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Infertility is a disease of the reproductive system that impairs one of the body's most basic functions: the conception of children. Conception is a complicated process that depends upon many factors: on the production of healthy sperm by the man and healthy eggs by the woman; unblocked fallopian tubes that allow the sperm to reach the egg; the sperm's ability to fertilize the egg when they meet; the ability of the fertilized egg (embryo) to become implanted in the woman's uterus; and sufficient embryo quality.

Finally, for the pregnancy to continue to full term, the embryo must be healthy and the woman's hormonal environment adequate for its development. When just one of these factors is impaired, infertility can result.

Is it common to have difficulties becoming pregnant?

Common believes that it is easy to have a child and are often surprised when the women does not fall pregnant as soon as they start trying for a baby. The chance of getting pregnant in each menstrual cycle (each month) is very high. However, it may take a long time to conceive, even if everything is looks normal, because some may just be a bit weak. Eight out of every ten women trying for a baby will fall pregnant within the first six months. Women who do become pregnant without any medical assistance generally do so within 8 months of trying. It is common for couple to seek help and advice if there is difficulty conceiving. Overall, around 15 per cent (one in six) of all couples will seek help. The point at which they may want to seek help will depend on various factors. For example, if they are over 35 years of age or if they have any worrying symptoms, such as infrequent period and so on, the couple should seek help after about six months of trying.

1. The woman
Ovulation is the end of a complicated series of events leading to the release of an egg from the ovary. If that egg is fertilized by a sperm and implants in the lining of the womb (endometrium), a pregnancy has started.

All of a woman's eggs will already be present when she is born. From the early years of childhood, she starts to lose eggs, but it is calculated that a woman aged 50 still has about 1000 of her eggs left.

A woman's cycle begins with a hormonal signal from the pituitary gland at the base of the brain. It releases a follicle stimulating hormone (FSH), which stimulates the ovaries. FSH stimulates a group of about 20 follicles on the surface of the ovary to grow. Within the follicles are the developing eggs.

Another hormone, estrogen, is produced by the ovary and in response to increasing estrogen levels, the largest follicle continues to develop. This is why most pregnancies result in only a single baby.

Another hormone, luteinizing hormone (LH), also produced by the pituitary gland, causes the follicle in the ovary to release the egg. This release of the egg (or ovum) is called ovulation.

After ovulation, the empty follicle forms a structure called the corpus luteum which produces a hormone called progesterone. Levels of progesterone rise after ovulation and prepare the womb to receive a fertilized egg (embryo). Fertilization by a sperm, if this occurs, takes place in the Fallopian tube, which then moves the early embryo along towards the womb itself. If the egg is not fertilized, or the embryo does not implant in the womb, the progesterone levels fall and a period starts. The whole cycle then begins again.

2. The man
The man's role in conception is the production and ejaculation of sperm cells. To fertilise an egg, a man must be capable of producing adequate numbers of swimming (motile) sperm. Only a few of these sperm cells will in the end reach the egg, and only one will actually enter and fertilise it.

During puberty, the testes become active and start to produce sperm. From his teens until about the age of 70, a man will typically produce 5,000 sperm cells every minute. Ejaculation produces semen, which is a mixture of two per cent sperm cells and 98 per cent liquid produced by the glands in the testes. Production of sperm is under the control of FSH and LH, the same hormones that control the woman's fertility.

Fertilization and conception chances.

Fertilization only happens if intercourse takes place almost around the time of ovulation. Ovulation only takes place once in every menstrual cycle, which means that there are only a few days each month when a woman can fall pregnant. However, intercourse and ovulation don't need to be at exactly the same time as healthy sperm can survive for about 48 to 72 hours inside a woman's body and a woman's egg lives for about 12 to 24 hours after ovulation.

Fertility is therefore a result of sperm and egg meeting each other almost immediately after ovulation. Ovulation occurs 14 days before the onset of a period normally but for some cases it has been proven that the women can ovulates during a high hormonal activities. This is reasonably predictable if the cycle is regular, but may be very unpredictable if the cycle is irregular.

Fertility depend upon

The hormone balance must be correct to ensure an egg develops and ovulates normally. Intercourse must take place during the fertile part of the cycle or at the time of high hormonal activities in the body. There must be an adequate number of strong sperm and no mechanical barrier such as blocked Fallopian tubes or others cyst, which may prevent sperm reaching the egg.

Infertility investigations

Semen analysis

This will give information about the number of sperm per milliliter, the percentage of sperm swimming normally (motility), and the percentage of abnormal sperm. There can be considerable variation in the results between different samples, which is why a reduced semen analysis will always be checked with one or two repeat tests.

The sperm must first looks normal in quantity and then the sperm must not be too thin, must be thick enough but not too dry like type.

Lower abdominal pain in women or Pelvic Pain

What causes lower abdominal or pelvic pain?:
Most women feel discomfort or pain in the lower abdomen below the navel from time to time, for instance, before or during menstruation.

Taking note of certain symptoms will help you and your doctor accurately diagnose the problem, although this can be difficult.

It some cases it can be difficult to identify the cause of the pain, but noting certain features will help you and your doctor come to a likely diagnosis.

The most common causes are a urinary system disorder such as a bladder or kidney problem, a bowel problem or a condition involving the reproductive system - the uterus, Fallopian tubes and ovaries.

Type of pain arising from the urinary system.

Pain from the urinary system can indicate such conditions as cystitis (inflammation of the bladder), inflammation of the collecting system of one or both kidneys (pyelonephritis), kidney stones or tumours.

The usual condition is a burning sensation when passing urine and a need to empty the bladder more frequently. In addition, pain travelling from the back and around to the front might suggest a kidney infection or kidney stone.

The pain associated with kidney stones may be particularly severe. The presence of blood in the urine raises the possibilities of infection, kidney or bladder stones or even a bladder or kidney tumour. Both benign and malignant tumours can first make themselves noticed in this way. The duration of the pain will further help you and your doctor to make the correct diagnosis.

Type of pain arising from conditions of the intestines

Bowel can give rise to a wide variety of symptoms including pain. Constipation and diarrhoea can be painful in themselves, and the change in bowel habit usually identifies the pain as coming from the bowel. Pain from the bowel is often described as colicky in nature. This means that the pain or discomfort comes in waves with little or no discomfort in between the pain. Bloating or swelling of the lower abdomen may be present in many intestinal conditions including irritable bowel syndrome. The passing of fresh blood or altered blood (black motions) from the back passage should be reported to your doctor as investigation is usually necessary.

The pain might originate from the uterus (womb), Fallopian tubes or ovaries. It is usually felt in the middle of the lower abdomen, above the line of pubic hair as far up as the navel. Occasionally, the pain is more to one side, which is more typical of a pain coming from an ovary.

There might be discomfort or even pain during intercourse (called dyspareunia) felt deep within the pelvis. Pain originating from the uterus is usually worse at the time of a woman's period (dysmenorrhoea). Examples of conditions of the reproductive organs giving rise to pain include endometriosis, pelvic inflammatory disease, ovarian cysts, fibroids and problems related to the early stages of pregnancy such as miscarriage and ectopic pregnancy.

In any case of sudden, severe, unexplained abdominal pain your doctor should be contacted.

Acute and sudden pains are always worrying but chronic pain can also have serious implications and a doctor should be consulted. These may be cause by periods, passing of urine and bowel movements. When there have been episodes of nausea, vomiting, or fever. It may also involes the person's emotional life - family, friends, work - and their sex life, stress.

Menstrual pain

Some women their monthly period is problematic and almost disabling because of the pain and inconvenience caused. They may have to take time off from school or work and stay at home for one or two days.

Period pain are only sometimes a sign of others disease, like cyst growth, cold overy or womb, obstructed Qi flow and others complications .

If period pains are more than an inconvenience then it is wise to take some herbal treatment.

What causes menstrual pains?

Pelvic inflammatory disease

Pelvic inflammatory disease is an infection that passes from the vagina through neck of the womb (cervix), the womb (uterus) and up to the Fallopian tubes. The ovaries are sometimes also involved. Bacteria and other micro-organisms can find their way through the vagina and the cervix to the internal reproductive organs. A bacterial infection can cause inflammation in these organs and their surroundings. This most commonly occurs in the Fallopian tubes.

Causes Pelvic inflammatory

It may result from a termination of pregnancy or following childbirth. Occasionally, it may be as a result of having sex with a new partner or many partners. But often no specific reason can be found.

It causes tenderness and pain in one or both sides of the lower abdomen. At the same time, it can cause fever and general discomfort. Finally, the infection can be accompanied by heavy, painful periods and sometimes severe brown or even black colour vaginal discharge.

Heavy periods (menorrhagia)

What are heavy periods?

The correct medical definition of heavy periods is the passage of more than 80ml of blood each period. It is seldom realistic or practical, however, to actually measure the blood loss and so doctors rely on the woman's description of her period.

Periods are considered heavy when:
a woman bleeds for more than 8 to 10 days, or a sudden twice as much as her normal flow, especially if this is repeated month after month.

a woman bleeds so much that it is difficult for her to attend her job. She may be forced to plan her holidays and leisure time according to the timings of her period.

the presence of high numbers of small clots for more than two days suggests heavy periods.

'flooding' describes the sudden, unexpected onset of periods, like a tap is busted , and indicates heavy periods.

Younger women heavy periods are most often due to a temporary hormone imbalance, which eventually corrects itself.

In the years close to the menopause, heavy periods are usually a sign of hormone imbalance.

Possibility of heavy periods being caused by an underlying disease increases with age.

Associated with heavy periods:

In the oldern days in villages, there are many cases of died from heavy and non stop menstrualtion.

Endometriosis

If the endometrium grows within the muscular layer of the womb it is called adenomyosis, which is just a different type of endometriosis.

The commonest areas to be affected are:
Ovaries where cysts might appear; these are called chocolate cysts because they contain brown material.
Area behind the womb and in front of the rectum (large bowel). This space is called the Pouch of Douglas and endometriosis here often causes deep pain and painful intercourse (dyspareunia).
less common sites include the bowel itself, the bladder and sites outside the pelvis including the navel or operation scars.
Like normal endometrium, the endometriosis tissue undergoes monthly changes according to the hormonal cycle and typically causes painful periods (dysmenorrhoea).

Endometriosis is a very common condition affecting up to 10 per cent of women between 16 and 50 years of age, often without producing any symptoms. Endometriotic tissue is under hormonal influence so it is almost never seen in children or postmenopausal women.

It appears as small blackish-blue nodules on the external lining of the ovaries or elsewhere in the pelvis. In some cases it may lead to the formation of cysts filled with altered blood, known as chocolate cysts.

Endometriosis may cause discomfort or mild to severe pain during a period (dysmenorrhoea), with many sufferers experiencing chronic pain. Sexual intercourse can be painful, and women with chocolate cysts may have a feeling of fullness in the lower parts of their stomach.

The formation of connecting tissues around endometriosis near the Fallopian tubes or ovaries may reduce fertility. Fortunately, most women with endometriosis have a mild form of disease and their fertility is not impaired. Once pregnant, most women's endometriosis gets better under the influence of the constant high levels of female hormones produced in pregnancy.

Infertility is the inability of a couple to become pregnant (regardless of cause) after 1 year of unprotected sexual intercourse (using no birth control methods).

Most experts define infertility as not being able to get pregnant after at least one year of trying. Women who are able to get pregnant but then have repeat miscarriages are also said to be infertile.

A diagnosis of infertility simply means that becoming pregnant may be a challenge rather than an impossibility.

Infertility is typically defined as the inability to achieve pregnancy after one year of unprotected intercourse. If you have been trying to conceive for a year or more, you may need to have an infertility evaluation.

Infertility is a medical condition that has many emotional aspects. Feelings such as anger, sadness, guilt, and anxiety are common and may affect your selfesteem and self-image.