Infertility is generally defined as the inability to conceive after 1 year of actively trying i.e. having sexual intercourse 2-3 times a week.
When to seek help
After 1 year of trying, 80-90% of couples would have been successful in conceiving. It is therefore advisable to seek help at this point.
Fertility does decline with age. Studies have found that the probability of conception over a month falls from 25% in women in their early twenties to 8% in their late thirties. Similarly, the probability of conception within a year falls from 97% in women in their early twenties to 65% in their late thirties.
It is therefore important to start planning for a pregnancy as early as possible and to seek help as soon as there seems to be difficulty. It would also be advisable to seek help early if you are over 30 years, or if there are any indicators of infertility factors such as irregular or painful menstruation.
Causes of Infertility
Infertility may be due to male or female factors.
Causes of male infertility include:
- Low sperm count
- Poor sperm motility
- Poor morphology or shape, so that the sperm is unable to penetrate the egg
Causes of female infertility include:
- Hormonal disorders resulting in anovulation or a failure of egg follicles to grow and be released
- Blocked fallopian tubes, which will prevent an egg and sperm meeting
- Endometriosis, in which tissue of the lining of the womb invades and damages neighbouring reproductive tissue
Often, there is a mixture of both male and female factors. In some cases, there appears to be no obvious reason and this is termed ‘unexplained infertility’.
Basic investigations of infertility include a semen analysis and, for the female partner, hormone tests and an ultrasound scan of the pelvis. Depending on the medical history and basic investigation results, advise will be given on the method of testing for patency of the Fallopian tubes.
Options for testing tubal patency include:
- a radiological dye test called ‘hysterosalphingography’ or
- hydrotubation at the time of minimally invasive laparoscopic surgery
Some women may be recommended a hysteroscopy to assess the cavity of the womb. This test involves visualizing the cavity of the womb with a fine telescope to ensure that that the cavity of the womb is healthy. Any polyps found will be removed.
Treatment Options for infertility
Based on the investigation results, appropriate treatment will be recommended.
Medical treatment for infertility
In cases of anovulation, ovulation induction medication may be given.
Reproductive Surgery for infertility
In some cases of tubal obstruction, minimally invasive laparoscopic reproductive surgery may be advised. Laparoscopic surgery may also be useful in treating pelvic adhesions, endometriosis, removing cysts, fibroids and polyps.Treatment of such conditions may help to enhance your fertility and increase your chances of getting pregnant.
Intra-uterine insemination (IUI)
This method is suitable for couples with mild male factory infertility, mild endometriosis, cervical factor infertility and unexplained infertility. Normal healthy fallopian tubes are essential for this method.
Assisted Reproductive Techniques or In- Vitro Fertilisation (IVF)
Assisted Reproductive Techniques or ART refers to the use of laboratory techniques to bring the egg and sperm together (fertilisation) outside of the woman's body. ART is often referred to as In-Vitro Fertilisation (IVF), which is the medical term for the technique. Nowadays, intra- cytoplasmic sperm injection (ICSI) is often utilized to enable the sperm to be directly injected into the egg.
ART or IVF is a complex and stressful process. It is usually recommended only if simpler treatment procedures have not worked. But it may be recommended earlier if there is severe male factor infertility with abnormal sperm count or quality, or if there is fallopian tube disease making natural pregnancy unlikely. It may also be recommended earlier if your ovarian reserve or egg count is low and if you are close to 40 years.
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