Causes of infertility
If you've had regular, unprotected sex for a year without falling pregnant, then you may have a fertility problem.
Try not to worry though. Problems with conceiving 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.
Infertility - Did you know?
Around 30% of infertility is attributed to female factors, around 30% to male, 20% combined male and female and 20% is unexplained.
Answering your top infertility FAQs
Charles Kingsland and Alison Campbell host a Facebook Live event at CARE Fertility Manchester.
What causes infertility?
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.
Female fertility problems
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.
Ovulation
Problems with ovulation are one of the most common causes of fertility issues for women. Poor egg quality, failure to ovulate through hormonal deficiency or imbalance, irregular ovulation and Polycystic Ovary Syndrome (PCOS) are commonly encountered problems. They are often related to age especially since egg quality is known to deteriorate quite dramatically from late thirties onward. Premature ovarian failure, when the ovaries stop working before age 40, is another reason for female infertility.
After a full assessment, treatment can include IVF, ovulation induction or IVF with donor eggs.
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
• endometriosis
• 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.
Miscarriage
So many people go through the heartbreak of losing a baby. In the first 12 weeks, the most common cause of a miscarriage is an abnormality in the embryo. You might wish to consider PGT-A in your treatment, as this identifies the chromosomal normal embryos which can be transferred, increasing the likelihood of a successful pregnancy.
Over 12 weeks it is more likely that the loss of pregnancy could be due to a maternal factor - it may be the uterus isn't working very well or the neck of the womb - the cervix - opens too early, or there's an abnormality in the pelvis. It is very unlikely that a woman will miscarry three times in a row but if she does, there is the possibility of an underlying immunological factor whereby the embryo doesn't implant properly or the body itself rejects a normal pregnancy or is mis-reading the embryo signals. We may need to undertake further investigations to look at the possibility of there being an underlying immunological abnormality.
Professor Charles Kingsland discusses miscarriage
Medication
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.
Overall health
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.
Male fertility problems
Sperm
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.
Excess oxidative stress in the body has been linked to abnormal sperm morphology and motility, as well as sperm DNA and cell membrane damage, contributing to poor sperm function. There are a range of male diagnostic tests we can perform, including Sperm Oxidative Stress (SOS) tests.
Blocked tubes
Either the tubes which store and carry your sperm from your testicles, or the vas deferens which leads 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.
Testicles
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.
Medication
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.
Next steps
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.
It's simple to get started with CARE:
Or contact our new patient enquiry team on 0800 564 2270
Treatment criteria
Whilst we aim to help everyone, there are some situations where we are unable to treat certain patients. These criteria are outlined below:
- Anyone who has a serious, pre-existing medical condition which would make it unsafe for them to become pregnant. If you think that this may apply to you then the first step might be to seek advice from your GP or an obstetrician.
- Anyone who has a serious, pre-existing medical condition or a serious allergy which would make it unsafe for them to undergo a procedure under conscious sedation in one of our CARE clinics. Not all of our treatment options will need you to have a procedure (if you’re having ovulation induction, treatment with donor eggs or surrogacy for example) but if you think that this may apply to you then let our appointments team know and they can seek some advice before making your appointment.
- Anyone with a BMI over 30 is encouraged to lose weight before treatment as success rates are better and pregnancy is safer. We do not offer treatment to enable a woman to become pregnant or involving a procedure under conscious sedation with a BMI above 35 because of the increased risks of treatment and pregnancy.
- We ask all women aged more than 50 years who are seeking treatment to carry a child to see an obstetrician to get advice on the advisability and safety of a pregnancy in their individual circumstances
- We can only provide treatment where a child born as a result of that treatment will have one legal parent who is aged 55 years or under. This is because we want to make sure that children born as a result of the treatment we provide have a good chance of having a living parent up to the age of adulthood.
- We can’t treat anyone aged less than 18 years old. This is because our registration with the Care Quality Commission only permits us to treat people aged 18 years or over.