Fertility and Parenthood

What is fertility, and what affects it?

Fertility is the ability to start a pregnancy. A healthy couple does not conceive every month. Even at the best age, the chance in any one month is only around one in four. It is a matter of timing as well as health. Eggs are released once a month (ovulation), and only a few days around that time can lead to pregnancy.

Things that affect fertility:

• Age: in women fertility slowly falls from the late twenties and faster after about 35. In men it falls more slowly.
• Health: body weight that is too high or too low, thyroid problems, PCOS (a hormone condition), endometriosis, diabetes.
• Lifestyle: smoking, heavy alcohol, drugs, long stress, poor sleep. In men, very hot surroundings can lower sperm quality.
• Infections: untreated infections of the reproductive system can block tubes. Safe sex and early treatment protect fertility.

These numbers are rough guides. Every person is different.

Infertility: causes and treatment

Infertility means not being able to conceive after about 12 months of regular, unprotected sex (six months if the woman is over 35). It is a medical condition. It is nobody's fault and not a reason for shame.

Causes are found roughly equally in three groups: about a third in the woman, about a third in the man, and about a third in both or unknown.

• In women: ovulation problems, blocked tubes, endometriosis, problems of the womb.
• In men: few sperm, slow sperm, blockages, hormone problems.

Treatment climbs step by step. First, healthy habits and treating illnesses. Then medicines (for example to help ovulation). Then small operations (for example to open a blocked tube). Then assisted methods: IUI (sperm are placed inside the womb) and IVF (egg and sperm meet in a laboratory dish, and the embryo is placed in the womb). Some couples choose adoption instead. Both partners should be tested together.

Pregnancy, birth and the time after

Pregnancy lasts about 40 weeks, a little over nine months, in three parts called trimesters. In the first part the main organs form. In the second the baby grows and movements are felt. In the third the baby gains weight and gets ready for birth.

Birth happens either through the birth canal or by an operation called a caesarean section, when the doctor decides it is safer. Birth is best with a trained doctor, nurse or midwife, in a place with emergency help.

Postpartum means the weeks after birth. The mother needs rest, healthy food, and a check-up. Feeling low or tearful in the first days is common, but if it lasts, talk to a doctor.

Breastfeeding: begin within the first hour. Give only breast milk for the first 6 months, then add soft foods and keep feeding milk until two years or more (this is the advice of the World Health Organization).

Baby care basics: keep the baby warm and clean, keep the cord stump dry, put the baby to sleep on the back, follow the vaccine schedule, wash hands before touching the baby.

Perinatal care and women's rights

Perinatal care means care before, during and after birth. It has three parts.

• Before birth (antenatal): regular check-ups (the WHO advises at least eight), iron and folic acid tablets, a tetanus vaccine, blood pressure and blood tests.
• During birth: a trained helper, a clean place, quick help if something goes wrong.
• After birth (postnatal): check-ups for mother and baby, feeding help, family-planning advice.

Danger signs: heavy bleeding, severe headache, swelling of face and hands, fever, the baby moving much less. Go to a health centre at once.

Rights: every woman has the right to respectful care, to understand what is being done and to agree to it, to privacy, to information on family planning, and to emergency care. Many countries give paid maternity leave (for example 26 weeks for the first two children in India) and protect women from losing a job because of pregnancy. Check the law of your country. Fathers can share care, and some countries give paternity leave.

Miscarriage and abortion: what the words mean

Miscarriage is the natural loss of a pregnancy early on, before the baby could survive outside the womb (usually before about 20-24 weeks). It is common: roughly one in ten known pregnancies. It is usually not caused by anything the mother did. It can be very sad, and support and time to recover are important. Seek a doctor if there is bleeding or pain.

Abortion means ending a pregnancy on purpose, by medicine or a small procedure done by a trained health worker. The laws are different in different countries, and people hold different views. Where it is allowed, doing it with a trained provider is much safer. Unsafe abortion can be dangerous. In this lesson we only explain the meaning and the medical safety. Please ask a doctor or check your country's law for details.

Try it

In the 3D move the Age slider and watch the bars. Move Habits from 0 to 5 and watch the scale tip. Then move Month from 1 to 9.

At home: with an adult, find the nearest health centre and write down the vaccines a baby gets in the first year. Draw a 6-month and a 2-year line to show how a baby is fed.

Key formulas and definitions

• Fertility = ability to start a pregnancy; depends on age, health, lifestyle, infections
• Infertility = no pregnancy after about 12 months of trying (6 months if over 35)
• Causes of infertility: about 1/3 woman, 1/3 man, 1/3 both or unknown (rough)
• Pregnancy ≈ 40 weeks ≈ 9 months = 3 trimesters of about 13 weeks
• Breastfeeding: start in the first hour; only milk for 6 months; continue to 2 years or more
• Perinatal care = antenatal (before) + intranatal (during) + postnatal (after)

Worked examples

Common mistakes

• Blaming only the woman for infertility. Causes are found in men about as often.
• Thinking fertility never falls. In women it falls with age, especially after the mid-thirties.
• Giving water, honey or other foods to a newborn. Only breast milk is needed for 6 months.
• Skipping check-ups when feeling well. Many risks can be caught early only by tests.