The number of online portals dedicated to the issue of fertility is just another alarming sign of an issue women of different ages are concerned about.

But according to our conversations with different gynecologists and specialists in infertility, the concern seems to be taken to a much higher level in Egypt. And despite the fact that women are as likely as men to be infertile, it seems that more often than not, women worry much more than their partners do about the issue, or at least they’re more vocal about it.

We polled our readers and friends asking about their attitudes towards infertility, and the responses we got were alarming.

About 77% of respondents, aged between 26 to 37, have or had at some point a fear of infertility despite the fact that 88% of them were not trying to conceive. Despite the fact that the majority of respondents do worry about being infertile, almost 62% of them never considered getting tested to put their fears to rest, adding even more strain and stress.

Women, and probably secretively men too, start worrying about fertility way earlier than they should especially in our culture where families constantly pressure and comment about your clock ticking and that you need to start having your first kid before it gets too late, it’s often hard not to stress out.

“Stress is the number one factor of delayed pregnancy in Egypt, I find couples worrying and looking for medical interventions only after a month or two of trials,” says Dr. Ihab Samaha, Consultant of Obstetrics and Gynecology.

“I fear that it would affect my [future] husband but he’d feel too bad about leaving me and it would cause some resentment from his side,” says a 30-year-old, single respondent.

“Society plays a very big role in possible infertility issues; the way families pressure the couples into getting pregnant right after they get married puts a great psychological and mental burden on the couple, leading to stress affecting the actual marriage and hence the ability to conceive or have kids,” says Dr. Emad Soliman, IVF and Infertility Consultant, El Nile Badrawy Hospital; this was apparent in many responses we received.

“After years of being married it gets a bit boring, even though you are in love and happy,  you still need kids to bring excitement to your life. You see people around you having kids and moving forward with their lives and you are standing still, especially that this is all what they’re talking about – their kids – and it won’t go away. They will talk about them being toddlers and then about school and then university and then their marriages and then their grand kids, once it starts, it doesn’t stop. You feel like you don’t have a purpose like people around you with kids,” says a 30-year-old, married respondent who has been trying to conceive for over a year. “It’s a bit scary [to think that] if we stay married for a long time until we get old, maybe one day one of us would want to get a divorce but can’t because they would feel responsible for the other sticking with them all those years and if they don’t feel guilty and just leave, it’s even worse because then you will be completely alone, no husband, no kids, no parents, it’s really scary.” 

Research indicates that in one menstrual cycle, even if the couple have sex every single day, the likeliness of pregnancy is only 25% while there’s a 80% to 90% chance of pregnancy to happen within the first year of trial.

We, Egyptians, however, don’t seem to bother with that. Among the 12% who were actually trying to conceive, only one was trying to conceive for over a year.

The World Health Organization (WHO) defines infertility as “the failure to conceive following twelve months of unprotected intercourse.”

So unless you’ve been trying for over a year, don’t go into a panic fit just yet. You should, however, educate yourself and your partner on causes of infertility, when to start worrying and what to do if need be.

Defining infertility

“People should differentiate between infertility and recurrent miscarriage. Infertility is the inability to actually conceive a baby, while there are many women who are able to conceive but go through miscarriages and are hence unable to have the baby. The reasons between both issues vary,” explains Dr. Soliman.

Causes of infertility vary from lifestyle and nutrition to sexually transmitted diseases and tumors.

Infertility causes in women

Ovulation disorders can affect the ovulation process by stopping eggs from being released altogether while others could affect ovaries release in one cycle and not the other. Ovulation disorders could stem from thyroid disturbances, polycystic ovary syndrome or premature ovarian failure where a woman’s ovaries stop working before she turns 40.

Damage in the womb or the fallopian tubes, which could occur due to:

–       Post cervical and pelvic surgery scarring

–       A defect in cervical mucus that could be too thick for the semen to get through

–       Pelvic inflammatory disease that could affect the ovary from traveling down the womb

–       Endometriosis where small pieces of the womb lining start growing in other places like the ovaries affecting the process of the eggs maturing and being released.

Medication such as inflammatory drugs used over a long period of time, chemotherapy and some medicine used to treat psychosis could also result in ovarian failure. Other illegal drugs like cocaine and marijuana are more likely to also affect the process of ovulation.

Age is a big factor affecting fertility in women, according to research the peak of fertility decrease starts at mid thirties with statistics showing that at the age of 35, 95% of women can get pregnant after three years of having regular unprotected sex, while only 75% of women at the age of 38 can conceive after three years of trying.

In Egypt, Dr. Samaha explains that the age concern in relation to fertility is more common in lower social classes where there is a lack of education and impatience when it comes to conceiving. This impatience is also fed by the need to have numerous children and little family planning.

Infertility causes in men

Abnormal Semen, whether it’s a low sperm count, decreased sperm mobility or an abnormality in shape, which makes it more difficult for them to swim to the ovaries.

Testicles affected by a tumor, infection, or injury can affect the quality of the semen.

Absence of sperm in the semen known as obstructive azoospermia caused by a possible blockage in the reproductive system.

A Vasectomy that was unsuccessfully reversed.

Ejaculation disorders, which could include retrograde ejaculation, where semen is ejaculated into the bladder, and premature ejaculation, where ejaculation happens too quickly.

Hypogonadism is defined as an abnormally low level of testosterone which is involved in actually making the sperm. This is caused by a tumor or an intake of illegal drugs.    

Medication such as anabolic steroids used to build muscle and enhance athletic performance, chemotherapy, and certain herbal remedies, such as root extracts of Tripterygium wilfordii, can affect the production of sperm.

Alcohol in excess — more than three to four units a day, according to the National Institute of Clinical Excellence — can affect the quality of the sperm.

Find the right doctor

Dr. Soliman explains that the issue in Egypt is much bigger and goes beyond just a medical concern; “the absence of medical consultants that couples can talk to plays a big role leading to getting advice from doctors who are not necessarily specialized and who can end up complicating matters even worse to an extent of permanent damage,” he says. “Dealing with infertility has psychological, mental and financial impacts. It is a very expensive process that needs to be given more attention on greater aspects so it wouldn’t result in unnecessary complications.”

Editor’s note: if you are worried you might be having infertility issues, make sure you talk to the right doctors about it. Check their medical backgrounds and what they’re specialized in before confiding in their medical help.

Dr. Emad Soliman • IVF and Infertility Consultant • El Nile Badrawy Hospital

Dr. Ihab Samaha • Consultant of Obstetrics and Gynecology • 27A, Baghdad Street, El Korba, Heliopolis • Tel. +2 (012) 2311-2238