Infertility

What is Infertility?

This is the inability of a couple to conceive naturally, which can cause a huge amount of distress when trying to start a family, and a subject that many people find too painful to discuss openly. If couples have not conceived after eighteen months of regular unprotected sexual intercourse, investigation may be recommended by your doctor.

What is the cause of infertility?

Around 15 per cent of couples of reproductive age have difficulty in conceiving which can be due to one of several reasons:

• Problems with production of sperm or eggs, including PCOS
• Problems with the fallopian tubes or the uterus
• Endometriosis in several sites in the pelvis
• Implantation of the embryo and miscarriage
• Hormonal and immune disorders in both men and women
• Long term use of some medication including long-term use of non-steroidal anti-inflammatory drugs (NSAIDs), the medicines used with chemotherapy, and some illegal drugs such as marijuana and cocaine

In addition to the above, infertility in women is also linked to age, and during a woman's mid thirties the biggest decrease in fertility begins.

In a third of infertile couples the problem is due to the male, in a third it is due to the female and in the remaining third there may be a joint problem or the cause may be unexplained.

Other factors affecting fertility

• Being overweight reduces both male and female fertility
• Smoking
• Stress
• Sexually transmitted infections

How is it diagnosed?

Initial investigations include assessment of both partners with blood tests, ultrasound scans and arrangement of checks of the fallopian tubes or sperm count as appropriate with active treatment, advice and planning.

What treatments are available?

Treatments include:

• surgery to unblock fallopian tubes
• tracking with ultrasound to identify optimum fertility
• simple follicle stimulation and ovulation induction

Further treatment would involve appropriate advice and counselling regarding onwards referral for assisted conception if necessary, including IUI (intra-uterine insemination) and IVF (in vitro fertilisation).

For couples with male factor infertility there is the ability to be referred for discussion of sperm treatments and/or ICSI (intra-cytoplasmic sperm insemination).

In many cases treatment is relatively simple but it is an area which is traditionally not always well served in the NHS. Discussion with your specialist infertility consultant and appropriate investigations should enable you to be guided toward your best chance of achieving a successful pregnancy where possible and as soon as possible.