What if getting pregnant does not work?
This information leaflet is intended for those with a desire to have a child, for which getting pregnant is delayed. You will find information here about:
- how long it takes on average for a woman to become pregnant
- when you can consult your doctor better
- what you can do yourself
- what you can expect after you have been referred for further investigation
The information in this folder is general and does not always have to apply to your situation. The chance of a pregnancy with a woman who regularly has sex, does not use contraceptives and has regular menstruation is 15% on average. On average, 80 to 90% of women in the first year become pregnant. When a couple is seriously trying to conceive and they have not succeeded after a year, this is called subfertility. This is the medical term for reduced fertility.
Symptoms like getting pregnant are not possible
Fertility disorder exists in approximately 25% of women. For 13% of women, this becomes clear when they want to become pregnant for the first time. A primary fertility disorder is then referred to. For the other women, the disorder only becomes apparent when they want to become pregnant again.
How is it possible that getting pregnant does not work?
In approximately 30% of couples with a fertility disorder, the cause lies with the man; for 20% for men and women and for 50% for women. It is also possible that no clear cause is found. Causes in the male A reduced fertility of the male is almost always related to the sperm. The cause of sperm abnormalities may be congenital or acquired later and cannot always be determined. It may have to do with factors such as smoking, alcohol consumption, congenital sperm cell malformation, a history of venereal disease or testicular inflammation (mumps), injuries or operations on the testes, medication use, exposure to harmful substances, radiation and chemotherapy. Sperm abnormalities can be divided into three groups:
- Too few sperm cells Normally, an ejaculate contains an average of 100 to 200 million sperm cells. This corresponds to 20 to 50 million sperm cells per milliliter of ejaculate. If there are fewer than 20 million sperm cells per m33illiliter of ejaculate, there is talk of reduced fertility (subfertility). It usually takes longer for the woman to become pregnant. If there are fewer than ten million sperm cells per milliliter of ejaculate (oligozoospermia), the chance of pregnancy is even lower. Only with less than five million sperm cells per milliliter, the chance of childlessness is clearly increased. It is also possible that there are no sperm cells in the ejaculate (azoospermia).
- Too few moving sperm In a normal ejaculate, at least 50% of the seed moves and at least 25% must swim well. If less than 25% sperm swim well (asthenozoospermia), it takes longer for the woman to become pregnant. If less than 20% of the sperm moves properly, the chance of a natural pregnancy is lower.
- Too few well-formed sperm cells In addition to mobility, the shape of the sperm cells is also important. In every man there are malformed sperm in the sperm. If this is more than 70% of the seed (teratozoospermia), it takes longer before a pregnancy is established. If more than 80% of the sperm cells are not in good shape, the chance of a natural pregnancy is lower.
Causes in women The most common causes of fertility disorders in women are cycle disorders, defects in the fallopian tubes and islets of the womb lining in the abdomen (endometriosis). In addition, medication use, chemotherapy, abdominal surgery and history of sexual diseases can reduce fertility.
- Cycle disorders In approximately 20% of women with reduced fertility, the cause is a cycle disorder. Normally, ovulation takes place every month, followed by menstruation fourteen days later. Women with a cycle disorder have less ovulation or no ovulation. Many cycle disorders can be treated well with hormones, so that ovulation eventually takes place and thus the possibility of becoming pregnant occurs. Sometimes the cycle disorder is caused by the so-called polycystic ovarian syndrome. This benign defect is often accompanied by excessive hair growth and weight gain. With hormones it is often possible to induce ovulation.
- Abnormalities of the fallopian tubes In approximately 14% of the women with reduced fertility, the cause lies in defects in the fallopian tubes. These may have been caused by inflammations that have taken off from the vagina to the area around the fallopian tubes. The inflammation leads to the formation of scar tissue, as a result of which the fallopian tubes may be sealed or stuck. The fallopian tubes can then no longer catch the egg after ovulation. Many of these abnormalities can be treated by surgery.
- Endometriosis In women with endometriosis, the womb lining is not only in the womb, but also in other places in the abdomen. Light forms of this do not seem to affect fertility and are therefore not treated. More severe forms of endometriosis can lead to adhesions of the fallopian tubes, thereby reducing their function and therefore fertility. The fallopian tubes may even be completely closed. The use of certain hormones can cause the adhesions to shrink. During such a tablet cure no ovulation takes place and the woman is therefore infertile. This can be a problem for women who want to become pregnant quickly, for example because of their age. Unfortunately, the cure has no demonstrable beneficial effect on fertility.
Is it serious and what can you expect?
Although 25% of women have a fertility disorder, only 3% of women really do not get pregnant. They are referred to as primary infertility (infertility). About 6% of women have secondary infertility disorders and as a result have fewer children than desired. So even if you are not pregnant within a year, there is a good chance that you will eventually get it.
When to the doctor?
If you have not become pregnant after a year, you can contact your doctor. If you are over thirty-five years old, you can consult your doctor after six months. The optimum age for your body to get pregnant is between twenty and thirty years. The older you are, the longer it takes before you become pregnant. It is also advisable to go to your doctor if you think you have been pregnant more than twice but have lost the fruit at a very early stage (a miscarriage). If you think that medical issues from the past may play a role, you can always contact your doctor.
What can you do about it yourself?
Before you go to the doctor, there are a number of things you can do yourself.
Maintain basic temperature curve
By keeping a basic temperature curve you will gain insight into your cycle. On the basis of the body temperature you or your doctor can check whether ovulation is taking place and if so, when in the cycle. The body temperature is somewhat higher after ovulation.
Moderate (be) with alcohol and no smoking
Solve any problems with sexual intercourse
Although problems with intercourse are almost never the cause of not getting pregnant, various problems with sexual intercourse can occur. Precisely because you may now experience sex as something that ‘must’, it can cause tension. It is good to talk about this openly with your partner and, if desired, with your doctor.
Impotence means that a man gets no or insufficient erection during sexual arousal, so that sexual intercourse is not possible. Impotence can occur at any age, but the chance increases with age. Of the men of sixty-five years of age or older, one quarter has impotence. Impotence is therefore completely separate from ‘less desire to make love’, or libido loss.
Not in the mood for sex
In the medical world, ‘no sex drive’ is indicated as reduced libido. This means not getting sexually excited anymore and having less pleasure in sex. There may be physical causes, but usually it concerns (temporary) psychological problems or relationship problems. Not wanting to have sex is common: around 20% of women and 15% of men say they suffer from it.
Some women, usually due to a traumatic childhood experience, have a cramping of the vagina when touched. This contraction can be so intense that it is impossible for the man to enter the vagina with the penis. This problem can be very frustrating and persistent. Therefore, do not keep walking around with it, but make an appointment with your partner at your doctor’s. With a lot of patience and good therapy it can completely pass.
Pain during intercourse
Pain during intercourse, also called dyspareunia, is common. The pain occurs during sexual intercourse. Sometimes sexual intercourse is not possible due to dyspareunia. About 10% of women and 5% of men are affected.
Dry vagina during sex
There are glands in the vagina that produce moisture: this keeps the vagina moist. During sexual contact, extra fluid is secreted, making it easy for the penis to enter the vagina. A dry vagina is often caused by a reduced effect of these glands. This can occur at any age, but the chance is greater after the transition.
Which examinations are possible if becoming pregnant does not work?
If you think you are less fertile and you go to the doctor for this, he wants to talk to you and your partner first. By asking questions, he tries to find out the causes of impaired fertility. Different organs and hormones play a role in fertility. By asking specifically, the doctor can sometimes discover which organ (system) is not functioning. The doctor will also ask you questions about your sexual past. It may not always be pleasant for you to talk about such topics. But the doctor has conversations with many people about sex and fertility. He therefore finds it very common to talk about this subject. If you find it difficult to talk about your sexual past in the presence of your partner, you can contact your doctor again after the consultation. There are GPs who then refer you directly to a gynecologist. Other general practitioners first do additional research.
In the case of a physical examination, the doctor examines your physique, height and hair pattern. This can provide clues about the cause of the reduced fertility. The doctor examines the sexual organs of you and your partner. In the case of the man, the doctor feels the size of the testicles, the test leader, and looks at whether the penis is bleeding. An internal examination is carried out on the woman. To do this, she must lie on her back with her feet in the supports. With a duckbill (speculum) the doctor keeps the vagina open and can look at the cervix. He takes a little mucus for examination. The doctor then removes the speculum from the vagina and begins an internal examination. With two fingers in the vagina and one hand on the abdomen, the doctor feels towards the womb and the ovaries.
Basic temperature curve
The doctor can obtain a lot of information from a basic temperature curve. It is nice if you have kept this up to three months before you go to the doctor. This process of the examination is then completed and the doctor can immediately proceed with the treatment or other additional examination. This also saves you time.
The doctor’s husband receives a special pot for a seed test. This jar must be filled with seed from a fresh ejaculation and is then taken to the laboratory. The man must induce an ejaculation through self-gratification. Usually the laboratory asks you not to have sex or to masturbate two days before this ejaculation, because that is good for the quality of the seed. The laboratory examines the quantity, shape and quality of the seed. When the examination is requested by the gynecologist, it is often possible to masturbate in a separate room in the hospital. In this room there is material for erotic excitement, such as video tapes and magazines. It is also possible that the partner comes along.
After intercourse test (post-coitum test)
The post-coitum test provides a lot of information about the different aspects of fertility. This test is often done by the doctor, but can also take place in the hospital. You are instructed to have unprotected sexual intercourse with your partner around ovulation. The next day the doctor does an internal examination of the woman and sucks some mucus from the cervix with a pipette. The doctor assesses the quality of this mucus and examines under the microscope whether sperm cells are present in the mucus. The test is good if there is at least one swimming sperm cell in the womb mucus.
Blood test for chlamydia
Chlamydia is a venereal disease that occurs in both men and women. Women in particular may have had a chlamydia infection, without ever having been bothered by it. Sometimes there are symptoms of a burning sensation when urinating, dirty vaginal discharge and fallopian tube inflammation. If the infection remains untreated for a long time, it can lead to infertility. Blood tests allow the doctor to check whether you have ever had such an infection. Chlamydia is generally easy to treat.
If the doctor wants more information about the internal organs, he can do an ultrasound. An ultrasound of the female sexual organs can be performed in two ways: internally and externally. For an external ultrasound, the woman must have a full bladder. The internal organs can be judged on shape and size by means of sound waves. The doctor can visualize any cysts on the ovaries or fibroids in the womb in this way. For an internal ultrasound, the gynecologist inserts a rod-shaped ultrasound viewer into the vagina. This does not hurt, but it does give a strange feeling. With this ultrasound, the ovaries and uterus are better represented.
If you have been referred to the gynecologist, in some cases he will make an appointment with you for a viewing operation (laparoscopy). You will then receive a general anesthetic. The doctor then makes a small incision in the navel. Because of this he brings a tube inside. This tube inflates the abdomen with a special gas, leaving space between the internal organs. After this, a viewer is inserted through the same or a second incision into the abdomen and the doctor can look into the abdomen. He can then assess the ovaries, the uterus and surrounding organs. He can also investigate whether uterine mucosa is present in the abdominal cavity (endometriosis) and whether inflammatory residues are visible. If necessary, he removes small pieces of tissue (biopsy) that can be viewed under the microscope. When the doctor is ready, let the gas escape again and the holes are stuck; sometimes only a patch is sufficient. You wake up shortly after the procedure and you can go home at the end of the day.
What treatment options are there if getting pregnant does not work?
Depending on the cause of your fertility problems, there are various treatment options for this. If no cause is found, the doctor may recommend that you continue to try to become pregnant. The treatment methods:
If there is something wrong with the hormonal system in women, hormone treatment can help. This consists of hormones (tablets and sometimes injections) that help to generate a normal ovulation cycle.
If there is a closure in your fallopian tubes, surgery can attempt to open the passage through the fallopian tubes. Such an operation is drastic and the results can often be disappointing.
There are various forms of artificial insemination (AI). Insemination literally means ‘sowing’ and means that seed is artificially introduced into the woman’s womb.
In vitro fertilization (IVF)
In vitro fertilization (IVF) is a fertilization (glassization) in glass (in vitro), also called a test tube fertilization. Usually IVF is chosen, with abnormalities of the fallopian tubes and proliferation of the womb lining (endometriosis).
Intra cytoplasmic sperm injection (ICSI)
If the sperm quality is poor, ICSI can be chosen. ICSI is an intra cytoplasmic sperm injection. One sperm cell is then selected in the laboratory, which is injected (directly) into an egg with a very thin injection needle. Furthermore, there is no difference with the regular IVF procedure.
Egg donation can be a solution for couples who want a child of their own, but where the woman does not have her own eggs or has a hereditary disorder. Another woman receives an IVF pre-treatment in which eggs are extracted. The donor egg is fertilized with the seed of its own partner and then injected into the womb of the woman who wants to become pregnant.
Source : dokterdokter