one of the 200-300 million sperm released by the man has to penetrate and fertilise the egg and the cells multiply to form an embryo. When the embryo reaches the uterus it will implant itself into the uterus lining.

To become pregnant a couple needs:

• A woman with the right hormonal balance
• Ovaries that are functioning
• Open fallopian tubes
• A healthy uterus
• A man with a good quality sperm count
• Intercourse at the fertile time of the month.

Natural conception is a team effort. Fertility-assisted conception just means that the team is bigger. Comprehensive infertility treatment is designed to maximise the chance of pregnancy by optimising all the conditions for conception. Treatment is specific for the individuals and requires experienced and specialised practitioners, specialized equipment and sometimes expense. Even then it may not all work. The success rate, that is, birth of a healthy baby, for IVF (in-vitro fertilisation) is from 15-25% and for GIFT (gamete intra-fallopian transfer) is marginally better at around 30%. Medical science is improving but around three out of every four couples who try medically-assisted fertilisation will end up disappointed.

The decision to not try again and accept life without children is a very personal one and some couples find the whole process overwhelming. The solution eventually may be to adopt but this is difficult due to a shortage of babies available for adoption.

What Causes Infertility?

• The man has to have a sufficient sperm count.
• Intercourse must occur two to three days before or at the time the woman ovulates.
• The woman has to develop and expel an egg (ovum) from one of her ovaries.
• The ovum has to go into the oviduct.
• Millions of sperm must swim by wriggling and twisting through the secretions of the cervix into the uterus.
• Hundreds of sperm have to survive the trip through the uterine cavity.
• Tens of sperm have to get into the oviduct opening and, against the current, swim along it.

The Problems of Infertility

Infertility

It is not uncommon for couples who thought they were infertile to seek out treatment and then find they just didn't have intercourse enough or at the right time to ensure pregnancy. Doctors normally advise couples to try for a year before seeking further specialised medical treatment for infertility.

The realisation of infertility is one that a couple arrives at slowly and it is important that one partner does not feel resentful of the other. It is just as important they realise exactly what they are going to need to do to achieve medically-assisted conception. Counselling from experts is a real help - on the nature of the testing, on the program to be followed, on the likely success or failure rate of the techniques used.

Infertility Treatment

This can sometimes be regarded as sex by a biological stopwatch. A woman may need to take her vaginal temperature every morning before she gets up and plot it on a graph to predict when she will ovulate. Blood tests and ultrasound scans have to be completed at the right time, injections have to be given at the right time and even sexual intercourse has to be done at the right time - right on cue.

For a working woman this can involve having a supportive employer or making the decision to leave her job. It can also involve the problem for some women - of seeing themselves as nothing other than a baby-making machine. For a man who is the source of the infertility it can be a challenge to his self-worth and his sexuality. Is he a lover, or a sperm-donor?

For both partners it can often reach crisis proportions because they are facing emotional and sexual issues they had not encountered before. The outcome of the relationship often depends on how strong or supportive it was before infertility was discovered.

What can Prevent Fertilisation?

The Woman

A woman may not conceive because she has a blocked oviduct. The oviducts need to be open so that sperm can swim along them to reach the ovum. If the oviducts are blocked, surgery can occasionally be used to cut out the block and rejoin the functioning parts of the oviducts. The success rate, judged in terms of whether the woman can then give birth to a child, is less than 20%. IVF can offer other chances.

A woman may not conceive because she does not ovulate. Women who do not ovulate at all or only an occasional basis account for a small percentage of infertility cases. A doctor can often help by prescribing 'fertility pills' or injections.

The Man

Problems in the man's body account for about 33% of infertility cases. In most of these situations it is because the man has few or no sperm. The quality and quantity of the sperm can be easily tested. At home or in a clinic a man masturbates into a jar and if laboratory tests show poor quality sperm or no sperm at all the test is repeated. A blood test is also taken.

If the man has no sperm or a very low sperm count nothing can be done. If the semen is of poor quality the chances of conception may be improved by only having intercourse at the most fertile times of the month.

Sperm Count

The first step to counter any fertility problem is to have a sperm count. A man usually refrains from ejaculation for at least three days then masturbates to produce semen. A laboratory tests the semen for the number of sperm and motility (how well they can swim) and if the result is poor another test is ordered, to verify the result. A blood test is taken as a back up.

If the result shows good quality sperm, the couple then knows that the man's body is functioning correctly. IVF or In-Vitro Fertilisation, in practice, means - 'fertilisation outside the body'. Because of media coverage in the past few years this is probably the best known technique for countering infertility. IVF is a by-pass of the fallopian tubes. It involves collecting the woman's eggs from her ovaries, mixing them in a glass container with the man's sperm and then waiting for fertilisation. If fertilisation occurs the cells multiply over the space of a few days and are then inserted into the woman's uterus to develop as usual.

GIFT

This is a technique to get the sperm and the egg together, if the woman has at least one healthy fallopian tube. The man produces the sperm which are examined and 'washed' by a laboratory technician to energise them. In the operating theatre the woman is put under a general anesthetic and a laproscope (a very slim tube with a camera attachment) is inserted through her navel into her abdomen. When the ovaries are located, eggs are collected through a suction tube. These are then mixed with the sperm and the resultant mixture is injected back into the woman's fallopian tube for fertilisation to occur.

Artificial Insemination

This is called AID - artificial insemination by a donor. The procedure is simple. The woman establishes exactly when she is ovulating and makes arrangements to go the fertility clinic that day. She will be there for just over an hour. The clinic will have frozen sperm available or else a donor will provide fresh sperm by masturbating.

At the time of ovulation sperm is injected into the woman's cervix and the process is repeated the next day. Statistics show that if AID is used on three successive months, 50% of the woman who are inseminated will become pregnant. There are strict rules about AID. The donor must not know who receives his sperm and the husband and wife must not be told who donated the sperm. However, in some clinics information is kept to allow a child from a donor insemination to trace its genetic father when it reaches adolescence. The donor is medically tested to ensure he is healthy and disease-free.