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Dr. Abayomi Ajayi

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Infertility means difficulty becoming pregnant or conceiving despite having regular sex when not using any form of contraception. There is no specific point to say when a couple is infertile. Some couples take few months to conceive, others could take from several months to one or more years before conceiving.

Infertility is a common problem. About one in four Nigerian couples usually have one problem or the other conceiving. Such couples do not conceive within a year of trying. However, more than half of couples that are having regular sex would normally conceive within one year if the woman is aged below 35.


On the average, half of couples that do not conceive in the first year will do so in the second year. Some couples will conceive over the following year without any treatment but there are those that will require assistance before they can conceive. There are various causes of infertility. In many cases, infection and other disorders are found in both the man and the woman; however, there will be no reason for infertility in a few cases. Some are easier to treat than others. For couples trying to conceive, it is useful to acquire as much education, awareness and assistance as possible.


Age can be a factor for a man as it can be for a woman. If a couple has not conceived after one year, despite regular sexual intercourse, it is advisable to seek professional help regardless of the age of the woman. Tests and treatment may be considered earlier, say after six months, if the woman is older, or if there is an obvious reason why a particular couple will not conceive, however long they try. The chance of conceiving gradually goes down over time especially for women. Older women tend to be less fertile.


The fall off of fertility seems to be greatest once past the middle 30s. For women aged 35-39, the chance of conceiving is about half that of women aged 19-26. It is also thought that men over the age of 35 are half as likely to achieve a pregnancy when compared with men younger than 25. Stress can also be a factor. If the man or the woman is stressed, this can affect libido and how often the couple has sex. However, for couples where no cause is found, there is still a good chance of conceiving without treatment. But it is usually advisable to seek help through Assisted Reproductive Therapy.


To appreciate the causes of infertility, it is important to understand how conception occurs. For every couple, whether or not there is a fertility challenge, it helps to understand how conception occurs. Normally, to conceive, an egg or ovum from the woman has to combine with a sperm from the man. Every month, a woman releases an ovum, when she ovulates. This usually occurs between the 12th and 16th day from the start of her last period if she has a regular monthly cycle of 28-30 days. The ovum travels down the Fallopian tube to the middle of the womb (uterus) within a day. Sperm lies next to the neck of the womb (cervix) when a man comes (ejaculates) during sex. The sperm travels up past the cervix to get into the main part of the uterus and into the Fallopian tubes.


If there is sperm in the Fallopian tubes, it may combine with or fertilise the ovum to produce an embryo that travels down into the uterus and attaches to the lining of the uterus. If the conditions are right, this embryo grows and matures into a baby. Common causes of infertility include ovulation (egg production) and Fallopian tube problems in women, as well as sperm production issues in men. A woman that does not ovulate will not conceive. Not producing eggs (ovulating) is the cause of problems in about 25 per cent of infertile couples. For some women, this is a permanent problem, while in others, it only happens occasionally.


The causes of ovulation problems are many including early menopause, hormonal problems, women with long-term illnesses such as uncontrolled diabetes, cancer and kidney disease may not ovulate. A condition which could affect fertility is found in the male partner in about half of cases. Some men are born with testicles (testes) that do not make any sperm or they make very few sperm. Some are born without testes or without a vas deferens. Others include infection and certain conditions people are born with that are passed on through families.


Society often fails to recognise the grief caused by infertility, therefore, those affected tend to hide how they feel, so it could be helpful to find other people who are going through the same thing, or talking to people who work in the field of infertility. Building a family and becoming parents are fundamental to life, but when these things don’t come easily, it’s common to feel that something is wrong with you or your partner or both of you. Couples that are successful in their careers can have a particularly difficult time dealing with the loss that comes with not being able to conceive. If you’ve planned everything else and suddenly discover that you aren’t able to have a child, it can be distressing.


It is usually worth seeing a medical practitioner if as a couple you have not conceived after one year of trying. There can be checks for common causes, talking things over and discussing possible options. It’s quite natural to feel disappointed if it is taking you longer than expected to conceive. The best advice is to seek help earlier if the woman is above 35 or if either partner has a history of fertility problems. You don’t have to blame yourself – or each other. The best thing to do is to accept that as a couple, you need to work towards conception.


If you’ve been trying for more than a year, you might want to consider making an appointment with a fertility expert. Many such problems are quite easy to treat, so you could end up sparing yourself a lot of further disappointment by identifying any problem quickly. Begin by recognising that infertility is a crisis. Then take consolation that there’s solution.

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