INFERTILITY EXPLAINED

Dr Catrin Bevan, The London General Practice

This is when a couple cannot get pregnant (conceive) despite having regular unprotected sex. Most couples take their fertility for granted ...until they cannot get pregnant. Around 1 in 7 couples may have difficulty conceiving.

Causes of infertility:

Female infertility 30%, male infertility 30%, mixed male female infertility 20%, unexplained infertility 20%.

Why do infertility problems occur?

1. Timing of intercourse. Probability of conception is maximum in the three days up to and including the day of ovulation.

2. Ovulation.

3. Egg quality.

4. Tubal disease.

5. Sperm quantity and quality.

6. Uterine pathology.

7. Hormonal reasons.

In women, infertility declines steeply after the age of 35 to 37 and spontaneous abortions (miscarriages) increase steeply at the same time. Women’s ovarian reserve, that is the number of eggs (follicle number) declines very gradually from birth then rapidly from age 35 until the menopause.

When to seek help?

1. Irregular or infrequent periods. These can also be short cycles or unpredictable irregular cycles.

2. Miscarriage.

The rate of miscarriages is 15-20% if under 35, 50% if 40 years old and 80% if over 42 years old.

3. If previous medical treatment, for example chemotherapy has been received, a woman should seek help earlier.

4. If there is a family history of early menopause.

5. Previous gynae or abdominal surgery.

IVF is an option. However, it has its limitations.

Live birth rate per IVF cycle is approximately:

• 30% for 35 - 37 year olds

• less than 20% for 38 - 40 year olds

• and approximately 6% for 41 to 42-year-old females.

Summary

Fertility problems are multifactorial. Female age is very important. Prompt investigations should be initiated, and help should be sought sooner than later especially if the woman is over 35.

At the London General Practice, we offer preconception counselling gynaecological investigations as well as hormonal testing and referral for specialist investigations for infertility.