Understanding infertility

 Infertility is defined as the inability to conceive a pregnancy after 12 months of unprotected sexual intercourse. It could be argued that the inability to successfully carry a pregnancy should be included in the definition. It is important to remember that you are not alone.

To achieve a successful pregnancy there are several prerequisites: good quality eggs and sperm, an open fallopian tube and a receptive lining of the uterus. A problem with any of these factors will reduce fertility and may cause infertility. The number one factor affecting a couple’s chance of conceiving is the woman’s age. The normal expected chance of conception in a 25 year old couple is approximately 20% in any one month – this chance decreases with age.

After a woman’s age, male related fertility problems are the second most common cause of a couple’s infertility.

Causes of infertility include

  • Male (sperm) factor
  • Ovulation disorders
  • Tubal disease
  • Endometriosis
  • Anatomical factors such as fibroids and other uterine abnormalities
  • Factors such as antibodies to sperm may also reduce the ability to conceive
  • Combination of male and female factors
  • In some couples no cause for infertility is able to be found. This is called unexplained infertility.

 

 

 

 

 

 

 

 

Treatments include:

Ovulation induction

Medications (oral or by injection) are used to stimulate egg production and often used with timed sexual intercourse or insemination.

Insemination

With this technique prepared sperm is inserted into the female’s uterus at the most fertile time. This technique may use the male partner’s sperm or, if required, donor sperm.

Fertility surgery

This includes the treatment of endometriosis, tubal microsurgery, the removal of fibroids and the correction of uterine abnormalities.

In vitro fertilisation (IVF)

After a course of ovarian stimulation, the eggs are collected from the ovaries using ultrasound-guided transvaginal needle aspiration. These eggs are placed in a dish with sperm allowing fertilisation to occur and some of these eggs go on to form embryos. Usually one or two embryos are then transferred back into the uterus using a small plastic tube and some can be frozen and stored for future transfer.

Intracytoplasmic Sperm Injection (ICSI)

This is a different, more sophisticated, form of IVF where the scientist injects a single sperm into the egg to assist fertilisation. This technique is an excellent treatment if the sperm is of poor quality.

 

TREATMENTS (CONT)

Blastocyst culture

This procedure involves the growth of the embryos for 5 days in the laboratory. This technique may help with embryo selection and give further information about embryo development.

Freeze storage of embryos

Some people will have excess good quality embryos following an IVF or ICSI treatment and these can be freeze stored for future transfer.

Fertility preservation

Men and women diagnosed with cancer who wish to conceive at some stage in the future may need to consider techniques to preserve their fertility as some forms of cancer therapy can affect their fertility.

Freezing mature oocytes (eggs)

Recent research into egg freezing is so far very promising. We are currently carrying out research on the Cryotop technique for freezing eggs. Egg freezing is currently offered to specific groups of patients such as those undergoing cancer therapy, but it may in the future be offered more widely to different groups such as single women.

Egg, sperm & embryo donation

We assist people who may require donor sperm, eggs or embryos in order to achieve pregnancy (both known and de-identifiable donors). We offer a comprehensive program to ensure that all legal, social and ethical issues are properly considered. See separate booklets for information on these options.

Genetics & Preimplantation Genetic Diagnosis (PGD)

We have genetic counselling available to assist couples with known or suspected genetic problems. Preimplantation Genetic Diagnosis is the earliest form of prenatal diagnostic screening which aims to prevent embryos carrying a genetic abnormality being transferred into.

Assessment plan

After a thorough history and examination, several tests can be performed to estimate a couple’s chance of natural conception. These include a semen analysis for the male and blood hormone tests for the female. An important new test for women is the Antimullerian hormone blood test that gives a very good indication of the number of eggs a woman has left in her ovarian reserve and therefore how much time she has to conceive. Furthermore an anatomical assessment of the female’s pelvis to exclude tubal disease, uterine abnormalities &/or endometriosis may be performed. For this an ultrasound, x-ray and/or keyhole surgery (laparoscopy) can be used. Once the assessment has been made, a personalised treatment plan can be formulated, beginning where possible, with the simplest, most natural options.

Once the assessment has been made, a personalised treatment plan can be formulated beginning, where possible, with the simplest, most natural options.