The human species is particularly poor when it comes to reproducing. With each ovulatory cycle there is only a 20% chance of achieving a pregnancy (known as fecundability) in the healthiest of couples. When other factors are introduced that potentially tip this scale further against conception it’s a wonder that we can create a baby at all.
When we define the “infertile couple”, the assumption is made that regular unprotected intercourse has failed to achieve a pregnancy after 12 months. 84% of couples achieve a pregnancy after 1 year of actively trying, which increases to 92% after 2 years.
Causes of Infertility
Approximately one in 6-9 couples in Australia will have difficulty conceiving, and this can occur for many reasons. 40% of the time there is a female factor contributing to the inability to conceive; another 40% can be attributable to the male and 20% of the time there is a joint problem or one that is inexplicable (idiopathic).
- Age: It is known that reproductive capacity declines dramatically after the age of 35 years before reaching menopause which, in Australia, occurs at an average age of 51 years. In some women <1% premature ovarian failure (premature aging of the ovaries) can occur at a younger age <40 years (early menopause) and therefore there reproductive life is shortened.
- Extremes of weight (both overweight and underweight)
- Ovulatory disorders:There are many reasons why an egg may not be released every month. Generally the cyclical ovulatory pattern is disrupted by hormonal imbalances which can occur in women with polycystic ovarian syndrome, conditions such as hyperprolactinaemia, eating disorders, excessive exercise, or pathology interrupting the hypothalamic/pituitary/ovarian axis.
- Endometriosis: Endometriosis can affect fertility in varying ways. It can cause scarring and adhesion formation distorting the anatomy. The endometrial tissue that implants outside the uterus causes inflammation and thought to be toxic to a growing embryo.
- Fibroids: Fibroids can affect fertility depending on their location, implantation can be affected if the uterine cavity is compromised, blockage of the fallopian tubes can decrease fecundity by preventing the meeting of the egg and sperm
- Fallopian tube damage or blockage: This can occur as a result of previous sexually transmitted infections, pelvic inflammatory disease or endometriosis and fibroids.
- Chromosomal and structural abnormalities: It is rare but the uterus, cervix, vagina and ovaries do not form or function correctly to allow fertilization.
- Environmental Toxins: Smoking is known to age eggs by up to 10years. The genetic material which is housed in the egg is damaged decreasing its chance of creating an embryo. Some data also exists for the consumption of caffeine, and excessive alcohol. Exposure to radiation, chemotherapy and chemicals in pesticides can cause decreases in egg numbers.
- Abnormal sperm production: This can occur for many reasons, such as chronic health conditions e.g., diabetes, previous infections (e.g. mumps), genetic abnormalities, neonatal conditions such as undescended testes, varicocoeles (scrotal veins enlarge and the increased blood flow and heat to the testes cause abnormalities in sperm)
- Abnormalities in the ductal system responsible for the delivery of sperm: Again these can be associated with genetic conditions e.g. Cystic fibrosis where there is total or partial absence of the ducts that lead the sperm from the testes to the urethral opening, injury to or inflammation of organs surrounding the ducts e. prostate abnormalities, sexual problems e.g. retrograde or premature ejaculation
- Medications or environmental toxins: Use of anabolic steroids and marijuana can cause permanent decreases in sperm production even after their cessation. Smoking can cause DNA damage within the sperm decreasing its capacity to fertilise. Exposure to chemicals in pesticides, radiation and use of chemotherapeutic medications can cause varying degrees of abnormal sperm production.
- Idiopathic: There are some instances where no cause can be identified for low sperm counts.
There are many steps in the management of an infertile couple which do not all end in “in vitro fertilization” (IVF). We commence and encourage the most non invasive modes of fertility treatments and will move in a step wise path to your goals. It is our belief that having a healthy base to start optimizes any subsequent intervention and in many situations decreases the need for more invasive treatment options.
Our recommendations may range from:
- Lifestyle modifications in diet and exercise
- Identifying and avoiding potential harmful toxins that impair fertility
- Ovulation or Cycle tracking
- Ovulation Induction (using medications to ensure ovulation)
- Ovulation induction & Intrauterine insemination (more common for male factor infertility)
- In vitro fertilization (IVF) & Assisted Reproductive Technologies (ART)
- Use of donor sperm/eggs/embryos