infertility explained

With today’s busy lifestyles, many couples plan carefully to ensure the time is just right to achieve pregnancy and start a family.

 

For the vast majority of couples pregnancy occurs naturally within 12 months of trying to conceive. However, for up to 20 per cent of couples it is a different story, they keep trying and nothing happens or they achieve pregnancy only to miscarry.

 

Infertility is defined as the inability to conceive after a year of unprotected intercourse, or the inability to carry pregnancies to a live birth.

There are many possible causes of infertility among males and females:

30% of infertility is due to female factors alone
30% of infertility is due to male factors alone
30% of infertility is due to both female and male factors
Up to 10% of infertility remains unexplained

 The affects of age on female fertility

As women are born with all the eggs they will ever produce, age becomes an issue. Female fertility declines slightly at 30 years and there is a significant decline around 37 to 38 years of age. By the time a woman is 40 years old her fertility is a quarter of when she was 30. The miscarriage rate increases with age from about one in seven for women aged less than 25 years to about one in two at 40 years of age.

 

Ovulation Disorders (See Ovulation Induction)

Tubal Blockage

Tubal blockage can occur as a result of previous sterilisation, previous abdominal or pelvic surgery or from a pelvic infection. Before the creation of IVF  tubal surgery was the only option available for women who were diagnosed with tubal blockage. Tubal damage increases the risk of an ectopic tubal pregnancy, (where the embryo implants in the fallopian tube instead of in the uterus). For this reason, unless the assessment of the tubes is favourable most Fertility Specialists recommend IVF rather than surgery.

Uterine causes

Forgotten IUDs, adhesions following multiple curettes, polyps, fibroids in the cavity of the uterus and tissue from a previous pregnancy loss or termination can all result in an embryo failing to implant. These conditions are diagnosed and treated by performing a surgical procedure called a hysteroscopy. The success rate will depend on the cause of the uterine problem.

 

Endometriosis

The tissue which lines the inside of the uterus is called the endometrium. In women of reproductive age (12 years – menopause) the tissue is broken down each month and shed as menstrual blood.
Endometriosis is a condition where the endometrium tissue is located in other sites of the body outside the uterus instead of being confined to the inside lining.

It is thought that this may happen for two reasons:

  1. Instead of the menstrual fluid flowing outside the body in the usual way, it flows back through the fallopian tubes.
  2. Patches of endometrium tissue may be deposited during the very early development of the reproductive organs.

Sites of Endometriosis

  • Ovaries
  • Behind the uterus (called the Pouch of Douglas)
  • The tissue below the ovaries (called the broad ligament)
  • The bladder
  • The bowel
  • The vagina
  • Rarely, it may occur in surgical scars, the navel or elsewhere

Endometriosis Facts

  • Endometriosis affects 1 in 10 women
  • It is commonly associated with infertility
  • 3 out of 10 infertile women have endometriosis
  • The surgical removal of endometriosis can help infertility
  • Untreated endometriosis is associated with an increased miscarriage rate
  • Women may have symptoms for many years before a diagnosis is made
  • A laparoscopy is the most reliable diagnostic method
  • Endometriosis can occur at any time between puberty and menopause
  • Endometriosis frequently occurs during teenage years

 

Male Factor Infertility

Male factor infertility is assessed by a semen analysis which measures sperm count, motility, shape and presence of antibodies. Generally speaking the more abnormalities found, the less fertile is the semen sample. However there are naturally fertile men with abnormal semen samples and infertile men with apparently normal samples. Sperm quality varies from sample to sample and often deteriorates following acute illness so impairment of male fertility should not be diagnosed on examination of a single sample. Men who have had a vasectomy may have their fertility restored by microsurgery. Sperm reappear in about 70% of cases, but half of these have high levels of sperm antibodies which vastly reduces the capability of the sperm to fertilise an egg. Since 1993 in Australia a method of sperm micro-injection has been used which involves the injection of a single sperm into the egg. This method is called Intra Cytoplasmic Sperm Injection (ICSI) and has proven to be very successful. It is appropriate for couples where there has been difficulty in achieving fertilisation with routine IVF methods or where semen tests show that routine IVF would not give satisfactory results. Couples where the male partner has very low sperm numbers and who would not be offered treatment with other IVF methods can now achieve good results with ICSI. Men who have had vasectomies (even if reversal has been attempted) and men with absent or blocked vas deferens (the tube that carries sperm from the testes) can now have sperm retrieved that may be used for sperm micro-injection. For men who cannot produce sperm, a surgical procedure called microsurgical sperm aspiration or testicular needle biopsy will need to be undertaken and this is routine at RMW.

 

Unexplained infertility

As the name implies, this is an inability when after full investigations have been carried out there is no medical cause found to explain an individuals infertility. However, this does not mean that the cause is psychological or that the couple is trying too hard. Although psychological issues may play a role in infertility, we feel that in most cases unexplained or poorly explained infertility probably means that our tests are insufficiently sensitive to diagnose the problem.

 

Zika Virus & Pregnancy

Data involving Zika, its transmission and infectivity, and its adverse effects on fetuses and adults is changing daily. Guidance based on current knowledge is iterative as our understanding of this virus rapidly changes. Any guidance published today may not be accurate for counseling and treatment of individuals tomorrow. Refer to the CDC Zika website for the most updated information: https://www.cdc.gov/zika/
 
SUMMARY TABLE. CDC recommendations for preconception counseling and prevention of sexual transmission of Zika virus among persons with possible Zika virus exposure – United States, August 2018
 

Exposure Scenario Recommendations (update status)
Only the male partner travels to an area with risk for Zika virus transmission and couple planning to conceive The couple should use condoms or abstain from sex for at least 3 months after the male partner’s symptom onset (if symptomatic) or last possible Zika virus exposure (if asymptomatic).
(Updated recommendation)
Only the female partner travels to an area with risk for Zika virus transmission and couple planning to conceive The couple should use condoms or abstain from sex for at least 2 months (8 weeks) after the female partner’s symptom onset (if symptomatic) or last possible Zika virus exposure (if asymptomatic).
(No change in recommendation)
Both partners travel to an area with risk for Zika virus transmission and couple planning to conceive The couple should use condoms or abstain from sex for at least 3 months from the male partner’s symptom onset (if symptomatic) or last possible Zika virus exposure (if asymptomatic).
(Updated recommendation)
One or both partners have ongoing exposure (i.e., live in or frequently travel to an area with risk for Zika virus transmission) and couple planning to conceive The couple should talk with their health care provider about their plans for pregnancy, their risk for Zika virus infection, the possible health effects of Zika virus infection on a baby, and ways to protect themselves from Zika. If either partner develops symptoms of Zika virus infection or test positive for Zika virus infection, the couple should follow the suggested timeframes listed above before trying to conceive.
(No change in recommendation)
Men with possible Zika virus exposure whose partner is pregnant The couple should use condoms or abstain from sex for the duration of pregnancy.
(No change in recommendation)

Source: Polen, KD, Gilboa SM, Hills S, Oduyebo T, Kohl KS, Brooks JT, et al. Update: Interim Guidance for Preconception Counseling and Prevention of Sexual Transmission of Zika Virus for Men with Possible Zika Virus Exposure – United States, August 2018. MMWR Morb Mortal Wkly Rep 67:868-71