Fertility difficulties are estimated to affect 1 in 7 couples in Ireland.
Approximately 40 percent of cases are found to stem from female factors and another 40 percent from male factors. In 10 percent of couples, infertility factors are found in both the man and woman. In the remaining 10 percent, the infertility remains unexplained after testing.
Infertility is described as an inability to become pregnant following 2 years of unprotected regular sexual intercourse. A fertility check would be advised in women of 30 years or older at an earlier stage i.e following 1 year of unprotected sexual intercourse. Fertility check would also be advised in women following 2 consecutive miscarriages.
A fertility check comprises of the following details with one of our experienced female doctors:
- Detailed History of your menstrual cycle
- General Health Status
- Relevant Family History
- Pelvic Exam if indicated
- Blood tests day 3 and 21
- Cervical Smear +/- chlamydia swab
- Advice – maximising chances of conceiving
- Risk factors identified and challenged
- Psychological issues addressed
- Partner Semen analysis and risk assessment
- Referral for Hysterosalpingogram – if fallopian blockage suspected
- Referral to specialist fertility clinic —- IVF/NAPpRO/ART where warranted.
What can cause infertility in females?
For a couple to conceive and carry a pregnancy, four parts of the reproductive system must be working adequately:
A woman’s ovaries must be regularly producing and releasing good-quality eggs.
Normal sperm must be produced in high enough numbers and delivered during sexual intercourse.
The reproductive passageways must be clear enough for: a) sperm to enter the uterus (through the cervix) and swim into the tubes to unite with the egg; b) the egg or early embryo to travel to the uterus (through the fallopian tubes).
The lining of the uterus must be capable of having the embryo implant, and of sustaining the pregnancy.
Many types of problems – including hormone abnormalities or blockages caused by infection or scar tissue – can affect one or more of these functions.
It is now recognized that a couple’s infertility is just as likely to stem from problems in the male partner.
Because either or both may be involved, it is important to test both the man and woman before starting treatment. No matter what the cause, most treatments require the active participation of both partners.
Women’s fertility begins to decline gradually after age 30, with a steep drop between 35 and 45. This means that, on average, it takes longer for an older woman to conceive, and older women are more likely to be diagnosed with infertility. Pregnancies in older women are also more likely to miscarry.
The most predictable age-related change is a gradual reduction in the number and quality of eggs produced as a woman enters her late thirties. As she nears menopause, eggs are not released in more and more of a woman’s menstrual cycles, making conception impossible
Also, as women age, they are more likely to have had illnesses or medical treatments that can compromise fertility. Some of these affect the reproductive system directly, such as endometriosis, sexually transmitted diseases (STD), surgery on the reproductive organs, or ectopic pregnancies. Others are general medical problems that can damage fertility, such as hypothyroidism, high blood pressure, diabetes and lupus.
As they age, men may also be exposed to infections, medications, or occupational or environmental chemicals that can impair fertility. However, they do not experience the same dramatic and predictable age-related decline as women.
Couples must find a balance between not allowing enough time for conception and delaying too long (making treatment less likely to succeed).
Can infertility be prevented?
Avoiding Sexually transmitted diseases- gonorrhea and chlamydia are particularly unwanted as they can infect the reproductive tract leading to blockage and scarring of fallopian tubes and also sperm carrying ducts.
If STD suspected to seek early medical opinion and treatment where necessary
When selecting an appropriate contraception remember to inquire as to impact on fertility.
When undergoing treatment for medical conditions alternative or otherwise inquire as to implications on fertility
Healthy lifestyle choices and attitude with healthy body weight and smoking cessation will help increase fertility.
In men : avoid excess heat exposure,
In women: avoid smoking, underweight, rapid weight loss, extreme
Obesity is associated with lower fertility.
Often couples may have more infertility factors which ,although does not make conception impossible, is likely to increase the length of time required to achieve conception.
Thus it is advisable neither to leave it too late in your reproductive life to conceive nor to leave a short time to conceive . Early success is less likely in these circumstances and thus medical intervention well be relied upon earlier when it may not have been necessary.
Can infertility be cured?
Some treatments correct factors that cause infertility. If they work, the infertility should be reversed and a couple should be able to achieve one or more pregnancies. In contrast, other therapies are used to establish pregnancy in a treatment cycle without permanently correcting the underlying problem.
In some cases, medication can improve or correct an underlying medical condition that makes it difficult to conceive. Women with endometriosis, cervical infections, polycystic ovarian syndrome, or hormonal imbalances can be treated with medications, thus easing barriers to conception.
When a woman has blocked or damaged fallopian tubes, surgery to repair them is an example of treatment aimed at curing infertility. If it is successful (meaning the tube is both open and able to function normally), she should be able to conceive one or more times without further medical intervention. However, many experts believe that, for most women with blocked tubes, the chance of becoming pregnant is greater using in vitro fertilization(a technique to get around the problem) than surgery.
When considering various treatments, ask whether each approach is supposed to circumvent infertility or cure it. Get information about the chance of success with each approach (in light of your age and diagnosis) and its costs (including learning if your insurance carrier covers it).
What can we do before seeing a doctor?
While you are trying to conceive, enjoy a healthful lifestyle.
Avoid douching or using vaginal lubricants.
Even a couple with no fertility problems have only about a one in four chance of conceiving during a single cycle.
Increase your chances by having sexual intercourse regularly during the fertile part of your cycle.
An ovulation predictor (available without a prescription) may help you determine when you ovulate so you can better time intercourse.