Infertility

Infertility can be caused by male and female factors but in 30% of cases there is no identifiable cause.

Female infertility

Infertility in women is typically caused by ovulation disorders, problems with the womb and fallopian tubes, medications or age.

Ovulation disorders
This is the common cause of female infertility. Ovulation problems can occur due to premature ovarian failure (ovary failure before 40 years-old), polycystic ovary syndrome (problems with egg production by the ovaries), thyroid problems or chronic conditions such as cancer.

Problems with the womb and fallopian tubes
If the womb or fallopian tubes are damaged through disease, surgery or sterilisation then conceiving naturally becomes very difficult.

Pelvic or cervical surgery can leave scarring on the fallopian tubes or shorten the neck of the womb (the cervix). Benign tumours in the lining of the womb can prevent implantation while endometriosis (a condition that causes cells in the womb to grow organs) can limit movement of the fimbria which directs eggs into the fallopian tubes.

Sterilisation
If a woman has been previously sterilised to prevent having any more children and decides to reverse the procedure conceiving again can be very difficult.

Medications
Prescribed non-steroidal anti-inflammatory drugs, chemotherapy and illegal drugs can all affect the function of the ovaries making it difficult to conceive.

Age
Fertility decreases with age with a woman in her early twenties twice as fertile as one in their late thirties.

Male infertility

The common cause of infertility in men is abnormalities with the semen such as a low sperm count, decreased sperm mobility or sperm that is abnormal in shape.

Semen abnormalities can be attributed to problems with the testicles (such as infections, cancer or surgery) and difficulties ejaculating (such as retrograde ejaculation whereby semen enters the bladder or blockages in the ejaculatory ducts).

Certain medications such as drugs used to treat Crohn's disease, anabolic steroids and chemotherapy can all affect sperm count and mobility.

Male and Female infertility factors

Certain factors affect fertility in both men and women. These include:

• Weight
• STIs (sexually transmitted infections)
• Smoking
• Stress
• Environmental factors
• Occupational hazards

Female infertility

Many women do not experience any symptoms of infertility while some have physical symptoms such as irregular periods, pelvic pain, absence of menstruation or skin problems (acne). If an infection is the cause then pain and discharge may appear.

While these symptoms do not necessarily indicate infertility, they may act as clues and you should inform your doctor.

Male fertility

As with women, men may not experience any symptoms but physical signs such as a change in size of testes or weight loss/gain may indicate a problem. Infections from sexually transmitted diseases or infections of the urinary tract may have associated problems and should be reported to your doctor.

If you are concerned about infertility then in the first instance you should visit your GP but be advised that infertility may not be diagnosed until you have tried to conceive for at least one year. Both partners should attend a GP appointment as fertility problems can be male or female in origin.

A GP will take a full medical, sexual and family/social history to determine any factors which may be the cause. Your GP will ask about previous pregnancies or complications and the length of time you have been trying to conceive. They will also ask about your sex life, the length of time since stopping using contraception and any medications you are taking. The GP will also ask about your lifestyle such as diet, smoking, alcohol consumption and stress.

If required, the GP will perform a physical examination. For women this will involve examining the pelvic area for signs of infection from endometriosis or PID (pelvic inflammatory disease). For men, the GP will examine and feel for any testicular abnormalities and check the structure of the penis.

The GP can also perform a number of diagnostic tests. For women these include:

• Pelvic ultrasound – to check for problems in the womb and ovaries
• Progesterone test – a blood test for ovulation
• Chlamydia test – a sexually transmitted infection which causes infertility
• Thyroid function test
• X-ray – called a hysterosalpingogram, this checks the fallopian tubes
• Laparoscopy – a surgical procedure to view the the womb, fallopian tubes and ovaries more closely

For men, tests include:

• Chlamydia test
• Semen analysis – to check sperm count, sperm mobility and abnormal sperm