Infertility

Infertility affects one in six couples. The number of infertile women increase with age. Between 20 - 24 years of age, 10% of women are infertile and by 35, 15% are infertile and at 40, 33% are infertile with the chance of conceiving after 40 being approximately 5%. After 45 fertility rates decline to below 5%.

Most couples will achieve a pregnancy in the first 6 months of trying - fertility rates start to decline after 6 months of trying and by the end of a year monthly fertility rates is only 4% per month. After 35 women should seek the advice of a fertility specialist if conception has not occurred after 6 months. Younger women should also seek advice if cycles are irregular or if they have a history of gynaecological problems such as pelvic inflammatory disease/ovarian cysts or endometriosis. Males should seek earlier referral for a semen analysis if they have a history of undescended testes / testicular surgery or testicular trauma.If the semen analysis is abnormal on 2 occasions 6 weeks apart then referral should be made to a fertility specialist.

INVESTIGATIONS

FEMALE

Blood test
AMH - Antimullerian Hormone (a test for your ovarian reserve)
- DAY 2-3 Blood Test
(FSH/LH/ESTRADIOL/TSH/PROLACTIN)

- DAY 21 Blood test
(PROGESTERONE)

- OTHER PREPREGNANCY TESTS: FBE RBC FOLIC ACID LEVELS COELIAC DISEASE (A CAUSE OF MISCARRIAGE AND INFERTILITY), RUBELLA/VARICELLA/CMV/PARVOVIRUS IMMUNITY VITAMIN B12 (CAN CAUSE FETAL DEVELOPMENTAL ISSUES).

Ultrasound
- TO ASSESS IF THE ANATOMY IS NORMAL

If all these tests are normal and your husbands tests are normal your doctor may recommend a tubal test that can be done with an ultrasound (Levovist), X-ray (Hysterosalpingogram- HSG) or a laparoscopy hysteroscopy and dye studies.

MALE

Semen Analysis
The semen analysis needs to be done 3 - 5 days of abstinence but not more than 5 days. A normal semen analysis is either measured compared to WHO criteria or KRUGER criteria - I would recommend that patients attend an IVF Clinic to have an analysis performed and make sure that a sperm antibody test is performed.

DRUGS THAT CAN AFFECT FERTILITY

Many medications can interfere with sperm and oocyte production and quality:

Men:
Sulphasalazine, nitrofurantoin, tertracyclines and colchicine - can all lower sperm motility and function. Ketoconozole, antidepressants, propranolol can cause impotence. Chenotherapy can lower sperm count. Cannabis, cocaine and alcohol can affect sperm motility, morphology and count.

Women:
Anti-inflammatories can cause stop oocyte from being released.

Cannabis and other illicit drugs affect ovulation

Chemotherapy - can cause ovarian failure.

SMOKING - DON’T SMOKE THIS DECREASES YOUR FERTILITY BY 5-10%.

CAUSES OF INFERTILITY

Unexplained: affects 10-15% of couples

Ovulatory: most common cause of infertility

Tubal: another common cause that affects fertility - common causes of tubal infertility are Chlamydia infections and endometriosis or previous pelvic surgery for ovarian cysts or fibroids.

Male factor: accounts for 45% of all infertility.