Fertility Problems - what could be causing your problems
You are not alone. Problems with conceiving a child are much more common than you may realise. Around one in six couples experience some difficulty in achieving a pregnancy, but the good news is that we can help almost 90% of them to achieve their dream of starting a family.
Have you got a fertility issue?
If you've had regular, unprotected sex for a year without falling pregnant, then you may have a fertility problem.
What might be causing it?
There are a number of possible reasons for infertility, after all the process of conception is a complex one:
For conception to take place and pregnancy to occur, hundreds of individual hormonal, chemical and physical events must take place at exactly the right time. A sperm must form in the testicle, mature, be released into the vagina, ‘swim’ through the cervical opening, continue through the uterus and into a fallopian tube. In the tube, it must encounter a healthy egg within hours of the egg's release, attach itself to the egg, penetrate its outer shell and fertilize it. After staying in the fallopian tube for about three days, the fertilized egg must descend into the uterus, grow and divide for a few more days and then implant itself in the womb. And all during this period the womb is undergoing changes to provide a fertile bed in which the embryo can implant normally.
Who should I speak to?
It is worth making an appointment to see your GP and discussing the issues surrounding your fertility and general wellbeing. If your GP feels that further investigation is necessary, he will refer you to a fertility clinic such as CARE.
Is there anything else I can do?
It is worth finding out some basic information about infertility and the CARE website is a good place to start. Or you could come along to one our Patient Information Evenings which are held on a regular basis at each of our four main clinics.
Your first consultation at CARE
When you attend your first consultation, one of our doctors will complete a review of your medical history. The doctor will also answer any questions you have.
You will both undergo some straightforward screening tests which may include blood tests, swabs and a semen assessment for the male partner. These tests will help us determine the cause of infertility and make recommendations about the most appropriate treatments available whilst evaluating your chances of success. In some cases more extensive investigation is required.
Around 30% of infertility is attributed to female factors, around 30% to male, 20% combined male and female and 20% is unexplained.
Problems with ovulation are the most common causes of infertility in women. Poor egg quality, failure to ovulate through hormonal deficiency or imbalance, irregular ovulation and Polycystic Ovary Syndrome (PCOS) are commonly encountered infertility problems. They are often related to your age especially since egg quality is known to deteriorate quite dramatically from your late thirties onward. Premature ovarian failure, where your ovaries stop working before you are 40 is another reason for female infertility.
After a full assessment of your condition, treatments can include IVF, donor eggs and fertility drugs.
Womb and Fallopian tubes
Your Fallopian tubes which carry eggs from your ovaries to the womb can be blocked or damaged preventing any chance of eggs meeting sperm. The reasons include
- scar tissue
- pelvic inflammatory disease
- adhesions from a previous operation
- damaged tube ends
- pelvic or cervical surgery
- submucosal fibroids
If you've previously been sterilised and had the procedure reversed, remember that it will not necessarily mean that you will become fertile again.
Treatment is usually by IVF, however sometimes if the problem is a blockage, and it is very localised, then it can be possible to clear it by keyhole surgery.
The drugs involved with Chemotherapy can sometimes cause ovarian failure which, sadly, can be permanent.
Advances in egg freezing of course now mean that if you have to undertake a course of chemotherapy you can take the precaution of freezing eggs in advance of your treatment.
Perhaps surprisingly, the long term use of some common medicines like Ibuprofen and Aspirin can make it difficult to conceive, as will the use of substances like Cocaine and Marijuana.
The most common cause of infertility in men involves abnormal or insufficient sperm. Problems can arise when either not enough sperm is being produced, or the sperm is of poor quality. In this case we mean that the motility can be low which affects the sperm's ability to ‘swim’ as vigorously as it needs to, or the sperm can be abnormally shaped. A normal sample will show 20 million sperm per millilitre at least half of which will be active.
Problems with sperm can be very difficult to solve, however some success has been achieved with fertility drugs, particularly in increasing volume. The development of Intra-Cytoplasmic Sperm Injection (ICSI) has also been a major step forward for couples with male infertility problems.
Either the tubes which store and carry your sperm from your testicles, or the vas deferens which lead from them and carry sperm immediately prior to ejaculation can be blocked. If everything else is healthy then a simple procedure to retrieve sperm may be the recommended way forward.
The testicles produce and store your sperm. Clearly, if they are damaged it will affect the quality and quantity of the sperm you produce. The damage could be caused by a wide number of events such as an infection, or testicular cancer or a testicular operation.
In these case, it may still be possible to retrieve sperm surgically.
Sulfasalzine used to treat Rheumatoid Arthritis and Crohn's Disease can decrease your sperm count, however the effects are only temporary and you should return to normal after your course of treatment. Long term use and abuse of Anabolic Steroids will reduce the number of sperm you produce and affect their motility. The drugs involved with Chemotherapy can severely reduce your production of sperm, however advances in egg and sperm freezing of course now mean that if you have to undertake a course of chemotherapy you can take the precaution of freezing sperm in advance of your treatment.