Struggling to conceive? Your infertility questions, answered.
Posted on 28 August 2019
Being diagnosed as infertile doesn’t mean you can’t fall pregnant, it just means something is preventing you from conceiving naturally.
What is infertility?
‘Doctors define infertility as the inability to conceive after twelve months of regular intercourse with a male partner without any form of contraception,’ says Dr Josh Matambo, a specialist obstetrician and gynaecologist at Mediclinic Morningside and Mediclinic Newcastle. ‘Remember, being diagnosed as infertile doesn’t mean you can’t get pregnant, it just means you might need medical intervention.’ Remember, not all medical interventions can ensure fertility or result in pregnancy.
Dr Kasturi Moodley, a Mediclinic Pietermaritzburg obstetrician and gynaecologist with a special interest in fertility, says research suggests that 35% of infertility cases are because of female factors and 35% are due to male factors. ‘Approximately 30% of cases are idiopathic, meaning the cause can’t be found,’ she adds.
When should I be worried?
‘Women often assume that if their general gynaecological check-up is normal, they are able to have a baby,’ says Dr Moodley. ‘This isn’t always the case. There’s an assumption that young women have high ovarian reserves – but they can often be lower than expected. If you are concerned, ask your gynaecologist to take things one step further and conduct specific tests.’
Apart from age, what are most common factors that contribute to a woman’s infertility?
Certain disorders and imbalances can also cause infertility, even in young women. ‘Ovarian cysts, trauma, undiagnosed endometriosis and obesity can compromise ovarian reserve, even at 29,’ Dr Moodley cautions. Endometriosis is when endometrial tissue grows outside your reproductive system, potentially causing cysts, blockages, or other reproductive complications. ‘Other common factors include previous infection of the fallopian tubes, which results in blockage of the fallopian tubes,’ says Dr Matambo. ‘Ovulation problems, fibroids (which may affect the uterine womb lining), polycystic ovarian syndrome (PCOS), smoking, and untreated sexually transmitted infections can also impair your chances of falling pregnant.’
And a man’s factors?
Potential causes for male factor infertility include a low sperm count (less than 15 million sperm per millilitre of semen) and poor quality (or abnormal) sperm. Swollen veins in the testicles; hormone imbalances; testicle damage or problems with ejaculation can also affect your fertility.
‘We have seen a considerable jump in the number of young males (late 20s to late 30s) who present with semen parameter abnormalities,’ says Dr Moodley. ‘Many know that certain lifestyle factors, such as smoking, alcohol, drugs, trauma and medical conditions can affect their reproductive system, but they don’t realise to what extent – and that some of these factors are irreversible. Wearing tight clothing and underwear, using vehicle seat warmers, and the unmonitored intake of multivitamins supplements and steroids can have a harmful effect on sperm.’
What fertility testing should your fertility doctor perform?
‘A fertility specialist will take a hormonal profile and can perform ultrasound to confirm the normal appearance and function of your uterus, ovaries and fallopian tubes,’ says Dr Moodley. ‘Fertility tests include blood tests to check reproductive hormone levels in the woman,’ says Dr Matambo. ‘Your doctor will also perform a complete semen analysis on the male.’
What options are available if you are struggling to conceive?
‘Therapeutic options depend on the cause of the infertility and are tailor-made for the couple,’ says Dr Matambo. ‘This can range from clomid tablets in order to stimulate ovulation to IUI (intrauterine insemination), IVF (in vitro fertilisation) and ICSI (intracytoplasmic sperm injection) cycles. Surgery is also an option if there are fibroids.
Intrauterine insemination (IUI) is the least-invasive procedure. This is when ‘good sperm’ is inserted into the woman’s cervix through a catheter.
In vitro fertilization (IVF) is when mature eggs are retrieved from ovaries and sperm is taken from the male. Fertilisation happens in a petrie dish and the fertilised egg (embryo) or eggs (embryos) are inserted back into the woman’s uterus.
Intracytoplasmic sperm injection (ICSI) happens when sperm and eggs are collected from both partners. In the laboratory, a single sperm is injected directly into each egg before being returned to the uterus.