Infertility can be defined as the inability to conceive despite having regular unprotected sex for a year or more. For some, getting pregnant can take some time, but we recommend seeking help if you have been trying for over a year.
There are many reasons for infertility, and it can affect both men and women. Conception occurs when the female partner produces an egg from one of her ovaries and the male partner has a high number of good quality sperm to fertilise the egg. After fertilisation has occurred, the embryo then implants in the womb where it develops. If any of these processes are compromised at any stage, the chances of conception are reduced.
Fertility and Age
The most common reason for female infertility is age. Studies have shown that fertility begins to decrease after the age of 35, and by the age of 40 is in significant decline.
The main explanation for age-related infertility is simply the approaching end of a woman’s reproductive life. Women are born with their lifetime supply of eggs, which sit in the ovaries at different stages of development and diminish in quantity and quality with age. Ovarian reserve is a measure of female fertility during the reproductive years and can be tested by hormone levels and ultrasound through our female IVF diagnostic tests.
Problems with ovulation are one of the most common causes of infertility for women. Poor egg quality, failure to ovulate through hormonal deficiency or imbalance, irregular ovulation and Polycystic Ovary Syndrome (PCOS) are commonly encountered problems.
Womb and Fallopian tubes
Your Fallopian tubes carry eggs from your ovaries to the womb and can be blocked or damaged, reducing the chances of eggs meeting sperm. Possible reasons include:
• scar tissue
• pelvic inflammatory disease
• adhesions from an 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.
Endometriosis is a condition where tissue that normally grows in the uterus implants and grows in other places in your body and can cause scarring, which may block your fallopian tubes. Mild cases of Endometriosis can be treated with a procedure known as a laparoscopy. More severe cases however can cause more serious fertility issues.
Too many people experience the heartbreak of miscarriage. It isn’t really possible to know exactly how many miscarriages occur because sometimes a miscarriage can happen before pregnancy is confirmed. Studies indicate that miscarriage occurs in around 1 in 4 recognised pregnancies, with 85% of those happening in the first trimester (weeks 1 to 12).
In the first 12 weeks, the most common cause of miscarriage is an issue with development of the embryo.
However, physical complications or health issues including shape of the uterus, diabetes, thyroid disease, hormonal problems, or immune conditions can also cause miscarriage.
Our recurrent miscarriage tests are designed to investigate the underlying cause of miscarriage and help us identify appropriate treatment options. We may recommend PGT-A (Preimplantation Genetic Testing). This test gives us information about the genetic health of embryos to help us identify embryos which have the correct number of chromosomes (chromosomes are very important for healthy growth and development).
CAREunity is a test which looks at a genetic "variation" in a specific gene (Annexin A5) which is partly responsible for normal clotting in our body. The presence of the variant gene can be associated with blood clotting disorders (sticky blood). Increased clotting in the placenta can lead to miscarriage or implantation failure by reducing the blood flow to the embryo at a very early stage of its implantation in the womb.
When you have been through miscarriage, having lots of support is really important. Talk to your family and friends family about how you are feeling, or you might want to reach out to a support organisation.
You can read one of our patient stories here.
You may also want to consider having a consultation with one of our specialists.
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.
Being overweight, being seriously underweight, smoking, and drinking too much alcohol can all have a negative impact on your fertility. Read more about our top tips for improving fertility.
Sperm Quality & Quantity
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. 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.
Intra-Cytoplasmic Sperm Injection (ICSI) can help to overcome certain male fertility problems caused by low sperm count or poor sperm quality. There are also a range of male diagnostic tests we can perform to identify if there are any issues with the sperm.
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. 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 a testicular operation. If this is the case, it may still be possible to retrieve sperm surgically.
Sulfasalazine 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 sperm freezing 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.
When you’re ready, talk to us. We will give you the information and support you need together with clear guidance on what we need to do together to achieve the best chance of success for you.
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Or contact our new patient enquiry team on 0800 654 2270
Whilst we aim to help everyone, there are some situations where we are unable to treat certain patients. These criteria are outlined below: