Infertility

Infertility is defined as absence of conception after one year of regular intercourse at the time of ovulation. Affects one in six couples. The number of infertile women increase with age. Between 20 - 24 years of age, 10% of women are infertile and by 35, 15% are infertile and at 40, 33% are infertile with the chance of conceiving after 40 being approximately 5%. After 45 fertility rates decline to below 5%.

Most couples will achieve a pregnancy in the first 6 months of trying - fertility rates start to decline after 6 months of trying and by the end of a year monthly fertility rates is only 4% per month. After 35 women should seek the advice of a fertility specialist if conception has not occurred after 6 months. Younger women should also seek advice if cycles are irregular or if they have a history of gynaecological problems such as pelvic inflammatory disease/ovarian cysts or endometriosis. Males should seek earlier referral for a semen analysis if they have a history of undescended testes / testicular surgery or testicular trauma.If the semen analysis is abnormal on 2 occasions 6 weeks apart then referral should be made to a fertility specialist.

INVESTIGATIONS

FEMALE

Blood test
AMH - Antimullerian Hormone (a test for your ovarian reserve)
- DAY 2-3 Blood Test
(FSH/LH/ESTRADIOL/TSH/PROLACTIN)

- DAY 21 Blood test
(PROGESTERONE)

- OTHER PREPREGNANCY TESTS: FBE RBC FOLIC ACID LEVELS COELIAC DISEASE (A CAUSE OF MISCARRIAGE AND INFERTILITY), RUBELLA/VARICELLA/CMV/PARVOVIRUS IMMUNITY VITAMIN B12 (CAN CAUSE FETAL DEVELOPMENTAL ISSUES).

Ultrasound
- TO ASSESS IF THE ANATOMY IS NORMAL

If all these tests are normal and your husbands tests are normal your doctor may recommend a tubal test that can be done with an ultrasound (Levovist), X-ray (Hysterosalpingogram- HSG) or a laparoscopy hysteroscopy and dye studies.

MALE

Semen Analysis
The semen analysis needs to be done 3 - 5 days of abstinence but not more than 5 days. A normal semen analysis is either measured compared to WHO criteria or KRUGER criteria - I would recommend that patients attend an IVF Clinic to have an analysis performed and make sure that a sperm antibody test is performed.

DRUGS THAT CAN AFFECT FERTILITY

Many medications can interfere with sperm and oocyte production and quality:

Men:
Sulphasalazine, nitrofurantoin, tertracyclines and colchicine - can all lower sperm motility and function. Ketoconozole, antidepressants, propranolol can cause impotence. Chenotherapy can lower sperm count. Cannabis, cocaine and alcohol can affect sperm motility, morphology and count.

Women:
Anti-inflammatories can cause stop oocyte from being released.

Cannabis and other illicit drugs affect ovulation

Chemotherapy - can cause ovarian failure.

SMOKING - DON’T SMOKE THIS DECREASES YOUR FERTILITY BY 5-10%.

CAUSES OF INFERTILITY

Unexplained: affects 10-15% of couples

Ovulatory: most common cause of infertility

Tubal: another common cause that affects fertility - common causes of tubal infertility are Chlamydia infections and endometriosis or previous pelvic surgery for ovarian cysts or fibroids.

Male factor: accounts for 45% of all infertility.