Infertility
Infertility is the inability to get pregnant even after having frequent and unprotected sex for one year.
Frequent intercourse means every two to three days or more often.
How common is infertility?
- An estimated 15% of couples will have trouble conceiving.
- About 85% of couples will be able to conceive in their first year of trying.
- Additionally, 7% of couples will be able to conceive in their second year of trying
- Infertility affects 10% of women between the ages of 15 and 44 in the U.S.
- In general, fertility begins to decrease for most women in their 20s and 30s and declines more quickly after the age of 35.
- Couples in which the male partner is 40 years or older are more likely to have difficulty conceiving.
Causes of infertility
Female infertility is often due to problems with ovulation that may be caused by ovulation disorders like polycystic ovary syndrome (PCOS), primary ovarian insufficiency (POI), or hyperprolactinemia. Female infertility can also be caused by uterine or cervical abnormalities, fallopian tube damage, uterine fibroids, endometriosis, early menopause, pelvic scar tissue, and even cancer treatment or severe psychological distress.
Male infertility is most often caused by testicles that aren’t working properly.
About 15 percent of infertile couples are diagnosed with unexplained infertility, also referred to as idiopathic infertility. Unexplained infertility most likely involves issues with poor egg or sperm quality, or problems with the uterus or fallopian tubes that aren’t identifiable during normal fertility testing.
Fertility tests for women
Tests to find out the cause of infertility in women include:
Blood tests
Samples of your blood can be tested for a hormone called progesterone to check whether you’re ovulating.
The timing of the test is based on how regular your periods are.
If you have irregular periods, you’ll be offered a test to measure hormones called gonadotrophins, which stimulate the ovaries to produce eggs.
Chlamydia test
Chlamydia is an STI that can affect fertility. A swab – similar to a cotton bud, but smaller, soft and rounded – is used to collect some cells from your cervix to test for chlamydia.
A urine test may be used as an alternative.
You’ll be prescribed antibiotics if you have chlamydia.
Smear Test
Ultrasound scan
An ultrasound scan can be used to check your ovaries and womb (uterus) Certain conditions that can affect the womb, such as fibroids, can prevent pregnancy.
A scan can also be used to look for signs that your fallopian tubes (the tubes that connect the ovaries and the womb) may be blocked, which may be stopping eggs from travelling along the tubes and into the womb.
If the ultrasound suggests a possible blockage, your doctor will refer you to a specialist to discuss further checks, such as a laparoscopy.
During a transvaginal ultrasound scan, an ultrasound probe is placed in your vagina. The scan can be used to check the health of your womb and ovaries and for any blockages in your fallopian tubes.
A hysterosalpingo-contrast-ultrasonography or hysterosonogram (Hy-Co-Sy) is a special type of ultrasound scan sometimes used to check the fallopian tubes.
A small amount of fluid is injected into your womb through a tube put into the neck of your womb (the cervix).
Ultrasound is used to look at the fluid as it passes through the fallopian tubes to check for any blockages or abnormalities.
If the test suggests a possible blockage, your doctor will refer you to a specialist to discuss further checks, such as laparoscopy.
X-ray
A hysterosalpingogram is an X-ray of your womb and fallopian tubes after a special dye has been injected.
It can be used to find blockages in your fallopian tubes, which may be stopping eggs travelling along the tubes and into your womb.
Laparoscopy
Laparoscopy (keyhole surgery) involves making a small cut in your lower tummy so a thin tube with a camera at the end (a laparoscope) can be inserted to examine your womb, fallopian tubes and ovaries.
Dye may be injected into your fallopian tubes through your cervix to highlight any blockages in them.
Laparoscopy is usually only used if it’s likely that you have a problem – for example, if you’ve had an episode of pelvic inflammatory disease (PID) in the past, or if scans suggest a possible blockage of one or both of your tubes.
Fertility tests for men
Tests to find out the cause of infertility in women include:
Semen analysis
This is to check for problems with sperm, such as a low sperm count or sperm that are not moving properly.
If the semen analysis is abnormal, a testicular ultrasound, blood tests and a review by a Urology Specialist may be indicated.
In DF Medical Centre we do most of the infertility investigations for both male and female partner with the exception of tubal testing/Hy-Co-Sy which is performed, with referral letter, in Coombe Hospital and Semen Analysis, for which the male patient is referred to the nearest specialized clinic.
We also have a Urology Specialist that can further investigate and treat male infertility. He performs testicular/prostate ultrasound on site.
If the cause is a female ovulation problem and both the tubal test and semen analysis are normal, we offer:
Follicle tracking ultrasound
Follicle tracking is a series of ultrasound scans, which usually takes 10-15 minutes to perform. These scans are performed from day 9 to day 17 of the menstrual cycle. These scans show the development of follicles, assessing their size and growth. Scanning continues until the follicles have disappeared and ovulation has occurred. We can advise couples through this technique when to have intercourse. Follicle tracking is a natural method of assisted conception, as it simply optimises the timing of the sperm and egg meeting.
Ovulation induction
Ovulation induction uses hormonal therapy to stimulate egg development and release, or ovulation. Historically, these drugs were designed to induce ovulation in women who did not ovulate on their own — typically women with irregular menstrual cycles. The goal was to produce a single, healthy egg.
The second use of ovulation induction was to increase the number of eggs reaching maturity in a single cycle, to increase chances for conception.
More recently, in the mid-90s, evidence developed to suggest there may be an advantage to treating even ovulatory women with fertility medications. These women with “unexplained infertility” may have subtle defects in ovulation, and medications may induce two to three eggs to mature, versus only one. This treatment therefore improves the quality and quantity of the ovulation, thus enhancing pregnancy rates.
