Infertility – difficulty in getting pregnant

What is infertility?

Infertility is when a couple tries to have a baby but can't, even after trying for 1 year (or 6 months if you are over 35 years). This is despite having properly timed, regular, unprotected sexual intercourse (three to five times per week).

What are the types of infertility?

Infertility can be broadly divided into two types.

Primary infertility is when a couple has never been able to have a baby or conceive (get pregnant), even after trying for at least 1 year. This is despite having properly timed, regular, unprotected sex.

Secondary infertility is when a couple has had at least one baby or been able to conceive in the past, but now they are not able to get pregnant again. This is despite having properly timed, regular, unprotected sex.

What are the causes of infertility?

Infertility can arise from many factors, which can be experienced by both men and women.

Hormonal imbalances

Hormones are chemicals made by different parts of the body. They play a crucial role in reproduction. Imbalances in hormone levels can affect fertility. For example, high levels of testosterone in men reduces sperm production and its quality.

Age

Fertility can decline with age. Women have a set number of eggs and, as they age, the quality and quantity of these eggs may drop. Men may also experience a decrease in sperm quality and quantity as they grow older.

Lifestyle

Habits such as smoking, excessive alcohol consumption, drug use, poor diet and being either overweight or underweight can impact fertility in both men and women.

Underlying health conditions

Certain medical conditions like polycystic ovary syndrome (PCOS), endometriosis, sexually transmitted infections (STIs) and diabetes can influence fertility.

Environmental factors

Exposure to specific environmental toxins, pollutants and radiation can also have implications for fertility.

Understanding these underlying causes can help to find the best approach to support individuals facing challenges with conception.

How do I know I am infertile? What are the symptoms?

It's important to remember that usually there are no obvious symptoms, so if you've been trying to get pregnant for about 6 months without success, it's a good idea to see a doctor for a check-up. They can help understand what might be going on.

For women, signs of infertility may include: irregular periods or no periods at all; painful periods; hormonal changes like excess facial hair or acne; obesity.

For men, signs of infertility may include: difficulty ejaculating or maintaining an erection; changes in hair growth or sexual desire; pain, swelling or lumps in the testicle area; testicles that are small and firm.

What tests are done?

Blood tests

Blood tests look at hormone levels to check if the woman is producing eggs and the man is producing sperm. These may include estrogen, progesterone, follicle-stimulating hormone (FSH) and luteinizing hormone (LH) levels in women, while men may undergo testosterone and other hormone level assessments.

Ovulation testing

Where advised by a healthcare provider, women may have other tests to determine egg release. Methods include using urine ovulation predictor kits or blood tests and ultrasound scans.

On rare occasions, minor surgical procedures, like diagnostic laparoscopy, may be used to assess the tubes, and some treatments may be offered if they can be done at the same time.

Semen analysis

Men give a sample for the doctor to check sperm quantity and quality, motility and morphology.

Imaging tests

Ultrasound through the vagina (transvaginal) or the tummy (transabdominal) can be done to check the Fallopian tubes in women (this is known as hysterosalpingography or HyCoSy), and ultrasound of men's testes and reproductive ducts (tubes) can be done to check for swellings or blockages affecting fertility.

Genetic testing

Your doctor may do some genetic testing to see if you have got a problem that can affect fertility and which can run in families.

These tests help to find and guide treatment of infertility. Couples can have different causes and both partners may have problems at the same time. It is not only a woman's problem.

How can I lower my chances of becoming infertile?

You can do the following:

• Reduce or stop completely smoking.
• Ensure you have protected sexual intercourse when you are not ready to have a baby.
• Avoid multiple sexual contacts.
• Reduce or stop completely alcohol and recreational drugs.
• Maintain a healthy body weight.
• Eat a healthy and well-balanced diet.
• Men should not use testosterone except under the guidance of a doctor.
• Wear loose-fitting underwear.
• Have regular sexual activity throughout the menstrual cycle.
• Seek medical advice sooner rather than later.

Can I check myself?

Although you might be able to check some things yourself, like tracking your menstrual cycle and using a urine ovulation-predictor kit at home, a thorough assessment for infertility generally needs you to be seen by a fertility specialist.

How do I get treated?

Treatment options for infertility depend on the cause and may include one or more of the following methods:

Assisted reproductive techniques (ART)

Medicines can be used to stimulate egg production and release in women or to improve sperm count and quality in men. The medicines can be in tablet form (like clomiphene citrate or etrozole) or they can be injections.

Surgery can be done to correct some physical abnormality affecting fertility, unblock Fallopian tubes, remove ovarian cysts or fibroids, or address conditions such as endometriosis in women or varicoceles in men.

Intrauterine insemination (IUI)

This procedure involves introducing cleaned and concentrated sperm directly into the uterus during ovulation.

In-vitro fertilization (IVF)

This process involves combining eggs and sperm outside the body and then transferring the resulting embryos into the uterus.

Intracytoplasmic sperm injection (ICSI)

This technique, used alongside IVF, involves injecting a single sperm directly into an egg to aid fertilization.

Donor eggs or sperm

In severe cases of male or female infertility, donor eggs or sperm may be used in conjunction with ART procedures.

Surrogacy

This method involves using another person to carry a pregnancy to term for those who are unable to do so themselves.

Other things that can happen during your journey towards becoming pregnant

The doctor may recommend you are seen before conception to assure you are fit and well to not only carry the pregnancy but also be fit enough to have fertility treatment. This is called preconceptual counseling. The doctor will also recommend you use some medicines like folic acid which is important for the development of the spine and brain of the child.

It is important you discuss all your medical conditions with your doctor as well.

Some couples may struggle with recurrent implantation failure. Research is ongoing to find the reasons this may happen and how to treat it. In the meantime, your doctor should offer you mental wellbeing support.

Remember

Infertility can be caused by various factors such as age, ovulation disorders, sperm health, Fallopian tube issues, and uterine problems. Difficulty in getting pregnant is not always a woman's problem. You can also struggle to conceive after having a baby before.

If you've been trying to get pregnant for a year (or six months if you're over 35) without success, please see a doctor, do not wait too long.

There are many treatments available for infertility, including medications, surgery, assisted reproductive technology like IVF, and lifestyle changes.

Dealing with infertility can be lonely and emotional. It's essential to seek support from loved ones or a counselor to cope with the stress. Share your journey with someone and remember you are not alone.

Treatments can be expensive. It is important to be aware of the costs involved and explore insurance coverage options. Consult professionals so you are not led to treatment that may not be useful for you.

Maintaining a healthy lifestyle by eating well, exercising, managing stress and avoiding harmful habits like smoking can improve fertility. Eating fruit and vegetables and drinking clean water is useful.

Difficulty in getting pregnant affects about one in six couples. You are not alone.

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