First Visit to Hospital

About one in six couples experience difficulty in achieving conception at some stage during their reproductive years. For some, this is temporary and pregnancy ensues spontaneously after a variable period of trying. However, there are others who can only become pregnant through medical intervention. Infertility is common, and most people will not find it hard to remember friends, relatives and/or other acquaintances with such problems. Not only is infertility common but the list of possible causes is quite extensive and to many this may initially appear intimidating. However, for conception to be possible, adequate numbers of good quality spermatozoa must be produced in the testes and delivered to the vagina at the right time in a woman's menstrual (ovarian) cycle. Conditions must be favorable enough to these spermatozoa to ascend the female genital tract and arrive at the site of fertilization in the fallopian tube. They should be functionally adequate for the task of breaking through the cells that surround the oocytes to enable one of them to fertilize the oocytes. The fertilized egg should develop normally and implant successfully when it arrives at the uterine cavity as an embryo. Difficulty in conception will be experienced if any factor prevents the successful completion of these events.

It is estimated that 80 out of 100 couples are able to achieve pregnancy within one year of having regular sexual intercourse without contraceptives. Ten more couples will get pregnant in the second year while the remaining 10 couples are not able to do so within that time frame and are said to be infertile. However, some of these infertile couples may still achieve pregnancies without any assistance in the third or subsequent years of trying. Since it took them all this time to get pregnant they are said to be sub fertile; their fertility is impaired to some extent but not completely. The remaining couples (usually- 3-5 %) rarely achieve conception unless some form of treatment is provided. This is because one or both members of the couple could be sterile. Infertility therefore encompasses sub fertility and sterility. Infertility is defined as an inability to achieve pregnancy within two years of having regular unprotected intercourse. Some authorities may use one year as the cut-off point. Infertility is a problem of the couple. None of the partners can be said to be infertile; one or both partners may be sub fertile or sterile. There are about 60-80 million infertile couples world-wide. Infertility is said to be primary if the couple have had no previous pregnancy and secondary if there has been at least one pregnancy irrespective of its outcome (miscarriage, ectopic pregnancy and preterm or term delivery.) The male partner is solely responsible in 40% of infertility cases while the female partner is responsible for another 40%. Both are responsible for the remaining 20% of cases.

Steady progress has been made in recent decades in the treatment of infertility. Consequently, a large proportion of infertile couples should now have a realistic expectation of being able to have children, although it may take time and many treatment attempts for this to happen. Treatment could be by the administration of medication or performing surgery or a combination of both. Couples in whom these treatments are unsuccessful or are not suitable can have assisted conception treatment; several thousand babies have now been delivered world-wide following the birth of the first so-called 'test-tube' baby in 1978. Infertility is associated with psychological upheaval and perpetual mental anguish. Furthermore, infertility treatments impose physical, social, financial and mental stress on the couple. The stress is worse with the assisted reproduction technologies and success is not guaranteed in the first or any specific cycle of treatment, knowledge and information are the best tools with which infertile couples can tackle their problems and obtain the best possible treatment for themselves. They need to know about their bodies and how conception takes place. They also need to know when, how and where to seek assistance for their continued inability to conceive. They should be aware of the various available treatment modalities, their efficacy and drawbacks. Their knowledge of the subject matter should be enough to allow them to follow their treatment as it progresses thereby making for better compliance with the treatment regimens. A manual such as this fulfils these objectives. In, addition, it ensures that the busy practitioner and the non-medical members of the team have access to a simple yet comprehensive text that will enable them to optimally perform their various roles in the care of infertile patients.