Infertility is defined as the inability to conceive after one year of regular, unprotected sexual intercourse. Infertility is very common. The World Health Organisation (WHO) says at least one-in-six couples will experience some degree of infertility during their reproductive lifetime.
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Whether you are trying for your first child or subsequent children, having an issue with your fertility can be frustrating and heartbreaking.
What is infertility?
1 in 6 couples will experience infertility
Causes of infertility
This document refers to infertility as when a man and woman cannot conceive after 12 months of timed sexual intercourse. Of course, there are many other reasons why individuals cannot conceive. Please contact Genea to discuss your personal circumstances.
When to investigate
Many people don’t realise just how low their chances of conceiving are each month.
A young, healthy couple has about a one-in-four chance (25 per cent) of conceiving each month.
However, as a woman and a man ages, these rates drop off quite significantly.
While a woman in her early to mid-20s has a 25–30 per cent chance of getting pregnant each month, this starts to slowly decline from her early 30s, then more rapidly from the age of 35. By the time a woman is 40, the chance of getting pregnant each month has fallen to about 5 per cent.
With age one of the most common factors affecting both male and female fertility, Fertility Specialists recommend people seek help sooner rather than later. This means within 12 months of trying to conceive naturally by having regular, unprotected sex (two to three times a week).
This drops to six months if the woman or couple is over the age of 35.
Early investigation to find the cause or causes of infertility is essential and gives patients the best chance of conceiving naturally or through assisted reproductive techniques, such as IVF.
Causes of female infertility
While age is one of the most common factors that cause female infertility, there are a number of others.
These include:
- Ovulation problems – This can be the result of conditions such as Polycystic Ovarian Syndrome (PCOS)
- Hormone problems – Various conditions, such as autoimmune diseases, can interfere with the delicate balance of female hormones required for ovulation to occur
- Endometriosis
- Blocked or damaged fallopian tubes
- Problems with the uterus, such as fibroids
- Lifestyle and environmental factors – Research is showing a link between lifestyle factors such as obesity and female infertility.
Sometimes, the testicles may have been damaged due to past or present infection, injury, congenital defect, undescended testicles, or as a result of cancer or cancer treatment. Occasionally, the tubes that transport sperm can become blocked, causing an obstruction.
Sperm antibodies present in either the male or female can also affect the sperm’s ability to fertilise an egg.
A number of genetic conditions can also affect sperm.
An increasing amount of research has shown certain lifestyle or environmental factors such as pollutants can affect sperm quality. Factors that adversely affect sperm quality include:
- Smoking
- Recreational drugs • Alcohol
- Stress
- Being overweight • Lack of exercise
- Excess heat, sometimes the result of certain occupations.
Age has become an increasing factor in male infertility. From the age of 35, men are roughly half as fertile as they were at 25. From the age of 55, their fertility begins to decrease dramatically.
While some problems relating to male fertility can be addressed with lifestyle changes or treatment, in other cases, the best option to achieve a pregnancy is assisted reproductive technologies
Initial assessment
If a person or couple has tried for some time to get pregnant, without success, it is worthwhile seeing a Fertility Specialist to find out if there are any reasons why conception has not occurred.
The first step will be a comprehensive fertility history for both partners, which looks at age, frequency of intercourse, time spent trying to conceive, a woman’s menstrual cycle, any previous pregnancies, including previous relationships, genital history, including previous genital or pelvic infections, medications and lifestyle factors.
A full medical history of female patients will include details of the menstrual cycle, including whether periods are regular (occurring every 26 to 32 days), duration, and any instances of pain or heavy bleeding that could indicate conditions such as fibroids or endometriosis.
A basic gynaecological exam should be carried out on female patients.
Both male and female patients will be asked to undergo certain fertility tests as part of the initial investigations.
This may include:
FOR MALES
- Semen analysis to check sperm count, motility and morphology
- DNA fragmentation to assess sperm DNA
- Antisperm antibody test to see if you are producing antibodies against your own sperm
- Blood and urine samples to assess general health and look for any conditions that may affect fertility, including STDs.
FOR FEMALES
- Blood tests to check a range of hormones important to fertility, such as FSH, LH and AMH
- Swab to rule out infections and STDs, such as chlamydia
- Pelvic ultrasound to examine ovaries, uterus and fallopian tubes.
If any of these initial tests show anything unusual, further testing may be required. For a woman, this can include a laparoscopy.
Unexplained infertility
Sometimes, despite testing, no clear answer is found for why a person or couple cannot conceive. In these cases it is best to consider beginning IVF treatment, especially if you are over 35.
When to seek help
Regardless of the results, the time spent trying to conceive should be monitored as it provides a strong indicator of fertility. The longer people try to conceive without success, the less likely they are to conceive naturally.
It is recommended that patients try to conceive for a maximum of 12 months, if under the age of 35 and six months, if 35 or over.