Infertility

What is infertility?

Infertility is the inability to conceive after having unprotected sex during a woman’s fertile period in an attempt to conceive. This can also refer to the inability to contribute to conception. Primary infertility is generally diagnosed when conception does not happen after 12 or more months of trying, which includes multiple miscarriages with no sustainable pregnancy.

It is normal for couples to take up to a year to conceive, and in the absence of other medical conditions, your doctor will generally investigate the causes of infertility if you’ve been trying for longer. In some cases, and in women over the age of 35, this investigation may occur if conception has not happened after six months of trying.

Some other reason to investigate your fertility include:

  • Painful periods
  • A history of fertility problems
  • Older age
  • Irregular or absent menstrual cycles
  • Endometriosis
  • Multiple miscarriages
  • History of pelvic inflammatory disease
  • History of chemotherapy and radiation
  • History of other drugs where infertility is a side-effect

Causes of infertility

Infertility can happen as you age or it can be present from birth. Some of the most common causes of infertility in women include:

  • Ovulation problems – conditions such as polycystic ovarian syndrome and hyperprolactinemia can prevent your ovaries from releasing eggs
  • Damaged fallopian tubes – any damage to the fallopian tubes can affect the fertilisation of the egg
  • Pelvic surgeries, adhesions and infections – the formation of scar tissue can damage the fallopian tubes or other pelvic organs
  • Cervical and uterine abnormalities – abnormal cervical mucous production, problems with the cervical opening, the presence of benign tumours, and abnormal shape of the uterus can contribute to infertility
  • Premature menopause – this is mostly caused by a condition known as primary ovarian insufficiency, which is when menstruation stops before the age of 40
  • Other medical conditions – endometriosis, diabetes, thyroid disorders, kidney disease and sickle cell disease can all affect a woman’s fertility
  • Medication –  certain medications can cause temporary infertility, but ceasing these medications should restore fertility and should only be done after consulting with your doctor
  • Smoking – this can significantly increase the chances of both men and women becoming infertile and can also undermine the effects of fertility treatments
  • Weight – being severely over or underweight can contribute to infertility
  • Mental stress – studies have indicated that stress can have adverse effects on a person fertility
  • Uterine fibroids – are very common, but do not necessarily cause infertility per se, though can be a factor
  • Sexually transmitted diseases – a history of sexually transmitted diseases can have an adverse effect on fertility

How do doctors treat infertility?

For anyone concerned about their fertility, it is a good idea to talk to your doctor sooner rather than later, as fertility testing can take a long time. Your GP can give advice and carry out preliminary assessments. It is important for both partners to have fertility checks. The treatment will depend on the age of the woman, how long she has been infertile, personal preference, and her general state of health.

Infertility treatments for women include:

  • Medication for ovulation disorders
  • Fallopian tube surgery – if the fallopian tubes are scarred or blocked, surgery may repair them
  • Laparoscopic surgery – this can remove scar tissue and implants to reduce pain and improve fertility
  • IUI (intrauterine insemination) –  a sperm sample is placed into the uterus and washed in a fluid to select the best specimens

What is in vitro fertilisation (IVF)?

IVF is an assisted reproductive technology and is a process of fertilisation. This works by extracting an egg, retrieving a sperm sample, and them combining the two in a petri dish. The embryo will be transferred to the uterus.

There are five steps to the IVF and embryo transfer process:

Step one
Fertility medications will be prescribed to stimulate the production of an egg. Multiple eggs are desired, as some will not develop or fertilise after retrieval. A transvaginal ultrasound will be used to examine the ovaries, and a blood test will be performed to check hormone levels.

Step two
The eggs are retrieved by guiding a hollow needle into the pelvic cavity using a minor surgical procedure that uses ultrasound imaging. Medication can be provided to alleviate any potential discomfort.

Step three
The male will be asked to produce a sperm sample, which is prepared for combination with the eggs.

Step four
The sperm and the egg will be mixed together and stored in a petri dish to encourage fertilisation. In cases where there is a low probability of fertilisation, other techniques may be used.

Step five
The embryo will be transferred to the woman’s uterus within three to five days of retrieval and fertilisation. A small tube or catheter is inserted into the uterus to implant the embryos, which is painless for most women, though some may experience some mild cramping. If the procedure is successful, the implantation will typically occur around six to 10 days after egg retrieval.

What are my chances of having a baby if I am infertile?

The success rate of fertility treatments will vary depending on many factors, such as:

  • Age of the partners
  • The clinic
  • The type of fertility treatment
  • Reason for infertility
  • If the egg has been frozen
  • If the embryo has been frozen

The chances of fertility treatments working decreases as a person ages. Fertility treatments can be time-consuming and expensive, but have allowed many couples to have children.

Coping with infertility

It is impossible to know how long a treatment will go on for and if it will be successful, which means coping and persevering can be stressful. The emotional toll can be considerable, and have an impact on relationships. It can be helpful to join a support group to talk to others who have or have had similar problems.

It is important to tell your doctor if you are suffering emotionally or mentally. You may be referred to a counsellor, as well as others who can help offer support.