Not Just the Woman’s Fault!
Unfortunately, most people have the mistaken impression that when a couple fails to bear children, it is usually the woman who is to blame. Well, here’s news. According to studies, about a third of infertility problems are due to female infertility, and another third are due to male infertility. In the remaining cases, infertility affects both partners or the cause is unclear.1 Infertility is a disease or condition that impairs the body’s ability to perform the basic function of reproduction. It is often diagnosed after a couple has not conceived after one year of unprotected, well-timed intercourse, or after six months if a woman is 35 or older.2
How Prevalent is Infertility?
In the past few years, the prevalence of infertility has increased due to a range of factors. It has been attributed to a tendency for women and partners to postpone childbearing. Studies show increasing obesity levels and a rise in sexually transmitted diseases, which leads to damaged reproductive organs3, have also affected the rates of infertility.
Causes of Infertility
In general, the source of the infertility problem is due to a female factor in approximately 40 percent of cases, and to a male factor in approximately 40 percent of cases, too. A combination of both partners having detectable abnormalities, or just due to unexplained causes, accounts for the remaining 20 percent of cases1. In women, hormonal imbalances are the most common cause of infertility in women, accounting for 25 percent of all infertility cases1, 4 Complications from pelvic inflammatory disease due to viral or bacterial infections or sexually transmitted diseases, and from endometriosis, can also make it difficult to conceive.
On the other hand, Male fertility problems can often be attributed to a condition known as azoospermia, when no sperm cells are produced and oligospermia, where few sperm cells are produced. Sperm cells can be malformed or die before they can reach the egg5 Smoking and alcohol have been linked to early menopause in women and an effect on sperm quality in men.
Fertility Risk Factors
Many factors, including health and lifestyle choices, can impact fertility for men and women. Fertility declines with age for both men and women, but the decline is steeper for women. Sexually transmitted diseases such as chlamydia can cause infertility in men and women. Use of tobacco products is linked to infertility and can cause early menopause in women and sperm problems in men. Alcohol consumption may affect fertility and can increase the risk of miscarriage as well as affecting sperm quality. Some prescription drugs can decrease a couple’s chances of conceiving and cancer treatments can also cause infertility
Burden of infertility
Infertility is a medical condition that has many emotional aspects. Feelings such as anger, sadness and guilt are common and may affect self-esteem and self-image leading to isolation among involuntarily childless people. Prior to and during treatment this often takes the form of depression, sexual and emotional anxiety and relationship problems with partner, family and friends
Treatment Options and ART Outcomes
It is important for couples experiencing fertility problems to see an infertility specialist, or in some cases an obstetrician/gynecologist, or urologist, for a complete fertility assessment and discussion of treatment options. Most infertility cases – 85-90% – are treated with conventional therapies, such as drug treatment or surgical repair of reproductive organs.
Dr. Loh Seong Feei, Medical Director at the Thomson Fertility Centre, and former head of the KK Women’s and Children’s Hospital Reproductive Medicine Department, collected data from 3200 IVF treatment cycles, and he said women aged 21 to 35 were more successful in conceiving, with about one in two treatments leading to pregnancy. He added the success rate falls to about one in three for 35-40 years old group and only one in 10 women aged 41 and above. He advises, “A couple who have not conceived after a year of unprotected, well-timed intercourse should seek medical help early if they want children.”
Simplified Fertility Injections
Good news for infertile couples going for In-Vitro Fertilisation (IVF) treatment. In May, MSD launched ELONVA® (corifollitropin alfa injection) in Singapore. Now, a single injection of the recommended dose of corifollitropin alfa injection may replace the first seven injections of any conventional treatment cycle. Simplified fertility treatment with Elonva will not only help to reduce the emotional and physical burden of fertility, it may also reduce dropout rates and potentially improve the overall chances of pregnancy. This could also encourage more infertile couple to embark on treatment earlier when the wife’s age is younger and ovarian reserves better.
Ms Chloe Lau, 34, went through two successful IVF treatments, and gave birth to three children – 5 year old Sophia and four-year-old twins Amanda and Laurence. However, she wishes she had taken Elonva though. She said she really dreaded the daily injections she had to have. These injections were administered by her husband, but she remembers him pushing the needle once too deep, and it was painful and she had a big bruise for a week.
Elonva enables one single injection to replace the conventional seven injections of treatment cycle. This makes the IVF process simpler, less stressful and more convenient.
Fast Facts On Fertility
• A woman’s fertility peaks in her mid-twenties and drops off dramatically after age 35 6,7
• Men older than 40 may be less fertile than younger men8
• One in six couples has problems conceiving9
• One in 25 men has a low sperm count and one in 35 is sterile1
1Fact file – Infertility. ABC Health & Wellbeing. http://www.abc.net.au/health/library/stories/2007/05/30/1919840.htm Accessed October 19, 2011.
2Definitions of infertility and recurrent pregnancy loss. American Society for Reproductive Medicine Web site. http://www.asrm.org/Media/Practice/Definitions_of_infertility.pdf Accessed October 19, 2011.
3Ledger WL Demographics of Infertility. Reprod Biomed Online, 2009: 18 Suppl 2: 11-4.
4Infertility: An Overview. A Guide for Patients. American Society for Reproductive Medicine, 2003. http://www.asrm.org/Patients/patientbooklets/infertility_overview.pdf Accessed October 19, 2011.
5Frequently Asked Questions About Infertility. American Society for Reproductive Medicine Web site. http://www.asrm.org/Patients/faqs.html Accessed October 19, 2011.
6Infertility. WomensHealth.gov Web site. http://www.womenshealth.gov/faq/infertility.htm Accessed October 19, 2011.
7Patient Fact Sheet. Reproductive Aging in Women. American Society for Reproductive Medicine Web site. http://www.asrm.org/Patients/FactSheets/reproaging.pdf Accessed October 19, 2011.
8Infertility. Mayo Clinic Web site http://www.mayoclinic.com/health/infertility/DS00310/DSECTION=3. Accessed October 19, 2011.
9Psychosocial Aspects of Infertility. British Fertility Society Factsheet, February 2005. http://www.britishfertilitysociety.org.uk/public/factsheets/docs/BFS-psychosocial%20aspects%20of%20infertility.pdf Accessed October 19, 2011.