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Infertility PDF Print E-mail
Thursday, 08 May 2008 20:59

Introduction

Infertility is when a couple fail to conceive (get pregnant) despite having regular unprotected sex. Although one in seven couples has difficulty conceiving, the number of couples who are actually infertile is relatively low.

About 85% of couples will conceive naturally within one year if they have regular unprotected sex. Of 100 couples trying to conceive naturally:

  • 20 will conceive within one month,
  • 70 will conceive within six months,
  • 85 will conceive within one year,
  • 90 will conceive within eighteen months, and
  • 95 will conceive within two years.

Therefore, you will only be diagnosed as infertile if you have not managed to have a baby after two years of trying. If you have never conceived a child, it is known as primary infertility. Secondary infertility is when you have had one or more babies in the past, but you are having difficulty conceiving again.

Some women get pregnant very quickly but, for others, it can take longer. Although there is not a cut off point to say when a couple is infertile, it is best to see your GP if you have not conceived after one year of trying.

If you are a woman over the age of 35, or you are already aware that you may have fertility problems, then you should see your GP sooner. They may be able to check for common causes, and suggest treatments that could help. If fertility problems are diagnosed, there are many different treatments and procedures which may be available to you.

For couples who have been trying to conceive for more than three years, the chance of a pregnancy occurring within the next year is 25%, or less.

Causes

Infertility can be caused by many different factors and, in 30% of couples, a cause cannot be identified.

Infertility in women

Ovulation disorders

Infertility is most commonly caused by problems with ovulation (the monthly release of an egg). Some of these problems stop women releasing eggs at all, and some cause an egg to be released during some cycles, but not others. Ovulation problems can occur as a result of a number of conditions that are outlined below.

  • Premature ovarian failure - when your ovaries stop working before the age of 40.
  • Polycystic ovary syndrome (PCOS) - a condition which makes it more difficult for the ovaries to produce an egg.
  • Thyroid problems - both an overactive and an underactive thyroid can prevent ovulation.
  • Chronic conditions - if you have a debilitating condition, such as cancer, or AIDS, it can prevent your ovaries from releasing eggs.

Womb and fallopian tubes

The fallopian tubes transport an egg from the ovary to the womb, where the fertilised egg will grow. If the womb, or fallopian tubes, become damaged, or stop working,then it may be very difficult to conceive naturally. This can occur following a number of procedures, or conditions, as outlined below.

  • Pelvic surgery - this can sometimes cause damage and scarring to the fallopian tubes.
  • Cervical surgery - this can sometimes cause scarring, or shorten the cervix (neck of the womb).
  • Submucosal fibroids - are benign (non cancerous) tumours that develop in the muscle underneath the inner lining of the womb, and may prevent implantation.
  • Endometriosis - this is a condition where cells, normally found in the womb lining, start growing on other organs. This can cause adhesions in the pelvis and limit the movement of the fimbria (tiny fronds at the end of the fallopian tubes) which direct the egg into the tube.
  • Previous sterilisation - some women choose to be sterilised if they do not wish to have any more children. Sterilisation involves blocking the fallopian tubes to make it impossible for an egg to travel to the womb. This process is rarely reversible. If you do have a sterilisation reversed, it will not necessarily mean that you will become fertile again.

Medicines and drugs

The side effects of some types of medication, and drugs, can affect your fertility. These medicines are outlined below.

Non-steroidal anti-inflammatory drugs (NSAIDs) - long-term use, or a high dosage of NSAIDs, like ibuprofen or aspirin, can make it more difficult to conceive.

Chemotherapy - the medicines used with chemotherapy can sometimes cause ovarian failure, which means your ovaries will no longer be able to function properly. Ovarian failure can be permanent.

Illegal drugs - drugs such as marijuana, and cocaine, can seriously affect your fertility, making it more difficult to ovulate. They may also adversely affect the functioning of your fallopian tubes.

Age

Infertility in women is also linked to age. Women in their early twenties are about twice as fertile as women in their late thirties. The biggest decrease in fertility begins during the mid thirties.

Infertility in men

Semen

The most common cause of male infertility is abnormal semen (the fluid ejaculated during sex that contains sperm). Abnormal semen accounts for 75% of male infertility cases, and the cause of abnormal semen is often unknown. Semen can be abnormal for a number of reasons which are outlined below.

  • Decreased number of sperm - you may have a very low sperm count, or have no sperm at all.
  • Decreased sperm mobility - if you have decreased sperm mobility, it will be harder for your sperm to swim to the egg.
  • Abnormal sperm - sometimes sperm can be an abnormal shape, making it harder for them to move and fertilise an egg.

Many cases of abnormal semen are unexplained, but there are several factors which can affect semen and sperm.

Testicles

The testicles are responsible for producing and storing sperm. If they are damaged, it can seriously affect the quality of your semen. This may occur if you have:

  • an infection of your testicles,
  • testicular cancer, or
  • testicular surgery.

Ejaculation disorders

Some men have a condition which makes it difficult for them to ejaculate. For example, retrograde ejaculation, causes you to ejaculate semen into your bladder. The ejaculatory ducts can also sometimes become blocked, or obstructed, and this too can make it difficult to ejaculate normally.

Medicines and drugs

  • Sulfasalazine - this is an anti-inflammatory medicine used to treat conditions such as Crohn's disease (inflammation of the intestine) and rheumatoid arthritis (painful swelling of the joints). This medicine can decrease your number of sperm. However, its effects are only temporary, and your sperm count should return to normal when you stop taking it.
  • Anabolic steroids - these steroids are often used illegally to build muscles and improve athletic performance. Long term use, or abuse, of anabolic steroids can reduce your sperm count and sperm mobility.
  • Chemotherapy - the medicines used with chemotherapy can sometimes severely reduce the production of sperm.

Factors that affect both men and women

There are a number of factors which can affect fertility in both men and women. These include:

  • Weight - being overweight, or obese, reduces both male and female fertility. In women, it can affect ovulation. Being underweight can also impact on fertility, particularly for women, who will not ovulate if they are severely underweight.
  • Sexually transmitted infections (STIs) - there are several STIs which can cause infertility. The most common is chlamydia, which can damage the fallopian tubes in women and cause swelling and tenderness of the scrotum (pouch of skin containing the testes) in men.
  • Smoking - not only does smoking affect your general and long term health, it can also affect fertility.
  • Occupational and environmental factors - exposure to certain pesticides, metals and solvents can affect fertility in both men and women.
  • Stress - if either you, or your partner, are stressed, it may affect your relationship. Stress can reduce libido (sexual desire), therefore reducing the frequency of sexual intercourse. Severe stress may also affect female ovulation and can limit sperm production.

Diagnosis

About 85% of couples conceive naturally after one year of unprotected sexual intercourse, so if you have not conceived after one year, you should visit your GP.

If you are worried about your fertility, or you are a woman over the age of 35, then you should visit your GP sooner. Fertility testing and investigation can be a lengthy process, and female fertility decreases with age, so it is best to make an appointment early on. Your GP will be able to give you advice about what to do next, and will also carry out an initial assessment to look for factors that may be causing your fertility problems.

It is always best for both partners to visit their GP because fertility problems can be caused by a male or female or, in some cases, both. The process of trying to conceive can be a very emotional one, and it is important that you try and support one another, as stress is just one of the many factors that can affect fertility.

Medical, sexual and social history

When you visit your GP, they will carry out a full medical, sexual and social history in order to identify any possible factors which may be causing fertility problems. Your GP may discuss the following with you:

  • Children - your GP will ask a woman if she has given birth previously and will enquire as to whether there were any complications with the pregnancy. They will also ask about any miscarriages. The man will also be asked about whether or not he has had any children from previous relationships.
  • Length of time trying to conceive - if you are young, and in good general health, it is likely that you will be able to conceive naturally. 95% of couples are able to conceive naturally after two years of having unprotected sex. If you have not been trying for a baby for very long, you may be advised to keep trying for a little longer.
  • Sex - you may feel uncomfortable, or embarrassed, about discussing your sex life with your GP. However, it is very important to be honest and open about this because the problem can sometimes be difficulty with sex which can be easily overcome.
  • Length of time since stopping contraception - your GP will consider the type of contraception you were previously using to see whether it may be affecting your ability to conceive. Sometimes, it can take a while for certain types of contraception to stop working.
  • Medication - the side effects of some medication can affect fertility. Your GP will therefore look at any medication you are taking and might discuss alternative treatments with you. You should inform your GP about any non-prescription medication that you are taking, including any herbal medicines.
  • Lifestyle - smoking, weight, alcohol consumption and stress can all affect fertility, so your GP may discuss ways that you could improve your lifestyle, and therefore increase your chance of conceiving.

After taking a medical, sexual and social history, your GP may conduct a physical examination, or refer you for further tests.

Women

When carrying out a physical examination, your GP may:

  • weigh you to see you if you have a healthy body mass index (BMI) for your height and build,
  • examine your pelvic area to check for vaginal infection, or tenderness, which could be an indication of endometriosis, or pelvic inflammatory disease (PID) - see causes section.

After your GP has considered your medical history, and carried out a physical examination, they may refer you for further tests and procedures, as outlined below.

  • Pelvic ultrasound - uses high frequency sound waves to create an image of an organ in your body, in this case an image of your womb and ovaries.
  • Progesterone test - this blood test checks to see if you are ovulating. The test should be taken seven days before you expect a period.
  • Chlamydia test - chlamydia can affect fertility. If you have chlamydia, your GP will be able to prescribe antibiotics to treat it.
  • Thyroid function test - it is estimated that between 1.3-5.1% of infertile women have an abnormal thyroid.
  • Hysterosalpingogram - this is a type of X-ray that checks your fallopian tubes.
  • Laparoscopy - a small cut is made in your lower abdomen and a thin, tubular microscope, called a laparoscope, is used to look more closely at your womb, fallopian tubes and ovaries. Sometimes, dye is injected into the fallopian tubes through the cervix (entrance to the womb) to highlight any blockages.

Men

During a physical examination your GP may:

  • check your testicles for any lumps or deformities, and
  • check your penis to look at its shape and structure and to look for any abnormalities.

Further testing can include:

  • Semen analysis - your semen will be tested to see if you have a low sperm count, low sperm mobility, or abnormal sperm.
  • Chlamydia test - chlamydia can affect fertility. If you have chlamydia then your GP will prescribe antibiotics to treat it.

 

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