Infertility is defined as the failure to conceive after 12 months of unprotected sex between two people of childbearing age.
Women over the age of 35 are advised to seek treatment after 6 months of trying as fertility decreases rapidly after this age due to the aging of the ovaries. Inability to carry a foetus to term may also require fertility treatment.
Infertility is fairly common, occurring in 10% to 15% of couples. Statistically the cause lies with the man in 40% of cases, the women in 40% of cases and with both partners in 20% of cases. In a few cases the cause is defined as “idiopathic,” meaning unexplained.
Many cases of apparent infertility can be easily treated resulting in a healthy pregnancy, while others may require more extensive treatment such as in vitro fertilisation or surgery. In about 20% of cases no pregnancy can be achieved, although success rates often depend on age (older women have a lower success rate).
People often believe that stress causes infertility and that if they “relax and forget about it” they will fall pregnant. While stress certainly doesn’t help, infertility is not your fault and is usually a medical problem requiring appropriate treatment.
The starting point is a comprehensive fertility investigation to determine whether the cause is:
- A semen problem
- An ovulation problem
- A fertilisation problem (egg and sperm failing to unite)
- An implantation problem
The most common causes
- Low sperm count and/or motility (movement) and/or abnormal morphology (size and shape)
- Varicoceles, which are abnormally dilated veins along spermatic cord
- Damaged or blocked sperm ducts
- Hormonal imbalance
- Some men have antibodies to their own sperm, while some women have antibodies to their partner’s sperm
- Testicular failure due to STDs, trauma, surgery, tumours or drugs
- Anovulation (failure to ovulate, i.e. release eggs) due to hormonal imbalance, polycystic ovarian syndrome (PCOS) or sometimes sue to diet or body weight (anorexia or obesity)
- Blockage or scarring of the fallopian tubes, usually after a pelvic infection or sexually transmitted disease (STD)
- Endometriosis, in which the lining of the womb grows outside the uterus, affecting fertility
- Abnormality of the uterus, such as fibroid tumours, scarring due to surgery or trauma or congenital abnormality
- Poor ovarian function due to advanced age or premature ovarian failure; and
- Problems with the cervix
The fertility investigation will include:
- Semen analysis for the male partner
- Routine blood tests to screen out conditions such as HIV, as well as underlying problems such as thyroid function, as well as to determine hormone levels
- An internal examination and ultrasound for the woman to examine the uterus and ovaries
Several tests can be done to determine whether ovulation is the problem, including urine and blood tests. These include urine and blood tests.
Depending on the findings, further investigation may include procedures such as:
- Hysteroscopy (where a thin telescope is inserted into the uterus through the cervix)
- Laparoscopy (a scope introduced through a small incision in the abdomen) to investigate the uterine cavity, ovaries and fallopian tubes.
A fresh sperm sample, probably produced at the fertility clinic’s rooms or lab, would be required for sperm analysis to test for sperm motility (movement) and morphology (shape and size).
Depending on the cause, treatment options include:
- Ovulation induction and timed intercourse
- Artificial insemination (AI) after sperm wash and stimulating ovulation
- Artificial insemination (AI) with donor sperm
- In vitro fertilisation (IVF) in which fertilised embryos are implanted in the womb
- Intra cytoplasmic sperm injection (ICSI) in which the single best available sperm cell is injected directly into the egg
- Pre-implantation genetic diagnosis (PGD) where genetic abnormalities are screened out before implantation