What the Experts
Say about Infertility
The Definition of Infertility/subfertility
This is defined as failure to achieve conception after 12 months of regular and unprotected sexual intercourse. At this stage fertility investigations should be done to assess the cause of the problem. In women with irregular periods or are older than 35 years investigations should be started after 6 months. Subfertility affects about 10% couples.
The Causes of Infertility
The cause may be related to one partner or both partners. The cause of Infertility can be due to a male factor(40%) or female factor(40%). In 10% percent of the couples there are combined male and female factors and in another 10% the couples have unexplained infertility(no cause found).
Conception and pregnancy is a complicated process that depend on a number of factors including:
The production of healthy sperm by the man
Healthy eggs produced by the women
Open fallopian tubes that allow the sperm and the egg to meet
The sperms ability to fertilize the egg
Ability of the fertilized egg to become a good quality embryo
Capability of that embryo to implant to the uterus
Causes of infertility include:
Male (sperm) factor
Sexually transmitted disease
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
Treatment by Fertility Specialists
The assessment and treatment of couples with fertility problems is best done by fertility specialists – people who are used to performing advanced endoscopic surgery and IVF (in vitro fertilization). The reason for this is that they will have the necessary experience and equipment needed for your therapy. All the correct treatment options can also be discussed outlining which procedure would be best for you. Sometimes the investigations may be done in conjunction with your referring gynaecologist.
What happens at your first appointment with the fertility specialist?
A detailed history will be taken from both you and your partner to find possible reasons for the fertility problem. A gynaecological examination will be done and a pelvic ultrasound scan performed. The male partner may also be examined to look for any urological problems and a sperm test permormed.
The investigations will be done according to the likely causes of the fertility problem. They may include:
1. Semen analysis for the male partner
2. Day 3 Follicle Stimulating Hormone(FSH), Luteinizing Hormone(LH), AMH, Prolactin, Testosterone, Thyroid function tests.
3.Day 21 progesterone (to assess for ovulation)
4. infection screen to include H.I.V TEST(If already positive Viral load test), syphilis test, Hepatitis screen and Rubella viral screen
5. Additional tests will be requested depending on the history and examination findings and the type of treatment needed.
6. Assessment of the pelvis will include a hysteroscopy and laparoscopy (to check the uterine cavity, fallopian tubes and the pelvis for endometriosis or scar tissue). A hysterosalpingogram X-ray may also be requested.
Starting the fertility treatment
Once a diagnosis has been made, the treatment will be started immediately. The doctor will advise you when to see him at the start of a period to commence treatment.