What is Infertility?
Infertility is a failure to conceive despite regular unprotected sexual intercourse at least 2- 3 times a week.
84% of couples will achieve a pregnancy within a year and 95% by 2 years.
About one in seven couples living in the western world have problems conceiving
Primary infertility: Failure of a couple to conceive or have achieved a pregnancy in the past.
Secondary infertility: Failure of a couple who have had one or more pregnancies to conceive.
What are the risk factors for infertility?
Age: A woman’s fertility declines from around 32 years of age.
Smoking: Smoking significantly increases infertility in both men and women.
Alcohol: Alcohol misuse can lower male fertility
Obesity: obesity in women and a sedentary lifestyle affect fertility and in a man can result in abnormal sperm.
Eating disorders: Being underweight causes problems with fertility
Diet: Lack of iron, folic acid, zinc and vitamin B12 can cause infertility problems
Over exercise: Exercising for more than 7 hours a day can affect ovulation.
Sexually transmitted infections: Chlamydia can cause tubal damage as can gonorrhea amongst many other infections.
Exposure to chemicals: pesticides, herbicides and solvents have been linked with infertility.
Mental stress: Ovulation and sperm production are affected by mental stress
What are the causes of infertility?
- The ovaries are not releasing eggs (anovulation) or the eggs are immature
- Uterine abnormalities
- The fallopian tubes are damaged or blocked or absent (for example after surgery for an ectopic pregnancy)
- The lining of the womb does not develop properly
- Hormone problems
- Sex-related problems (difficulty getting an erection or ejaculating)
- Retrograde ejaculation (sperm travels backwards to the bladder)
- The tubes that carry the sperm are damaged or blocked or absent
- Testicular failure
- Drug treatment
When should a couple seek medical advice?
Couples should try for a minimum of one year before seeking medical advice. If either of the couple have a known medical condition that can affect fertility, or the female partner is older than 35 years medical help could be sought after 6 months of trying. These patients should be investigated and referred to a specialist centre.
What investigations do we need?
A detailed medical history and examination of both partners is undertaken.
Blood tests if indicated
Assessment of Tubal patency
Assessment of ovarian reserve (AMH)
What Treatment options are available?
Ovulation induction: Medication is given to stimulate the ovary into developing eggs that mature for ovulation. This can be in the form of tablets (Chlomiphene citrate) or injections called Gonadotrophins
Artificial Insemination: Intrauterine insemination (IUI) is a process where sperm is washed and prepared for placement into the uterine cavity, bypassing the cervix.
In Vitro Fertilization (IVF):Is a process where eggs are collected and fertilized outside the body in a laboratory.
Intra Cytoplasmic Sperm Injection (ICSI) is a technique used to fertilise eggs by injecting a single sperm into a mature egg.
Donor egg or sperm: Third party provides either sperm or eggs with the purpose of helping the infertile couple achieve a pregnancy
These treatments are available in specialist infertility centres
Further discussions will depend on the cause identified for infertility