Infertility Frequently Asked Questions | Answers to Questions about Infertility and its Treatment | Dr N Layyous

Infertility Frequently Asked Questions - Answers to Questions about Infertility and its Treatment

1 - Q: Does temperature affect the fertility of men such as in the use of very hot water in the shower?

Answer: The temperature can effect a man's fertility, but more so in a bath over a shower. It can affect sperm production, decreasing the quantity and quality. To restore a man's ability to produce sperm to normal levels, it needs at least three months to bring sperm counts back to better quantity and quality. Always keep genitals away from heat sources, and in general, it is important to keep testicular temperature 1 to 2 degrees Celsius lower than normal body temperature.

2 - Q: Does wearing tight clothes affect men's fertility?

Answer: No, but if those clothes elevate testicular temperature, it will affect it. It is better to wear loose fitting clothes as much as possible.

3 - Q: Does masturbation affect fertilization?

Answer: No, unless obtained at the time of ovulation. If copulation is being planned to fertilize the wife's eggs, masturbation is not recommended until fertilization has been accomplished and a pregnancy has been the result. And certainly, if the husband already suffers from low sperm count or bad quality, masturbation is not recommended.

4 - Q: If the man has sexually transmitted infections does it affect fertility?

Answer: It may indirectly affect the potential for a pregnancy. For example, in the case of epididymitis can lead to an obstruction so the sperm will not be able to exit. In general, these diseases may not affect fertility, unless the disease reaches the testicles.

5 - Q: Can the use of creams or medicines during intercourse affect fertility?

Answer: Most of these materials have an unpleasant effect on sperm. Preferably use only when absolutely necessary

6 - Q: How often should I have intercourse?

Answer: Plan intercourse every other day as sperm can remain alive for 38 hours inside a woman's body and the egg should be fertilized within 48-72 hours.

7 - Q: Does the use of certain drugs affect fertility?

Answer: There are toxic substances that affect sperm, called Gonadotoxins which includes alcohol, marijuana and smoking.

8 - Q: Most men complain about different results on their semen analysis from time to time and from one lab to another?

Answer: Semen quality can vary from day to day, and week to week or month to month. It may also vary from lab to lab depending on the techniques used in examination. This does not mean that varying semen analyses, with many problems discovered cannot be rejuvenated by your physician. It is better to order at least three tests in the same way. They collect semen every time in special lab using identical methods. If the same defect is found in these three results of analysis, we must then look toward management.

9 - Q: Is there a problem when there is a burning sensation during urination, after ejaculation?

Answer: No, the sensation is created by friction, which happens in the Urethra (tube inside penis), during intercourse or masturbation. When it comes in contact with your urine, this can cause a burning sensation

10 - Q: Some men wonder why they see Clumps accumulating in their semen, when ejaculating?

Answer: Semen is a material that comes from the testicles, prostate and seminal vesicle. When there is an ejaculation of semen, which is jelly-like, it quickly becomes liquid within 5-30 minutes and during this transformational process into a liquid, it may show clumps, and this is normal.

11 - Q: The couple may wonder about the position that they must take during sexual intercourse, and if it affects pregnancy?

Answer: There are no specific positions that increase the incidence of pregnancy, as long as semen enters the vagina. It is normal for some semen to flow out of the vagina, after intercourse. This does not necessarily affect the ability to conceive. It is preferable not to go to the bathroom too frequently to urinate after intercourse. It is best to empty your bladder / urinate, before intercourse.

12 - Q: As long as only one sperm is needed for fertilization, why must there be a large number of sperm needed to ensure fertilization?

Answer: Most of the sperm will die on the way and a large amount will flow out of the vagina or remains in a section of the cervix so only about 1/1000 enter and penetrates the cervix. Most of them die within the uterus and only about 200 remain to potentially penetrate and fertilize the egg. Many of the remaining sperm will penetrate the outer shell of the egg, but only one can fertilize it.

13 - Q: How long does the sperm stay alive inside a woman's body?

Answer: There is no sure answer. Where sperm survives about 2-4 hours in the vagina, with some being found alive after nearly 16 hours of sexual intercourse. Once sperm enters the cervix, uterus or uterine tubes it's time of survival is fixed. The average is 3-4 days, with rare recorded cases where sperm has remained alive for as much as 7 days.

14- Q: How many sperm are needed for conception to occur?

Answer: No one knows exactly, but we should take into account that abnormal sperm with decreased count and / or motility will lower the incidence of pregnancy.

15 - Q: How does the fertilized egg attach to the endometrium?

The answer: This happens when the fertilized egg reaches the Blastocyst stage. The implantation process occurs about 7 days after fertilization.

16 - Q: Is it possible that women can conceive at any time during the menstrual cycle?

Answer: No. Pregnancy should occur soon after ovulation, which is usually the middle of the menstrual cycle. However, ovulation can occur at different times and not necessarily mid-cycle.

17 - Q: What are the most fertile days in the menstrual cycle?

Answer: In the regular cycle (28 days), Days 12-13-14-15-16 are the most fertile. If we take into account the fact that the sperm has the ability to continue fertilization for 48 hours after ejaculation, and egg fertilization remains possible for 25 to 48 hours after ovulation, conception may occur on Days 9 to up to 15 of the menstrual cycle.

18 - Q: Is it possible to determine the sex of the baby while having natural intercourse?

Answer: Since the sperm contains chromosome X and Y, as mentioned previously, it depends on the sperm. Each of chromosomes has a certain quality, as it is known scientifically. The Y chromosome is more powerful and faster sperm than that which carries the X chromosome. However, the Y chromosome has a shorter life span than the sperm that carries the X chromosome, which moves slower, but lives for days longer than the sperm that contain the Y chromosome. From this, we can conclude that the period of intercourse may help to choose the sex of the baby. So, if intercourse is 3-5 days before ovulation, (which is usually in Day 13 or14 of the menstrual cycle), the fetus will most likely be female, but if intercourse occurs at time of ovulation, the fetus will most likely will be male.

19 - Q: Is orgasm during intercourse necessary to conceive?

Answer: No.

20 - Q: Is it possible to get pregnant if intercourse occurs at time of ovulation?

Answer: No, because the likelihood of pregnancy for normal couples is 15-20%.

21 - Q: Is the concern of genital hygiene an important issue for males and females?

Answer: Yes, psychologically it may create an aversion between the husband and his wife. If they do not take this aspect into account, it can affect the relationship and sexual intercourse. The male must wash his genitals and the female should wash as well for the following reasons: -

A – The urethra is so nearby, the vagina secretes vaginal discharge and when urine passes, if drops accumulate, and are not cleaned, it can lead to inflammation.

B - External female genitals secrete sweat heavily.

C – Heavy vaginal secretion may lead to skin infection.

22 - Q: What are the changes that occur in a woman's body when she becomes pregnant?

Answer: Many changes occur, organic, physical and psychological. These are temporary and will gradually disappear after birth, such as the enlarged breast size , the emergence of nipple-Sadr, 40% increase in body fluid, increases the work the heart must do and accelerated heart rate, some changes in skin color face and abdomen and weight gain, especially in the second half of pregnancy to mention a few.

23 - Q: How long does a pregnancy take, in normal circumstances?

Answer: On average, a 25 year old woman practicing unprotected sexual intercourse, on a regular basis, there is a possibility 20 -25% to become pregnant each month. This means that most of the couples, in this case, can create a successful pregnancy, during the first year of marriage.

24 - Q: Is there a difference in age between the women and men and their fertility?

Answer: Yes. Above the age of 35 years in females, the fertility rate decreases and if she gets pregnant, the rate of abortion increases. Even the risk of an abnormal baby increases with increased maternal age. The ability of fertilization in men may not be affected up to the age of 60 years or more.

25 - Q: Does a Retroverted Uterus affect a pregnancy and lead to infertility?

Answer: 80% of women have an Anteverted uterus and the remaining 20% have a Retroverted uterus. This is very unusual condition which does not affect or delay pregnancy, only if the uterus has no ability to move due to the presence of adhesions or a condition of Endometriosis.

There is a concern that if you tell the woman that her womb is retroverted, she may worry more than she needs to.

You must understand that normal uterus change direction due to the fullness of the bladder or the rectum. Often, it may remain at a right angle with the vagina. In the event that the uterus is tilted backward, moving the cervix up and forward, and the base back and down toward the rectum that most reasons for this are congenital, other reasons may be due to repeated pregnancy and childbirth, especially if the birth was hard and / or took a long time. This leads to weakness of connective tissue in the uterus.

So, in response to a question that occurs to many, that the uterus has been in a natural position in the past, the woman has never been informed that the uterus is retroverted as a result of poor, loose connective tissue. But, if there are no problems, there is no need for medical intervention.

If the uterus is retroverted backward as a result of adhesions, this sometimes can lead to a delayed pregnancy. Adhesiolysis may be needed.

26 - Q: Does obesity lead to infertility?

Answer: Generally, there are many obese women who have good fertility and the ability to conceive. But in the event of difficulty in conceiving, we advise her to lose weight to ameliorate known issues of hormonal balance. In case of PCOS, the extra weight may make fertility more difficult. There are some patients who may not show symptoms unless there is a weight increase.

27 - Q: Is it true that taking the contraception pill delays pregnancy?

Answer: You may need longer time to conceive when taking these pills, but most ladies return to their ordinary cycle within 3 months after removing the pills from their regimen. If pregnancy is delayed, you must look for other causes, and not the pill itself. But, the menstrual cycle being interrupted by using the pill for a long time, is not true. We must draw attention to the fact that taking the contraceptive pill, helps about 50% improves cases of chronic pelvic inflammation, one of the reasons for a delay in pregnancy. This means that the pill, in this case, indirectly may help to improve the ability to conceive.

28 - Q: Can the use of IUDs, as a contraceptive for pregnancy, affect the next pregnancy?

Answer: If the IUD used has led to inflammation in the pelvic area, it may affect subsequent pregnancies a little, especially if these infections lead to adhesions in the fallopian tube, but it may not have a direct impact.

29 - Q: Is it possible for the oocyte to be fertilized in every cycle?

Answer: No. In the beginning stage of maturity, when the irregular and non-fertilized (no ovulation). Alternately, Menopause or Premenopause, may occur during the lifetime of fertility in women. There may be some courses in fertilizing and this is normal. Sometimes, the reason may be an organic disturbance of Hypothalamic pituitary ovarian axis or abnormal thyroid function. These cases need special care.

30 - Q: Is it true that if there is no menstrual cycle, there will be no ovulation?

Answer: Yes. If the endometrium does not develop, due to lack of hormones, there will be no cycle. This is what happens at a certain age and menopause occurs.

31 - Q: Does irregular cycle mean no ovulation?

Answer: In this case, either there will be no ovulation or ovulation will be reduced in an irregular cycle. For example, when speaking of the menstrual cycle of a woman that occurs every six weeks to every six months, this condition is called Oligomenorrhea. In this case, the possibility of pregnancy is reduced.

32 - Q: Is the absence of menstrual cycle mean that there is still a possibility of pregnancy (and what if there is no cycle at all)?

Answer: It depends on the case. Is it primary amenorrhea or secondary amenorrhea? Most of these cases need special care and treatment, unless it is due to an ovarian failure.

33 - Q: What does, “Premature Menopause,” or, “Premature Ovarian Failure,” mean?

Answer: This can happen if the menstrual cycle is interrupted, before 40 years old. There are several reasons for this and it can be diagnosed by a physician. This situation is usually associated with low estrogen and high FSH with menopause. Treatment is usually difficult because it is often due to obvious reasons, such as congenital diseases like Turner Syndrome and other causes. The probability of pregnancy in this case is very difficult. In rare cases of ovarian failure, some may return to normal temporarily. Remember, this is an age related condition.

34 - Q: Can severe weight loss lead to amenorrhea?

Answer: Yes, if the decreased weight is too much, it may affect the potential for ovulation. A possible issue for this may be Anorexia Nervosa.

35 - Q: Does excessive exercise lead to amenorrhea?

Answer: Yes. You must avoid regular, severe, strenuous exercises.

36 - Q: Is polycystic ovary syndrome a genetic disorder?

Answer: There are some scientific results that, if a woman is affected by this disease, it is possible for her daughter or sister to experience the same condition. However, this is not always the reason. The real reason is still under discussion and there are still some theories taught that may better clarify these reasons.

37 - Q: If I need treatment to become pregnant, does that mean that I would need to be treated every time?

Answer: No. In some cases, pregnancy occurs naturally, without the need for treatment. It depends on the reason why your pregnancy is delayed. The correct diagnosis and proper treatment is necessary.

38 - Q: How does endometriosis cause a delay in pregnancy and infertility?

Answer: This happens in cases of a severe degree where the disease can be divided into mild, moderate and severe. In severe cases, it may lead to adhesions in the fallopian tube, ovary, uterus, intestines, etc., according to the area where it is located. Adhesions may be so severe that the position of the ovary, fallopian tube or uterus may become adherent to other organs and this leads to interference with the passage of the egg from the ovary to the fallopian tube or the passage of the sperm.

39 - Q: Does pregnancy occur if the woman has only one patent fallopian tube?

Answer: Yes. It will if it’s healthy and patent or viable.

40 - Q: Is it possible to re-open the tubes after they have been blocked or tubal ligation has been performed?

Answer: Yes. It depends on the type of the procedure used in closing the tube. If it was by burning, Electro diathermy, the tube was severely harmed and the tissue is very difficult to re-open. The probability of success is very low. However, if clips were used, it may be easier.

41 - Q: If a man reaches maturity, does that mean he must have a good semen analysis, and vice versa?

Answer: No. You may experience external manifestations of masculinity and even the external genitalia look good but the analysis may have some abnormalities, and vice versa.

42 - Q: How many eggs does the female have at birth?

Answer: At birth, both ovaries contain around 2 million eggs, and the eggs remain in a dormant state until puberty. Only 400,000 of those follicles reach puberty. Even during periods of pregnancy and during each monthly cycle, around (20) follicles grow but only one reaches the stage of maturity and the rest vanish. There are factors that program the rate of egg development through the life of the woman, each inherited through their genes. Some are due to environmental factors such as exposure to radiation, certain drugs, smoking. And the age of menopause varies each individual.

43 - Q: What is the Follicle?

Answer: It is a fluid-filled sack that contains the egg.

44 - Q: How is the oocyte released from the follicle?

Answer: By the LH hormone, which is secreted from the pituitary gland and leads to the development of a hole in the membrane, leading to the egg being released, then it is picked up by the fallopian tubes.

45 - Q: What is the shape of the sperm?

Answer: Sperm consists of the head that contains the genetic material and the middle part called the neck that gives the energy needed for sperm movement, and the tail. The tail is designed to push the sperm inside the female genital tract. We would like to note here that the man starts producing sperm at puberty only, unlike a woman as she delivers her eggs from the ovaries after puberty but has them inside her at birth.

46 - Q: What is the amount of semen normally ejaculated?

Answer: Between 1-6 mm. When ejaculated, seminal fluid is viscous but soon turns into a liquid in the vagina. This takes about 20-30 minutes. It takes sperm about two minutes to penetrate the mucous substance in the cervix.

47 - Q: What is the amount of sperm required during intercourse to conceive?

Answer: About 100-300 million. The release of this enormous number of sperm, although only one is required to fertilize the egg. Most of these sperms die during their way in the female genital tract. Most of the seminal fluid pours out of the vagina, and about 1,000 sperm make it to the egg to be fertilized. Some of these may be able to penetrate the outer membrane of the egg. But, only one sperm is required for fertilization.

48 - Q: How long is the life span of sperm inside the female genital tract?

Answer: Although the answer is certainly difficult, sperm can be observed in the vagina about 16 hours after intercourse. Once the sperm penetrates the cervix, uterus and uterine tube they remain about 3-4 days.

49 - Q: Will abstinence from sex and masturbation improve sperm count?

Answer: Abstinence will increase the number of sperm but most of them will be dead or be of bad quality, and with time, their ability of fertilize will decrease.

50 - Q: Does disease affects the sperm count?

Answer: In the case of mild disease, even tonsillitis for example, may reduce sperm count. Due to this, we can not judge seminal ability on a single semen analysis.

51 - Q: Does smoking and alcohol intake have an effect on male fertility?

Answer: Smoking leads to a decrease in the number of sperm and interferes with sperm motility, but for the alcohol excessive drinking leads to a lack of sperm production, and that effects, indirectly, can lead to inefficient sexual activity.

52 - Q: Is it possible to menstruate if there is no ovulation?

Answer: The menstrual cycle is the blood from the lining of the uterus, ( endometrium ), under the influence of estrogen and progesterone in the blood. These hormones can be excreted from the ovary, even in the absence of mature eggs.

52 - Q: Is it possible to menstruate if there is no ovulation?

Answer: The menstrual cycle is the blood from the lining of the uterus, ( endometrium ), under the influence of estrogen and progesterone in the blood. These hormones can be excreted from the ovary, even in the absence of mature eggs.

53 - Q: What is the cause of the chemical pregnancy?

Answer: It has been scientifically found that many early miscarriages are caused by genetic abnormalities, (genetic and chromosomal), and this leads to a chemical pregnancy as well as problems in implantation embryos in the lining of the uterus which may also lead to a chemical pregnancy.

54 - Q: - What is the cause of nausea, bloating and weight gain, cramps in the abdomen, as well as congestion in the breasts before a pregnancy test? Is it possible that these are symptoms of pregnancy?

Answer: It is mainly due to the hormones given to the patient and rarely occurs before a missed cycle.

55 - Q: What is the period in which they can use clomid, then move to use injections for ovulation induction and then assisted reproduction procedure?

Answer: In most cases, pregnancy occurs within 4 - 5 cycles and if there is no pregnancy, other procedures are indicated.

56 - Q: How many trials of intrauterine insemination can we apply before moving to the IVF procedure?

Answer: We can apply it 3 times before ivf.

57 - Q: What are the chances of ovarian cancer after taking ovulation induction?

Answer: It has not been proven scientifically through research and studies that there is no relationship between the ovulation induction hormones and the incidence of ovarian cancer.

58 - Q: How long does an egg remain valid for fertilization? After how many days does implantation of a fertilized egg occur and how long does it take for pregnancy to be verified?

Answer: The egg remains valid for fertilization approximately 24 to 48 hours after ovulation occurs and it decreases with the increase of age. The fertilization occurs within 24 hours after ovulation. The implantation of the fertilized egg occurs 6 days after ovulation.

59 - Q: Does the length of the menstrual cycle affect reproduction?

Answer: As long as there is a regular menstrual cycle that means ovulation occurs. Some women have an interval between sessions about 40 days. This is normal but can reduce the number of fertilizable eggs.

60 - Q: When the couple are of different blood groups, does it affect their chances of pregnancy?

Answer: No.

Dr Najeeb Layyous F.R.C.O.G

Consultant Obstetrician, Gynecologist and Infertility Specialist