Infertility: understanding the emotions involved

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In today's world, it’s not uncommon for couples to plan their families meticulously, considering all factors and waiting until the time is just right to have a baby. One assumption in this planning is that the couple is fertile and that they will conceive shortly after they stop using birth control. For some couples, however, such is not the case.

Infertility is defined as a couple's inability to achieve conception after a year of unprotected intercourse (six months if the woman is over the age of 35) or the inability to carry a pregnancy to a live birth.

Physical factors affecting fertility

Many couples who experience infertility will have specific problems that cause their inability to conceive. In 40 per cent of cases, the problem is traced to the male; in another 40 per cent, the problem is identified with the female. In 10 per cent, both partners share the problem. The remaining 10 per cent is due to unknown causes.

Some of the factors that may affect a woman's inability to conceive include:

• Abnormal ovulation. Approximately 40 per cent of women who experience infertility have problems with their ovaries. This could be indicated by irregular or absent menstrual cycles, which can result from a hormonal imbalance. In these situations, consult with your doctor before trying to conceive. In many cases, this can be treated successfully with medications.

• Blocked fallopian tubes. Blocked or damaged fallopian tubes may impact fertility by interfering with the egg and sperm uniting, or with proper embryo development and implantation in the uterus. Often, there are no symptoms and the blockage is only discovered during an infertility evaluation. Treatment may require specialized surgery. 

• Endometriosis. This is a disease in which tissue from the uterus implants on the ovaries and other pelvic organs. Symptoms may include heavy, painful or long menstrual periods. Several forms of treatment are available, involving both medications and surgery.

• Cervical problems. Cervical problems may be related to the cervical environment, such as the consistency of the mucus as well as the anatomy. Both may impede conception.

Male factors affecting the couple's ability to conceive successfully include problems related to inadequate sperm count or abnormalities relating to the size, shape and movement of sperm. About 30 per cent to 50 per cent of male infertility relates to the presence of a varicocele, or varicose veins within the scrotum, which affects sperm quality and quantity. Testicular injuries, hormonal imbalances and other diseases such as diabetes mellitus, central nervous system problems and pituitary tumours can also affect fertility.

Fertility also decreases as age increases, especially in women. For women, maximum fertility occurs between the ages of 15 and 24. One out of three women who wait until their mid-30s to have children experience problems with fertility, which rises to one out of every two women who wait until their 40s.

Personal factors affecting infertility

Personal and lifestyle factors may impact fertility in both females and males. These may include:

• Diet and exercise. Proper diet and exercise are important for optimal reproductive functioning in both men and women. Women who are significantly under- or overweight may have difficulty getting pregnant.

• Smoking. Smoking may affect sperm count in men and may increase the risk of miscarriage in women. It may also contribute to premature birth and low-birth-weight babies.

• Alcohol. Alcohol consumption may affect sperm counts in men and may increase the risk of birth defects in babies.

• Medications. Some medications may play a role in sperm count and sex drive.

• Drugs. Drugs, such as marijuana and anabolic steroids, may affect sperm counts in men. Cocaine use by mothers may increase the risk of kidney problems in babies.

• Caffeine. Caffeine may impact a woman's fertility and may increase her risk of miscarriage.

• Lubricants. Lubricant products used during intercourse may affect sperm quality.

Emotional aspects of infertility

Individuals and couples experience a roller coaster of emotions—always hopeful that this month will be “the month.” The experience of discovering that one is unable to bear a child involves a number of emotional stages, including denial, anger, bargaining, guilt and depression. These emotions may occur in any order, and you may find yourself revisiting them even once you believe you have passed into the next phase. Each member of the couple may experience these emotions differently and at different times, causing the potential for increased conflict between them.