Fertility problems

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?

Female problems:

• 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
• Endometriosis

Male problems:

• 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.

Fertility Tests for men:

Semen analysis

Blood tests if indicated

Fertility Tests for women:

Chlamydia screen

Rubella Status

Hormone profile

Assessment of Tubal patency

Pelvic ultrasound

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