Take care of your fertility

The time it takes to conceive increases with age. Why? Girls are born with a fixed number of immature egg cells in their ovaries. Their number decreases as age increases. At birth, most girls have about 1 to 2 million oocytes, but by puberty, this number has dropped to 400,000, and by the time women reach 37 years of age about 25,000 remain. By the time the average woman reaches menopause (age 51), about 1,000 more immature oocytes have accumulated in her ovaries, but they are not fertile. Under undisturbed conditions, in every single menstrual cycle, one of the immature oocytes matures and is released during ovulation. In total, there are about 400 such cycles during a woman's entire reproductive period. Cells that do not "get their chance" die and are absorbed by the body. It is important to know that age decreases not only the number of oocytes but also their quality.

The best time for a woman to have a baby is between the ages of 22 and 28. The reproductive capacity of women decreases in their thirties and drops drastically after the age of 35. Every month a healthy, fertile 30-year-old woman has about a 20% chance of becoming pregnant. This means that, for every 100 healthy, fertile 30-year-old women who rely on natural conception for a single cycle, 20 will succeed and the remaining 80 will have to try again. Half of trying couples will get a positive pregnancy test after about 6 months, and 3/4 will get a positive pregnancy test after 9 months. After a year of regular intercourse, about 15% of couples fail to fulfil their dream of having a child. By the time a woman reaches 40, the chance is less than 5% per cycle, which means exactly that less than 5 out of 100 women each month have a chance of getting pregnant. Most women will not succeed in conceiving a child naturally in their 40s.

Research confirms that as the mother gets older, the risk of miscarriage, premature birth, low birth weight, and Down syndrome increases.

A man's age is also not insignificant. The cells that makeup sperm also age, and as they age, they are exposed to harmful factors that can lead to genetic disorders in the offspring. It is estimated that male fertility begins to decline between the ages of 40 and 45. Importantly, just because men can have ejaculatory sex does not mean they are (still) fertile.

Not everyone knows that age also limits the success of conception with assisted reproductive technologies (ARTs), including the effectiveness of in vitro fertilization. Although celebrity stories show mature, affluent parents raising pubertal babies, metrics (especially in women!) matter a great deal, even with the support of ART techniques and the extraordinary dedication of the treatment team.

Source: Material prepared on the basis of information from the "Guide to Fertility" by Prof. J Boivin, Cardiff University, made public by the British Fertility Society, "Age and Fertility" by the American Society for Reproductive Medicine and scientific resources of the American College of Obstetricians and Gynecologists. American Society for Reproductive Medicine, and the research resources of the American College of Obstetricians and Gynecologists.

When you are trying to get pregnant, sex becomes more than just fun. For procreative purposes, it is important to have intercourse often, regularly and with a good attitude. Busy everyday people tend to schedule sex around the time of ovulation, but research confirms that limiting ourselves to a calculated "fertility window" decreases our reproductive effectiveness.

Over the past decade, information has emerged that, at least in theory, can help define the optimal frequency of intercourse. While abstinence intervals longer than 5 days can adversely affect sperm counts, intervals as short as 2 days are associated with maintaining normal sperm density. A common misconception is that frequent ejaculations reduce male fertility. A retrospective study that analyzed nearly 10,000 semen samples found that in men with normal semen quality, sperm concentration and motility remained normal even with daily ejaculation. However, it is worth noting that after longer abstinence intervals of 10 days or more, semen parameters begin to deteriorate.

World recommendations unanimously recommend to have sex every 2-3 days for procreation purposes. When trying to have a baby, it is worth doing it more often than less often, but you should not force yourself to follow a restrictive schedule. In a study involving 221 presumably fertile couples planning to get pregnant, the highest fertility per cycle (37% per cycle) was associated with daily sexual intercourse. Intercourse every other day produced a comparable pregnancy rate per cycle (33%), but the likelihood of success dropped to 15% per cycle when intercourse occurred only once a week.

Interestingly, scientific observations confirm that the stress of trying to conceive reduces confidence, sexual satisfaction, and frequency of intercourse. These parameters worsen when the moment of intercourse is associated with attempts to predict ovulation or strictly plan a potential pregnancy. Therefore, it is worth remembering that reproductive efficiency increases with the frequency of intercourse and is highest when intercourse occurs every 2 days on average, but the optimal frequency of intercourse is one that is in harmony with you and your partner. Stress-free.

For sex education purposes, the term "fertility window" is used. It is best defined as a conventional "time of fertility" covering a 6-day period ending on the day of ovulation. At least, in theory, the viability of both oocytes and sperm should be maximal during this time. For clinical purposes, the period of maximum fertility can be estimated by analyzing intermenstrual periods, sets of ovulation indices, or assessing cervical mucus. Under home conditions, precise calculation of this moment is very, very difficult.

In the case of intercourse, the probability of pregnancy usually occurs during a three-day period ending on the day of ovulation. In the study involving 221 women cited above, peak fertility was observed when intercourse occurred within 2 days before ovulation. In another family planning study, researchers combined data from two groups, one using baseline body temperature monitoring and the other using urinary estrogen/progesterone metabolite analysis designed to determine the likely time of ovulation; the likelihood of pregnancy was highest when intercourse occurred on the day before ovulation and began to decrease on the day of presumed ovulation.

It was observed that among women who described their menstrual cycles as "generally regular," the likelihood of conception from a single sexual intercourse increased during the presumed fertile period. The chance of achieving a clinical pregnancy increased from 3.2% on cycle day 8 to 9.4% on cycle day 12 and decreased to less than 2% on cycle day 21.

It is estimated that a regularly menstruating woman has an average of 13 menstrual cycles per year, or 13 chances to get pregnant. Since accurately predicting ovulation is difficult with any available method, counting on one's infallibility to determine the "fertility window" robs us of valuable reproductive time. The likelihood of conception should be maximized by increasing the frequency of intercourse beginning soon after menstruation stops and continuing through ovulation in women who have regular menstrual cycles. The length of the fertile period can vary among women, changing the probability of success for each individual. Therefore, regular intercourse throughout the cycle is recommended. Targeted intercourse is not advisable; it is better to have sex when you feel like it, bearing in mind that sex for two should not be approached with impatience and tension. After all, in most cases it is not necessary to try to get pregnant, it is enough not to avoid getting pregnant.

It is assumed that over 80% of couples in the general population will become pregnant within 1 year if they do not use contraception and have regular intercourse every 2-3 days. Of the couples who do not get pregnant in the first year, about half of them will get pregnant in the following year. If you are not managing to get pregnant, contact your gynaecologist and/or a fertility specialist. How long you should wait before seeing a doctor depends on your age:

• Women under the age of 35 should seek medical attention after unsuccessful attempts at natural conception lasting at least 1 year.

• Women age 35 or older should see a doctor after 6 months of fruitless efforts.

Source: Joint Practice Committee document of the American Society for Reproductive Medicine and the Society for Reproductive Endocrinology and Infertility, "Optimizing natural fertility: a committee opinion" (2017), National Health Service statistics: https://www.nhs.uk/conditions/pregnancy-and-baby/getting-pregnant/ (1.10.2020), UK National Institute of Health and Care Excellence guidelines (NICE 2004, revised 2013), and the 2018 paper "Diagnosis and Treatment of Infertility - Recommendations of the Polish Society of Reproductive Medicine and Embryology (PTMRiE) and the Polish Society of Gynecologists and Obstetricians (PTGP)".

Cancer is not a death sentence. By taking up the fight against it, you are not only fighting for your life, but also for its quality after cancer treatment. Fertility preservation may be one of its key elements. It is worth knowing this before you start treatment! Why? Many people do not know that with chemotherapy and radiation therapy, the risk of damage to the reproductive system in both sexes is particularly high, potentially making it much more difficult, or even impossible, to have future biological offspring.

In clinical practice, only slightly more than 30% of cancer patients receive fertility preservation information prior to treatment. What we do know is that chemotherapy can lead to the disappearance of menstruation and a significant reduction in the ovarian follicle pool. Depending on the type of drug used, it can lead to the partial or complete destruction of the patient's oocytes. Similarly, radiation therapy can have a devastating effect on the process of sperm formation and maturation. It has also been proven that cytostatic drugs used in anticancer therapy damage not only the spermatogenic epithelial cells but also their genetic material.

This doesn't mean that we don't have any options to protect our fertility. We just need to think about it before starting treatment.

What treatment options are available for women?

Patients can use the following cryopreservation techniques individually or they can also be combined:

• Ovarian tissue freezing - This is recommended when a patient needs to take on cancer quickly and cannot be given the additional hormonal medications needed for hormonal stimulation. Ovarian tissue is harvested using a laparoscope and frozen. Once the cancer treatment is complete, it is thawed and transplanted, so it is not uncommon for a woman to conceive spontaneously without the help of IVF.

• Oocyte vitrification - A woman's gametes are collected, frozen and stored until she recovers and decides to become a mother.

• Embryo freezing - In this case, even before cancer treatment begins, eggs are taken from the woman, fertilized with her partner's sperm ,and frozen as embryos formed after IVF. They can be stored for many years.

A retrospective evaluation of research papers from the past 50 years shows that pregnancy in women does not increase the risk of cancer recurrence.

Sperm preservation in oncology patients

Because cancer therapy can also cause permanent damage to reproductive potential in men, it is recommended that they proactively try to preserve their fertility. Fertility preservation in men is much simpler than in women, and it comes down to donating sperm, which is then frozen. The effectiveness of possible artificial insemination with cryopreserved and fresh semen is the same.

Source: Text based on reports from"Clinical Obstetrics and Gynecology" December 2010 - Volume 53 - Issue 4 - p 727-739, doi: 10.1097/GRF.0b013e3181f96b54 "Toxicity of chemotherapy and radiation on female reproduction" aut. Meirow D., Beiderman H., Anderson RA, Wallace WH, the article "Cisplatin and Doxorubicin Induce Distinct Mechanisms of Ovarian Follicle Loss; Imatinib Provides Selective Protection Only against Cisplatin" aut. Stephanie Morgan, Federica Lopes, Charlie Gourley, Richard A. Anderson, Norah Spears, and the work"Discussions Regarding Reproductive Health for Young Women With Breast Cancer Undergoing Chemotherapy" by Christine M. Duffy , Susan M. and Pregnancy after breast cancer, Upponi SS. et. al. Eur. J. Cancer 2003 (https://fertiprotekt.com/english).

Human fertility is a complex phenomenon, and infertility can result from many causes involving both partners. Studies have shown that extremes of BMI - both deficiency and excess body weight - negatively affect women's reproductive function.

When we think of obesity, we immediately associate it with high blood pressure, diabetes and heart disease. However, most people are surprised to learn that there is a link between overweight or obesity and infertility. Epidemiological data confirms that obesity is the cause of 6% of primary infertility. Low female body weight also accounts for 6% of primary infertility. Thus, a total of 12% of primary infertility is due to weight deviation from established norms. It is believed that this infertility can be corrected by restoring body weight to normal, established limits. It is estimated that over 70% of women who are infertile as a result of weight disorders will become pregnant spontaneously if their disorder is corrected through a healthy diet.

Interestingly, some doctors and patients are so focused on the medical problem that they perceive the body mass parameter as less important in the evaluation of the causes of infertility. The truth is, however, that lifestyle optimization should concern practically every couple who visits an infertility clinic. The awareness of the importance of body weight for reproduction also enables couples to maintain an appropriate body weight or correct any disorders before undergoing the expensive, time-consuming procedure of infertility treatment.

In the human body, adipose tissue is an endocrine organ that influences the action of many hormones. Hormonal disorders can, in turn, contribute to a wide variety of other disorders. It has been shown that both deficiency and excess body weight resulting from a person's diet can adversely affect a couple's fertility.

Analysis of data from the Nurses' Health Study II, an 8-year follow-up of 17,544 women aged 25-42 years who were trying to get pregnant, showed that certain features of the dietary pattern may have a significant effect on reducing the risk of infertility resulting from ovulatory disorders. Greater compliance with a "fertility diet" pattern is associated with a lower risk of infertility due to lack of ovulation. It has been proven that proper dietary and lifestyle habits can reduce the risk of infertility due to ovulation disorders by approximately 69%!

It takes two to have a baby

If a woman's body weight is less than 95% of the predicted ideal body weight or greater than 120% of the predicted ideal body weight, then the primary treatment recommendation should be to increase or decrease it accordingly. Why? Because proper body weight ensures proper functioning of the reproductive system in women and has a beneficial effect on hormonal and metabolic parameters. Reducing or gaining body weight may result in an improved hormonal profile, help restore normal ovulatory cycles, facilitate pregnancy, and allow avoidance of many pregnancy complications resulting from obesity. Maintaining adequate body weight may also promote an improved hormonal profile and reduce disease symptoms in women with PCOS that are overweight as a result.

Over the past 30 years, male obesity in men of reproductive age has nearly tripled and coincides with an increase in male infertility worldwide. Evidence is now emerging that obesity in men has a negative impact on their reproductive potential, not only reducing sperm quality but specifically altering the physical and molecular structure of germ cells in the testes and - ultimately - mature sperm. Recent data has shown that male obesity also impairs the metabolism and reproductive health of offspring, suggesting that a father's health signals are passed on to the next generation, and the mediator is most likely his semen.

Source: American Society for Reproductive Medicine, including "Abnormal body weight: a preventable cause of infertility," "Impact of obesity on male fertility, sperm function and molecular composition," by Nicole O. Palmer, 1 Hassan W. Bakos, 2 , 3 Tod Fullston, 1 and Michelle Lane 1 , 3 ,* published Spermatogenesis. 2012 Oct 1; 2(4): 253-263. doi: 10.4161/spmg.21362; text "The effect of body weight on fertility in women" aut. M. Hajduk (Via Medica) and results of the study by Chavarro J.E., Rich-Edwards J.W., Rosner B.A. et al: "Diet and lifestyle in the prevention of ovulatory disorder infertility." Obstet. Gynecol. 2007; 110: 1050-1058.

Smoking leads to 14 cancer sites and causes nearly 4 million deaths each year.  It also affects every stage of the reproductive process in both men and women. There is no safe limit to cigarette smoking; the only way to protect yourself and your unborn child from the side effects caused by smoking is to quit.

The chemicals (such as nicotine, cyanide, and carbon monoxide) in cigarette smoke accelerate a woman's loss of egg cells. Unfortunately, once the eggs die, they cannot be regenerated or replaced. This means that menopause occurs 1 to 4 years earlier in women who smoke (compared to nonsmokers). Women who smoke during pregnancy have a higher risk of miscarriage than non-smokers. Their babies have an increased risk of low birth weight, premature birth, and birth defects.

Smoking also increases a woman's risk of ectopic pregnancy, in which the baby begins to develop outside the uterus, usually in the fallopian tube, where it will not survive. This is also a dangerous phenomenon for the mother.

To highlight the significant weight of evidence in the literature, a recently published study by Hull using a large population-based sample of pregnant women found that smoking can significantly delay the time to conception. This important observation is the first large-scale population-based study to show that smoking has a negative effect on fertility, independent of other factors. In the women analyzed, active smoking was associated with failure to conceive within 6 or 12 months with an increased delay correlated with an increase in the number of cigarettes smoked per day. The percentage of women who experienced a delay in conception lasting more than 12 months was 54% higher for smokers compared with nonsmokers. Exposure to secondhand smoke further increased the odds of a woman conceiving within 6 months.

Male smokers may suffer from reduced semen quality with lower sperm count and motility and an increased number of abnormally shaped sperm. Smoking can also reduce the ability of sperm to fertilize eggs. Additionally, men who smoke may have trouble getting and maintaining an erection. Intense smoking (more than 20 cigarettes a day) by fathers at the time of conception increases the risk of childhood leukaemia.

Because smoking damages the genetic material of both eggs and sperm, rates of miscarriage and birth defects in offspring are higher among smokers. Smokeless tobacco also leads to an increased number of miscarriages.

Quitting smoking at least three months before trying to have a baby is important to make sure your sperm is healthy for conception.

Source: Material compiled from information in American Society of Reproductive Medicine (https://www.reproductivefacts.org/globalassets/asrm/asrm-content/learning-resources/patient-resources/protect-your-fertility3/smoking_infertility.pdf) and https://www.yourfertility.org.au/everyone/lifestyle/smoking, texts from the Cohrane database and studies "Delayed conception and active and passive smoking" aut. Hull, M., North K., Taylor, H., Farrow, A., Ford, W.C., et al. Fertil Steril 2000; 74, 724 - 732.

We feel young, we live actively, and often we do not even suspect that the age of our ovaries may not correspond with our self-image. It happens differently. However, the biological potential of ovaries can be estimated by AMH determination.

Women are born with a certain, individual lifetime supply of eggs, and the quality and quantity of those eggs gradually decrease as we age. The biological clock ticks at a different rate for each of us. A good indicator of your actual reproductive potential is the determination of AMH levels. Determining the level of your individual ovarian reserve will allow you to assess your chances of becoming a mother.

Anti-Mullerian Hormone (AMH) is a hormone secreted by follicles in the ovaries. A woman's blood AMH level is a good indicator of her ovarian reserve. Learn more about the AMH determination itself. By taking the test at TFP clinics, you can learn the results without leaving your home by logging into the Patient Portal. Importantly, AMH does not change during the menstrual cycle, so a blood sample can be taken at any time of the month - even when you are taking oral contraception.

If you are concerned about your fertility potential - get tested. AMH levels are not rigid, fixed or age specific, they fluctuate over time, so tracking them is key.

About 13 out of 100 couples cannot get pregnant by having unprotected sex. There are many causes of infertility, and in more than one-third of infertility cases, the problem concerns the man. Knowing the root of the difficulties and proactively counteracting them is important and gives a significant number of people a chance to biologically conceive a child.

How do you find out if there is a male factor underlying the failure?

You need to get tested, simply put. A standard semen examination is the first step in assessing a partner's fertility. A seminogram determines, in a very fast and reliable way, the state of reproductive health of a man. To perform it, one visit to the clinic is often enough. Based on the results of the analysis of the ejaculate, the urologist or andrologist may order further, extended analyses, which will more fully describe the clinical situation of the patient and take the appropriate steps to bring the couple closer to parenthood.

Semen is examined for the number and quality of sperm present. For example, any abnormalities in sperm shape (morphology) and movement (motility) are looked for. The andrology lab may check the ejaculate for signs of possible problems, such as infections.

Basic semen examination in our clinic is performed in accordance with the most current guidelines of the World Health Organization - according to the fifth edition of WHO ("Laboratory manual for the Examination and processing of human semen 2010"). The current semen standards according to WHO state that the volume of semen should be at least 1.5 ml. The correct concentration is considered to be 15 million sperm in 1 ml of semen. More than half should be live sperm, and 32% of them should show progressive movement. It is important that a minimum of 4% of the sperm have the correct structure. The appropriate pH of the sperm should exceed 7.2. If something is wrong, the fertility specialist should provide a targeted approach to therapy and suggest treatment.

If you want to ensure peace of mind in your family planning, it's a good idea to make sure that nothing (and it's often trivial reasons!) gets in the way of paternity. Know that at TFP clinics, the wait time for the results of a basic semen test is, at most, 2 hours. You can even easily check the results without leaving home (through the Patient Portal) or pick them up at the clinic the same day. There is no need to wait!

There is strong scientific evidence that alcohol can reduce fertility in both men and women. Why does alcohol reduce your chances of having a baby? What amount is too much when trying to get pregnant?

Alcohol consumption is associated with many reproductive health risks. Studies in humans and animal models have shown changes in ovulation and menstrual cycle regularity in women with prolonged alcohol consumption. Schliep et al. found that increased alcohol consumption increased estradiol, testosterone, and LH levels, with greater increases observed in women who reported binge drinking, although not accompanied by menstrual cycle disturbances.

It has been proven that heavy alcohol consumption can reduce ovarian reserve and reproductive capacity in women. Ovarian reserve, a measure of a woman's reproductive potential determined by her remaining egg cells, can be measured in a variety of ways, including levels of follicle-stimulating hormone (FSH) and anti-Müllerian hormone (AMH), as well as the number of antral follicles. A study of African-American women in Michigan found that women who regularly drank two or more times a week had 26% lower AMH levels than current drinkers who did not drink after adjusting for age. There is also evidence that women who suffer from alcoholism may experience menopause at an earlier age than their alcohol-abstaining counterparts.

If you are already pregnant and drank only small amounts of alcohol early in your pregnancy, your risk of harming your baby is low. However, it is important to remember that drinking alcohol during pregnancy can lead to long-term health problems in the baby, such as the onset of Fetal Alcohol Syndrome (FAS). For this reason, the safest approach for pregnant women is to abstain from alcohol altogether.

Alcohol consumption in men can also cause fertility problems. Some studies of long-term heavy alcohol use have reported decreased gonadotropin release, testicular atrophy, and reduced testosterone and semen production. A reduction in the quality of semen parameters in heavy alcohol users has also been consistently documented, even with occasional azoospermia. In addition, there is strong evidence that alcohol abuse and acute intoxication are associated with sexual dysfunction, including impaired arousal and desire, as well as erectile and ejaculatory dysfunction, which can lead to difficulty conceiving.

The most important thing in the context of alcohol is moderation. If we don't exceed an average amount of 25g of alcohol per day and at the same time we take care about the quality of the alcohol we consume (e.g. opt for good red wine), we shouldn't suffer any negative consequences. When it comes to alcohol, a little bit of pleasure is allowed, but use good judgeand in moderation!

Source: Material prepared on the basis of the publication "Alcohol and fertility: how much is too much". "Alcohol and fertility: how much is too much?" KV Heertum and B. Rossi, as well as Polish documents: "Dietary management as an element of treatment of fertility disorders in men with reduced semen quality" by aut. A. Jeznach-Steinhagen and A. Czerwonogrodzka-Senczyna, the article "Influence of the diet on the fertility of men and women" auth. B. Sawaniewska, D. Gajewska and E. Lange, as well as the materials "Problems of procreative health related to alcohol consumption" by J. Moskalewicz and "Fertility disorders in alcohol-dependent men" by A. Moskalewicz. A. Czerwiñska and T. Paw³owski and once the work "Diet and fertility" by D. Szostak-Węgierek.

Undetected or untreated STDs are very often virtually asymptomatic, but they do a lot of damage to the reproductive health of the couple.

Chronic inflammation of the cervix and endometrium, changes in reproductive tract secretions, induction of immune mediators that affect gamete or embryo physiology, and structural abnormalities (i.e., intrauterine adhesions) contribute to female infertility.

Infections caused by bacteria, viruses or protozoa attacking our genitourinary system are also a major factor causing reduced fertility in men, second only to abnormal semen parameters in the list of major fertility killers. Obstruction of the epididymides or ducts or testicular damage caused by testicular inflammation are just some of the mechanisms that can affect fertility in men through the inflammation caused by STDs.

What bacteria are primarily considered infertility bacteria?

Chlamydia trachomatisi, which is transmitted during sexual intercourse, is also transmitted during during childbirth. This infection, unfortunately, is most often asymptomatic or "scanty", which makes it more harmful because the lack of symptoms prevents the patient from seeking prompt medical intervention. If it does manifest, the first symptoms are usually unnatural vaginal discharge and burning during urination in women and discomfort during urination in men. When you observe such symptoms, act immediately! Keep in mind that chlamydia trachomatis causes about 50% of epididymitis in sexually active men under the age of 35. Long-term, untreated infection can lead to powerful damage to fertility potential in men, as well as pelvic inflammatory disease in women.

Gonorrhoea can also affect the reproductive system, especially in men. One of the possible complications of untreated infection with this pathogen is epididymitis, which can result in obstruction of the vas deferens and problems with conception.

It is important to know that women are twice as likely as men to get gonorrhoea or chlamydia during a single unprotected intercourse with an infected partner.

Diagnosis of urogenital infections for pathogens should be a concern for you if you fail to spontaneously conceive a child after 12 months of regular, frequent sex every 2-3 days. You should go to a doctor, have the proper tests done, identify the problem, and start the necessary treatment.

Remember that treating sexually transmitted infections or other infections greatly helps prevent damage, disability, chronic pelvic pain, altered ovarian-ovarian relationships, and ultimately helps maintain fertility. In both sexes!

Source: Text based on the review "Genital Infections and Infertility" edited by A. Darwish, the material "Conditions that affect fertility" published by Harvard Health Publishing and ASRM guidelines on the impact of sexually transmitted diseases on human fertility (https://www.asrm.org/topics/topics-index/sexually-transmitted-infections/)

The individual functioning of the reproductive organs, as well as diseases, can be related to many psychological factors. Their influence may be psychosomatic (when psychological factors affect the human body and its functioning) and somatopsychic (when diagnosed illnesses or body conditions affect psychological functioning). Being a parent can be an extremely important factor affecting self-development and self-fulfilment, for both women and men. In a situation of inability or difficulty in satisfying one's need to become a parent due to disorders in the functioning of sexual organs or control systems, psychological problems arise. The higher in the hierarchy of human needs the need to be a parent is, the greater the frustration caused by the deprivation of this need. The key point is that the consequences of this frustration have a direct impact on the relationship between the partners.

Research conducted so far shows that, after one year from the beginning of efforts to have a child, the vast majority of people experience their failure to conceive an offspring as a psychological problem. Although the motives for having a child are varied (strengthening the bond between the partners, expression of feelings in the relationship, immortality through the transfer of genetic material) problems with pregnancy in almost every case lead to a crisis that can be called growing trauma. A study by Freeman et al. found that as many as 48% of women who underwent in vitro fertilization described infertility as "the most difficult experience of their lives." In other studies, the stress of infertility has been compared to "(...) the stress experienced after the loss of a loved one, or the stress that occurs after a cancer diagnosis or a myocardial infarction" (Bidzan, 2010, p. 43).

Infertility in some ways is similar to losing a loved one. The circumstances are special in that, in this case, the loved one never existed. You can, while trying to have a child, become emotionally connected not with a concrete, real existing person, but with an idea of a legitimate offspring and of life in a family with a child. In such a situation, you might feel a loss of the opportunity to realize your desires and dreams at a particular point in life.

The diagnosis and treatment of infertility also affects the functioning of the couple and their feelings and behaviour towards each other. Whether the difficulty in conceiving is on the female or male side, the problem always affects both partners in the relationship. The treatment process requires a great deal of commitment and input from each of them, as well as compliance by both parties to the doctor's instructions. The therapy to achieve conception is time-consuming and also expensive. It's important to remember the fact that the emotional reactions and behaviour of each party directly affect the feelings of the other party. The interactions between the two parties can both exacerbate and amplify the intensity of negative emotions.

Taking into account the enormous impact the process of trying for a child has on a person's functioning, not only medical but also psychological care seems to be an extremely important factor. Maintaining internal balance, awareness of experienced emotions and constructive ways of coping with stress, often turn out to be a key factor in the success of treatment.

Prepared by Daria Terlikowska based on the literature on the subject.