Infertility

What does infertility mean?

The World Health Organization defines infertility as not achieving a pregnancy after 12 months or more of regular unprotected sex. Most couples where the woman is under 40 conceive within a year of regular sex. Of those who do not conceive in the first year, about half do in the second.

This definition is not a label, and it does not mean pregnancy is impossible. It only says that it is time to look into it.

When should we come?

• After one year of trying, if you are under 35
• After six months of trying, if you are over 35
• Sooner, if you are over 40 or have irregular periods, endometriosis, a past pelvic infection or past cancer treatment

Tests take time and a woman’s fertility falls with age, so it is better not to put this off.

Causes

The cause can lie with the woman, the man or both, and in about a quarter of cases none is found. Common causes are:

• Irregular or absent ovulation, the most common cause in women
• Poor semen quality
• Blocked or damaged fallopian tubes
• Endometriosis

Age, weight, smoking, alcohol and sexually transmitted infections also affect fertility.

What is checked?

The first visit starts with both partners’ histories: how long you have been trying, periods, past pregnancies, health conditions, medicines and lifestyle. Your sex life is part of this. It may be hard to talk about, but plain answers help find the cause.

Then, depending on your situation, blood tests for ovulation and hormones, an ultrasound, a check of the tubes and a semen test are requested.

What are the options?

Treatment depends on the cause and falls into three groups:

• Medicine: to help ovulation
• Surgery: for example for endometriosis, fibroids or tubal scarring
• Assisted conception: such as IUI (placing sperm inside the uterus) and IVF (fertilisation in the laboratory)

For each method you should hear the benefits, cost and risks separately. IVF can raise the chance of a multiple pregnancy and slightly raises the risk of ectopic pregnancy. No method guarantees a result.

The emotional load

This path can be hard and long. Looking after your relationship and getting psychological support are part of care. Counselling is also available through the patient support network.