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Basics of Fertilization
 
Every school child Knows that you need eggs and sperm to make a baby. When a man and woman have sexual intercourse, the man places his erect penis inside the woman's vagina. Here it releases millions of sperm when ejaculation occurs. Once the sperm have been deposited here they have a long journey ahead of them.

Some of the sperm swim straight up into the fallopian tubes through the cervix and the uterus - and some of them are so fast, that sperm has been found in the tubes in as little as a few minutes after ejaculation. Some sperm die in the acidic vaginal fluid and some enter the cervical mucus and cervical crypts. They are stored here and can remain alive for as long as 48 to 72 hours, even though the egg remains alive for only 24 hours.

During this time, the sperm is released in small numbers and these continue to swim towards the fallopian tubes. That is why you don't need to have sex every day to become pregnant.

Once the sperm is in the female reproductive tract the whip- like activity of their tail propels them on. Of the millions of sperm released in an ejaculate, only a few hundred will make the arduous trip up to the egg successfully. Perhaps that is why millions of sperm are produced in the first place even though only one is needed to fertilize the egg. There is an inordinate amount of wastage!!

What about the other partner in this mating dance; the egg? Remember that a mature egg is released from the ovary (this process is called ovulation) only once during the menstrual cycle. This is the "fertile time", during which a pregnancy can occur.
 
How does the egg reach the tube?
When ovulation occurs, the mature egg is released from the follicle in the ovary. This process of follicular rupture looks a bit like a small volcano erupting on the ovarian surface. During this time, the tubal fimbria, like tentacles, sweep over the surface of the ovary, and actually "swallow" the egg.

The egg has a shell, called the zona pellucida, and this takes a form which looks like the rings around Saturn. It is surrounded by a cluster of nest cells called the corona cells and these serve to nurture the egg.

They form the cumulus oophorus which is a sticky gel that protects the egg and also helps the beating of the hair-like cilia of the fallopian tube to propel the egg towards the uterus - like a conveyor-belt. The egg must now wait in the protective confines of the fallopian tube for the sperm to swim up to it and penetrate it. An egg remains alive for about 24 hours, and if fertilization does not occur, it dies.

The genetic material of the sperm (the male pronucleus) and the genetic material of the egg (the female pronucleus) fuse - to form an embryo, which then divides into 2 cells. These cells in turn then continue to divide rapidly, producing a ball of cells - the embryo. The embryo then travels through the fallopian tube (which nurtures it and propels it) into the uterus - a journey which takes about 3 to 5 days. The embryo must then break through its zona (this is called embryo hatching); and then attach itself to the lining of the uterus in a process called implantation - and in 9 months, if all goes well, a baby is born.
 
Menstrual Cycle
The menstrual cycle is the time from the beginning of one period to the beginning of the next one. Usually menstrual cycles last about 28-35 days. Anywhere from 3 to 6 weeks is considered normal.

During the menstrual cycle, the uterus gets ready for pregnancy. Under the influence of the hormones oestrogen and progesterone, its lining grows rich and thick to prepare for the fertilized egg. If pregnancy doesn't occur, the uterus must get rid of this lining so that it can grow a new one in the next cycle. The old lining passes out of the uterus through the vagina as the menstrual flow.

Many infertile women are obsessed with their menstrual periods, and they worry about every little variation - whether it's too dark, too light, too much or too little. However, remember that the menstrual flow has no connection to your fertility and you should not be too concerned about variations since these are quite common and of little significance.
 
Basic Tests
In order to understand why pregnancy doesn't occur, we need to examine only the four critical areas which are needed to make a baby-the eggs, the sperm, the fallopian tubes, and the uterus.

The first day the bleeding starts is called Day 1, and a semen analysis to check the husband's sperm count and motility can be conducted on Day 3-4, as long as he abstains from ejaculation for at least 3 days. The wife's blood is then tested in order to measure the levels of her four key reproductive hormones: prolactin, LH (luteining hormone) , FSH ( follicle stimulating hormone) and TSH ( thyroid stimulating hormone). Since these levels vary during the menstrual cycle, the tests should be conducted between Day 3-5 of the cycle. We then carry out a hysterosalpingogram (an X-ray of the uterus and the tubes) after the menstrual bleeding has stopped, between Day 5-7, to confirm whether her uterus and her tubes are normal. The couple is then seen on Day 9 when all the reports and the results are reviewed.

These three basic tests allow us to check whether the eggs, the sperm, the uterus and the tubes are normal. .
 
Myths and Misconceptions
Myth: The reason I'm not becoming pregnant is because most of the sperm leaks out of the vagina after intercourse.

Fact: Loss of seminal fluid after intercourse is perfectly normal, and most women notice some discharge immediately after sex. Many infertile couples imagine that this is the cause of their problem. If your partner climaxes inside you, then you can be sure that no matter how much fluid you lose afterwards, enough sperm will reach the cervical mucus. This discharge is not a cause for infertility.

Myth: A man can judge his fertility by the thickness and volume of his semen. Fact: Semen consists mainly of seminal fluid, secreted by seminal vesicles and the prostate. It is the sperm count that relates to the degree of fertility and not the volume and consistency of the semen. The sperm count can only be assessed by a microscopic examination.

Myth: Infertility is hereditary.

Fact: If your mother, grandmother or your sister have had difficulty becoming pregnant, this does not necessarily mean that you will have the same problem! Most problems related to infertility are not hereditary, and you will need a complete evaluation for confirmation.

Myth: A retroverted ("tipped") uterus causes infertility because the semen cannot swim into the cervix.

Fact: About one in five women will have a retroverted uterus. If the uterus is freely mobile, this is normal, and is not the cause for infertility. Surgery is not necessarily the answer.

Myth: Pillows under the hips during and after intercourse enhance fertility.

Fact: The sperm is already swimming in the cervical mucus as soon as ejaculation as occurred within the vagina. It will continue to travel up the cervix to the fallopian tube for the next 48 to 72 hours. The position of the hips really doesn't matter.
 
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