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 impact of stress on fertility
Stress is not only unpleasant but it can also have an impact on fertility treatment success. Recent research demonstrates that stress is associated with stopping treatment. Many women with infertility report symptoms of anxiety, sadness, irritability, hopelessness and confusion. Some women suffer in silence, some receive wonderful support from their partners, some have a family member or close friend to provide insight, and other obtain their support over the internet. Patients who are distressed are more likely to drop out of treatment after only one IVF cycle, and patients who stop treatment before exhausting the number of IVF cycles covered by government or insurances cite stress as the most common reason for dropping out. Research shows that women who learn how to cope more effectively with their infertility and IVF treatment and learn stress management skills can improve their overall chance of conceiving. The available options to help with stress include counselling, support groups and mind-body approaches.
AMH for Ovarian Reserve Testing
Anti-Müllerian Hormone (AMH) is a substance (protein) produced by granulosa cells in very small follicles in the ovaries and is undetectable in girls until they reach puberty. AMH levels can be easily measured in the blood, and reflect more accurately than other available ovarian function biochemical markers such as follicle stimulating hormone (FSH), luteinising hormone (LH), inhibin B and oestradiol (E2), the remaining egg supply (also know as ovarian reserve). AMH production decreases as ovarian follicles develop and almost stops as follicles reach a diameter of 8-10mm. With increasing female age, the size of the pool of remaining very small follicles decreases. Low levels of AMH in the blood are indicative of suboptimal ovarian reserve and it has been found to predict reliably the response to the IVF drugs in terms of developing follicles and available mature eggs (oocytes). In generalUnlike the other hormonal markers, there are insignificant cycle specific fluctuations in AMH levels, and blood samples can be obtained at any time of the woman's menstrual cycle. Repeated AMH levels appear to enable clinicians to chart the ovarian reserve in time, thus predicting the physiological decline of ovarian function with chronological age or following some specific treatments such as surgery for ovarian cysts, chemo- or radiotherapy. Furthermore, high AMH levels appear to offer the potential of identifying women with polycystic ovary syndrome (PCOS) and in some rare cases women with granulosa cell tumours.