Fertility and Infertility

What is fertility?

About one in seven couples living in the western world have problems conceiving. It has been estimated that around 80 million of couples worldwide have some fertility problems. Fertility is the ability to conceive. The crucial step of this process is known as fertilisation -- an egg bursts from the follicle and is released from the ovary. The egg then travels along the Fallopian tube where, at some point, it fuses with the sperm to form a single cell. The fertilised egg takes three days to travel to the uterus (womb), and during this time the cells continue dividing. The fertilised egg, now known as an embryo, implants itself in the endometrium (lining of the womb).

How long should it take?

Couples who have regular unprotected sexual intercourse (2 to 3 times a week) should conceive within two years. The chance of getting pregnant in any one month is 20%, but this declines with the female age.

In every 100 couples:
• 20 will conceive within one month
• 70 will conceive within six months
• 85 will conceive within a year
• 90 will conceive within eighteen months
• 95 will conceive within two years

Five important things you can do to protect your fertility

1. Eat a healthy, nutritious and varied diet
2. Have an adequate body weight
3. Avoid excessive alcohol (14 units/week for women - 21 units/week for men)
4. Quit smoking cigarettes and marijuana
5. Prevent sexually transmitted infections

What is infertility?

Infertility means being unable to conceive. Few couples are infertile, while most are subfertile, which means they have problems that make conception difficult and medical help is needed.
There are two types of couple infertility:
Primary infertility -- couples who are unable to conceive and have never achieved a pregnancy.
Secondary infertility -- couples who after having had one or more pregnancies are unable to conceive.

What are the causes of infertility?

Female problems

• The ovaries are not releasing eggs (anovulation) or the eggs are immature
• Hormone imbalances and deficiencies
• Genetic abnormalities
• The fallopian tubes are damaged or blocked or absent (for example after surgery for an ectopic pregnancy)
• The lining of the womb does not develop properly
• The lubricating mucus from the cervix (neck of the womb) is hostile
• Endometriosis
• Previous infections (particularly sexually transmitted infections)
• Previous surgery for ovarian cyst(s)

Male problems

• Hormone problems
• Genetic abnormalities
• Sex-related problems (difficulty getting an erection or ejaculating)
• Retrograde ejaculation (sperm travels backwards to the bladder)
• The tubes that carry the sperm are damaged or blocked or absent
• Previous inflammation of the testes (orchitis caused by virus or bacteria)
• Previous surgery to correct undescended or twisted testicles
• Varicocele (varicose veins on the testicles)
• Drug treatment or previous radiotherapy for cancer

Who and when to investigate?

Couples who have not conceived after 1 year of regular unprotected sexual intercourse should be investigated. Also, couples who have a known cause of infertility, have predisposing factors, or where a woman is aged 35 years or over should be offered early investigations and if necessary referred to an assisted conception centre soon.

The One-stop Fertility Clinic is a comprehensive and quick outpatient service that enables assessment of the reproductive performance of both the female and male partners at the time of a single outpatient visit. A diagnosis of the possible cause of infertility will be made, specialist advice will be offered and appropriate treatments will be recommended without further delay.

A series of tests have to be organised at a specific time before the visit in order to have the results available for discussion with Mr Nardo.

Prior to the appointment the female partner will be required to have the following tests:

• Blood test for AMH
• Blood test for Rubella immunity
• Urine sample for Chlamydia screening

Prior to the appointment the male partner will be required to have a semen analysis.

The One-stop Fertility Clinic appointment lasts approximately 60 minutes and involves:

• Fertility consultation
• Gynaecological examination
• Transvaginal ultrasound scan of the uterus (womb) and ovaries
• HyCoSy test (to check whether the Fallopian tubes are blocked or open)*
• Discussion of the results of the female partner's tests
• Discussion of the semen analysis report
• Expert advice on the most appropriate fertility treatment, as necessary

*Hysterosalpingo-contrast-sonography (HyCoSy) is a non-invasive ultrasound procedure that takes approximately 15 minutes. It is usually carried out between day 5 and day 12 of the menstrual cycle. A thin catheter (tube) is passed through the cervix into the uterus (womb) and a tiny balloon is inflated to hold the catheter in place. A transvaginal ultrasound scan is performed and echo-contrast fluid is injected through the catheter. The fluid shows up as bright white and its path can be followed into the uterus and through the Fallopian tubes on each side. Once the patency of the tubes has been established, the ultrasound scan and catheter are removed.
It is advisable to take some form of analgesia (pain killer -- ibuprofen, paracetamol) prior to the procedure, and in order to minimise the risk of pelvic infection a course of oral antibiotics is prescribed after the procedure for 5 consecutive days.