Infertility is when a couple who on the surface have no problems (e.g. regular menstrual cycle, viable sperm etc.) have tried to achieve pregnancy for one year after unprotected sexual intercourse but have been unsuccessful to result in a pregnancy. Women aged 35 and over are recommend to try for a natural pregnancy for 6 months and if after unprotected sexual intercourse there is no viable pregnancy, then it is advised for them to seek medical help.
The definition of Infertility is when no viable pregnancy is achieved after attempts of trying to fall pregnant naturally.
There are two types of Infertility
Couples who have tried to fall pregnant after one year of unprotected sexual intercourse but have had no success.
Couples who have fallen pregnant and had a live birth but when trying again for a second have been unsuccessful.
What are the causes of Infertility?
When assessing a couple and why they are unable to conceive naturally, it is important to assess them together and not put the blame on one partner. As infertility issues are related to both male and females.
Female related Factors (40-50%)
Studies have shown that problem with ovulation is a factor most commonly found in women. A problem of ovulation can be due to there being many eggs and this called Poly-cystic Ovary Syndrome (PCOS), but on the contrary there may be cases where the ovaries are weak for various reasons (advanced age, early menopause, past operations, chocolate cysts, genetic reasons etc.) and this could cause a problem in ovulation too.
The diagnosis of whether there is a problem with ovulation is made by assessing the menstrual cycle, the number of potential eggs which are called Antral Follicles via the aid of the ultrasound, and there are a number of hormones that can be checked also (such as FSH-AMH) to determine the best dose and medication for stimulation.
The fallopian tubes are two thin tubes, one on each side of the uterus, and they help for a mature egg to enter the uterus. When there is an obstruction, this prevents the egg from traveling down the tube, and then a woman has a blocked fallopian tube, also known as tubal factor infertility. The tubes must be healthy for a natural pregnancy, in some cases some women have one damaged fallopian tube and the healthy tube is enough for a pregnancy to occur.
When both tubes are damaged or blocked, it is important to determine whether there is Hydrosalpinx present or what the tubes shape look like etc.
Women who have undergone previous abdominal surgery (appendicitis, Myoma or Cyst removal operations) have endometriosis or have undergone a severe infection that can affect the tubes without knowledge.
HSG (Hysterosalpingography or Hycosy) is a simple imaging method used for assessing the fallopian tubes. If this technique is not used, then a laparoscopy can be carried out with the assistance of a camera that is inserted via the abdomen to determine whether there is a problem with the tubes and they can then be removed accordingly.
Male Related Factors
Approximately 40% of infertility are sperm-related causes. We may refer to male infertility when sperm production is affected by congenital (from birth) or other reasons that may affect sperm and production (vasectomy etc.). In order to evaluate male infertility, an examination called Spermiogram is performed.
After a viable sperm sample is provided, it is then assessed under a microscope the speed, movement and count are monitored in the sperm sample provided.
The results of the Spermiogram can be evaluated by an experienced gynaecologist who has experience in the IVF procedure. They may refer you to an Urologist for an examination and they may advise that more tests will be needed to be carried out if necessary. According to the results of the test, it can be identified if there is or is not a problem and the treatment plan can be prepared according to the sperm findings.
Genetic factors can cause male infertility, such as congenital (undescended testis, congenital absence of vessels, etc.) or acquired conditions (such as febrile diseases such as mumps, varicocele etc.) these can adversely affect sperm production.
Applying the correct treatment according to the findings
It has been found that 20% of couples who undergo fertility tests and seek help, may not actually have a medical reason or explanation as to why they have not fallen pregnant or cannot. In this case it is called unexplained Infertility.
Couples who have been diagnosed with Infertility and have not undergone a cycle of IVF as yet have been known to fall pregnant spontaneously. Patients who are not as lucky then proceed to the next step of beginning their IVF journey.