Infertility means a couple has not been able to get pregnant after 12 months of regular sex without contraception (6 months if the woman is over 35). It affects about 1 in 6 couples. The cause can be in the woman, the man, or both — in about one third of cases the problem is with the man — so both partners should be checked. Many causes can be treated.
Symptoms
Not getting pregnant after 12 months of trying
Irregular periods or no periods
Very painful periods
In men: problems with erection or ejaculation, or swelling of the testicles
Often there are no other symptoms
Causes
In women: eggs not being released (ovulation problems), often from PCOS or thyroid problems
Blocked tubes after a pelvic infection, an unsafe delivery or abortion, or tuberculosis
Endometriosis or fibroids
In men: low or weak sperm, sometimes after mumps, infection or a varicocele
Age — fertility in women falls after 35
Smoking, naswar, or being very overweight or underweight
Prevention
Treat vaginal and pelvic infections early and fully
Give birth and have any procedures in a safe health facility
Keep a healthy weight
Avoid smoking, naswar and drugs
Mumps vaccination, where available, protects boys from testicle damage
Do not delay seeing a doctor if you have irregular periods
Treatment
Tests for both partners: a semen test for the man, hormone tests and ultrasound for the woman
Treating the cause, such as thyroid problems, infections or PCOS
Medicines to help ovulation (for example clomifene) — only under a gynaecologist
Surgery for blocked tubes, fibroids or varicocele in some cases
Assisted methods such as IUI or IVF where available
Avoid unproven treatments, and do not take hormones without a doctor
Common questions
Is infertility always caused by the woman?
No. In about one third of couples the cause is in the man, in one third it is in the woman, and in the rest it is in both or unknown. A simple semen test for the man should be done early.
How often should we have sex to get pregnant?
Every 2 to 3 days throughout the month gives the best chance. The most fertile days are usually about 14 days before the next period.
