#1: They have problem with the production of eggs.
For your information, ladies produce eggs—like birds! This is called ovulation, and it occurs normally every month at about the 14th day after the commencement of menstruation. It is tightly regulated by special hormones and body chemicals. It is this egg, produced and released, that joins with sperm cells from the male to form babies. Some women menstruate without ovulating, and without the egg (ovum), there can’t be pregnant. Others produce eggs but have problems with the release of the egg to meet the sperm. Hormonal problems can affect these and many complex processes involved in ovulation–eggs production and release. Fortunately,  there are tests to show if a lady ovulates or not, and drugs to assist ovulation.
And, ladies, please, have babies as early as possible! After the age of 30, the number and quality of eggs you produce reduces (by about 5% each year, after 30 years of age). This reduces the likelihood of getting pregnant, and having normal delivery, with time. Worse of all, some ladies, these days, have sudden unexplained early menopause–no menses, no eggs, no pregnancy!


#2: They have damaged or blocked tubes.
If the eggs are produced, they are released and pass through a tiny tube (called fallopian tubes) to get to the womb. You see, if one or both of these tubes are damaged or blocked, the chances of the sperms reaching the eggs and going through the tiny tube to the womb to form babies are slim, or not possible! Some ladies are born with abnormal or blocked tubes. Also, the tubes are blocked commonly after gonorrhea, genital infections, abortions, ectopic pregnancy, and so on. Some surgeries in the abdomen can cause some scar tissues and adhesions that might block the tubes. There are ways to check if the tubes are blocked, especially by a procedure called hysterosalpingography (HSG), and even though delicate, expensive  microsurgery can be done to repair damaged tubes, the outcome is usually poor with few success stories. IVF–in vitro fertilisation–is a good solution to blocked tubes.


#3: They have problems with their wombs.
The womb is where the baby forms. It must be conducive and accommodating for a successful and healthy pregnancy. Several things can go wrong here. Some ladies are born with abnormal and malformed wombs and cervix. Some ladies, after having abortions, especially D and C, develop all manners of bizzare complications; for example, the walls of the womb can get glued and attached in ugly ways during the healing process, thereby closing every space where they baby could develop and grow. Also, ladies who don’t have babies early enough in their reproductive life might develop fibroids–the womb hates being empty for long: if you don’t put babies in there, it will grow fibroids! Fibroids and polyps make pregnancy very difficult or even impossible for many ladies, and cause repeated miscarriages. Fortunately, we, the doctors, know what to do, most of the time.


#4: The problem is from their male partner
For every case of infertility, on the average, about 40% of the time, the problem is from the male, (and also 40% from the female). Morals: Don’t be quick to point at the lady for every case of infertility–the male also has an equal chance to be the cause of the infertility! He might have failure to produce or transport sperm cells properly; the sperm cells might be weak in activity, or very few in number thereby reducing the possibility of pregnancy; he might have damaged testes from diseases like mumps or gonorrhea; excessive cigarette smoking and consumption of alcohol might be the case; and so on. Flash the light on the man, and about 40% of the time, he would be the culprit!


#5: The problem might be unknown, vague, or funny!
Ideally, medically, adequate sexual intercourse is sex on at least 3 days in every week of the month! Stop calling my phone complaining of infertility when you “meet” your husband only once in a month–it might just always be during your “safe periods”! I, Dr. ‘Malik, will be angry with you if you do! Some ladies are, unknown to them, under the effects of contraception, maybe, injection or implant, and might find it difficult conceiving for some time. Interestingly, some virgins are complaining of infertility! We have ignorant, naive couples who think they have been having sex [I wonder what on Earth they were doing], yet on examination you find her  hymen intact (and she’s still a virgin) after months of marriage! Go and learn! Also, some times, breastfeeding is a powerful way of contraception. A couple came complaining of inability to conceive for months; and the problem was simple: when she weaned her baby, her husband took over!


All said and done, about 20% of the time, no-one is sure why a lady can’t conceive and have a baby. All might be okay with the guy and the lady, yet with regular, 3-days-in-a-week, unprotected sex, for over a period of one year, she still can’t get pregnant! Pray hard–and adoption of a child is a great, commendable alternative.


Having a hard time getting pregnant? Do you need sex-therapy and counselling? Want to adopt a child? Reach me.