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INFERTILITY - an overview for patients
Dr Freddie Graham - Fertility Associates
What is infertility?
A typical fertile couple in their mid-to-late 20's, having
regular sex, has about a 20-25% chance of conceiving each
month. After 6 months, at least three quarters of young
fertile couples will be pregnant, and after a year at least
90%. Infertility is usually defined as not being pregnant
after a year of trying, but some couples know or suspect
they are infertile well before a year is up. For instance,
the woman might have irregular periods or not ovulate at
all.
Studies from various European countries show 15-20% of
couples experience infertility some time in their reproductive
life, so it is a very common problem. For many people infertility
is not absolute. The chance of conception may be only 5%
a month instead of 20%, so it takes longer to get pregnant.
For some people infertility is absolute - there may be
no sperm, or the woman's fallopian tubes may be blocked.
This used to be called sterility, but this is a misleading
term because modern treatment gives most 'sterile' couples
a good chance of having a child. Very broadly, about half
of infertility is male based and about half female based.
Whatever, it is a couple's problem and requires the couple
to work together towards a solution.
When should I do something?
The right time to seek help is when you are concerned
about your fertility. Often, simple tests that check ovulation
and sperm quality can provide reassurance to a couple so
that they are happy to try a little longer before more intensive
investigation. On the other hand, these simple tests can
often identify a severe problem quickly. A woman's fecundability
(the chance of conceiving each month) falls with age, especially
in the late 30s and early 40s, so age is also a factor to
consider. Generally, the older the woman the faster she
should seek help. If there is a lesson to be learnt from
the past, it is not to take too long to seek advice and
help.
What happens when I see a fertility specialist?
One of the first jobs your fertility specialist has to
do is to estimate your chance of a spontaneous pregnancy
(without medical intervention) in the next 1 to 3 years.
The first step is to investigate possible causes of infertility.
The common tests are:
Medical history of both partners
Semen analysis for the man, to look at the number of sperm
('concentration'), the proportion of sperm moving and the
way they move ('motility'), and the shape of the sperm ('morphology')
Ovulation tests, usually blood tests for progesterone
timed 6-8 days before next menstrual period.
Laparoscopy, a simple operation in which a type of telescope
is inserted into the belly to look at the woman's fallopian
tubes. Often dye is passed through the Fallopian tubes at
the same time, and the uterus and even the tubes themselves
can be viewed from within using a hysteroscope and a falloposcope.
Some times major factors are discovered - few or poor
quality sperm, extensive scarring in or around the fallopian
tubes, or irregular ovulation. The chance of spontaneous
pregnancy is very low, and the treatment options are clear.
Quite commonly, the factors are less severe - sperm quality
less than average, some endometriosis (where cells that
usually line the uterus grown in the belly), or a combination
of mild factors.
In around 20% of couples everything looks 'normal', which
is described as 'unexplained infertility'. In these cases,
the duration of infertility seems to be the most important
predictor of the chance of spontaneous pregnancy in the
future. The treatment options are often the same as for
severe infertility, the question is when to try them. You
and your specialist will need to map out a management plan
- balancing the emotional, physical and financial 'costs'
of possible treatments with the chance of success.
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