It normally takes a maximum of two years for a couple to conceive after they started trying for a baby.
Sometimes the woman fails to get pregnant even after years of trying. If reduced fertility is suspected, both partners are usually prescribed a fertility assessment. When a medical reason for the infertility is detected, the problem is with the woman in approximately one in three cases, with the man one of three cases and with both partners in one in three cases.
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When should you have a fertility assessment?
If the woman is under 36, the couple is usually advised to try having unprotected sex at the time of ovulation for one year. Research has shown that there is roughly a 30 percent chance of becoming pregnant during each ovulation cycle. This means many attempts may be needed, even if you choose the right days.
If the woman is over 36, it is not necessary to wait a year before seeing a gynaecologist. If there are medical reasons why you can't have children together, or if you know from the outset that it will be difficult, you can seek help immediately. The same applies to lesbian couples who live together and want children.
The fertility assessment can be divided into three parts
• Ovulation examination.
In order for fertilisation to occur, the sperm needs to reach the egg at the right time. The woman's ovulation cycle is documented in order to plan intercourse on the right days. Ovulation can be examined with blood tests that measure hormone levels, ultrasound scans that monitor the eggs' maturity, ovulation sticks and the classic thermometer method. A commonly recommended treatment for sterile women is a hormone that guarantees ovulation. For many, this is sufficient to become pregnant.
• Examination of uterus and ovaries.
First an ultrasound scan is performed via the vagina to check for physical obstructions in the pelvic area. After this a contrast medium is used, and if something suspicious is detected, a laparoscopic examination is performed. It is actually not uncommon for the woman to become pregnant after her fallopian tubes are examined with contrast medium. This may be because the contrast agent flushes the fallopian tubes, removing any blockages.
• Semen analysis.
A simple semen analysis can provide a lot of information. The gynaecologist assesses the sperm quality. Ideally, the sperm count should be over 20 million per millilitre. More than half of the sperm should be very active and mobile in order for the sperm quality to be considered normal. The sperm activity is measured using a swim-up test. The sperm is left for a while in a test tube with nutrient solution, and then an analysis is performed of how many sperm succeeded in swimming to the top layer of the solution.
Sometimes the man also has a blood test.
Male infertility may be caused by:
• Congenital factors such as chromosome abnormalities.
• Environmental factors such as radiation, cytostatics, pharmaceutical drugs or smoking.
• Past infections such as chlamydia.
• Chronic illness such as diabetes.
If the man's sperm are only slightly slower than normal, intrauterine insemination may be prescribed to help the sperm reach the egg. In this treatment, a sperm sample is concentrated and transferred to the woman's uterus at the optimal time via a plastic tube. This means the sperm have a shorter distance to swim to reach the egg. If tests show that the man has no sperm, the insemination can be done using sperm from a donor.
Female infertility may be caused by:
• Problems with ovulation or egg production. This is the most common cause of infertility. PCOS (polycystic ovary syndrome), a hormone disorder that can prevent the eggs from developing sufficiently to trigger ovulation. Symptoms include irregular or no periods.
• Problems with the fallopian tubes, such as obstruction caused by infection, chlamydia or gonorrhoea.
• Endometriosis, an illness in which the mucous membrane that normally lines the uterus grows outside it, for instance in the gut, the fallopian tubes, the ovaries or sometimes in the intestines.
• Less common problems are cervical disorders, polyps or uterine fibroids.
Many of these conditions can be cured with surgery. Surgery can either be used to solve the problem, or to prepare for IVF treatment to aid a planned pregnancy.
In over one in ten cases, the cause of the infertility is never discovered. This is known as unexplained infertility.
There are various treatments for involuntary infertility. IVF is often the first line option, and can be used to treat all types of involuntary infertility. Adoption is another solution.
One in six couples who want children have problems with involuntary infertility. This may be caused by reduced fertility in one or both partners. A fertility assessment may explain the reason for the infertility.