Infertility and Reproductive Endocrinology
Infertility can be a loaded term, but it simply means that conceiving naturally is difficult. If a couple has not previously conceived a pregnancy, it is referred to as primary infertility. However, infertility can occur even when a couple has previously conceived a pregnancy, which is known as secondary infertility.
About 1 in 6 couples experience difficulty conceiving, making it more common than you might think. The most common explanation is inadequate sexual exposure, i.e. not enough sex. That might sound strange, but there is only a very small window for conception to occur. A couple having regular sexual intercourse only has a 1 in 4 chance of conceiving in any one month (or menstrual cycle). When you take into account that sperm can fertilise the egg only up to three days after sexual intercourse, and that the egg is only available to be fertilised by sperm up to 24 hours after ovulation, you start to realise how narrow the margins actually are.
For an investigation of infertility to be worthwhile, a couple needs to have had unprotected sex at least twice weekly for more than twelve months. At this point, an investigation can begin into whether the infertility is caused by issues arising in the male, female, both, or neither partner (so-called unexplained infertility).
How is infertility investigated?
Due to the many potential causes and contributing factors of infertility, we first get a thorough history of each patient. We also perform a detailed examination of both partners’ reproductive organs. We’ll run a series of tests to determine what the potential problem could be, and offer solutions to give you the best chance of successful conception. Don’t worry, we’ll talk you through each step, so you have a full understanding of what we are doing and why. Whatever the outcome, we’ll be with you every step of the way.
The major causes of conception issues in women are absence of ovulation (anovulation) and damage to the fallopian tubes (tubal disease). Pelvic infections, pelvic surgery and endometriosis may damage the fallopian tubes, causing difficulty in conceiving. Once we have diagnosed what is causing problems with conception, we will talk you through all the options until we find the one that works best for you.
Problems with the male partner are present in about 1 in 4 couples with difficulty conceiving. They include absence of sperm, sperm quality (low count, slow movement and high proportion of abnormal sperm) and antibodies against sperm. Whatever the issue may be, our team of professionals will discuss the best option for you.
General fertility advice
Healthier couples have a better chance of successfully conceiving a pregnancy. Therefore, you should both try to live a healthy lifestyle with a balanced diet and take regular exercise. Smoking and drugs should be avoided at all costs, and you should limit your use of alcohol and caffeine. Both partners should strive to maintain their BMI and other health problems should be controlled before trying for pregnancy. Besides providing general fertility advice, our experts will be happy to advise you on your specific circumstances.
If you or your partner has a condition which is known to delay or prevent conception, this does not apply and you may want to seek expert help from an earlier stage.
Treatment of infertility
Treatment of infertility depends on its cause. We offer a comprehensive range of services to give you the best chance to conceive:
The only routine medicine recommended for women trying to conceive is one (400 microgram) tablet of folic acid daily. This helps to prevent problems with the development of the baby’s spinal cord (spina bifida). It should be started before pregnancy actually occurs and continued for three months into pregnancy.
The most commonly-used specific infertility medicines are those that induce ovulation and these may be given as tablets, nasal puffs and/or injections. Others include medicines that are used to correct abnormal female hormone levels (such as hyperprolactinaemia).
Surgery may be needed to release adhesions, treat endometriosis in the pelvis and/or re-open blocked fallopian tubes. We undertake laparoscope ovarian drilling for women with polycystic ovary syndrome who do not respond satisfactorily to other treatments.
Some couples with infertility will ultimately need assisted conception, either because no other options are available to them or because other treatments have failed. If this is the case, our dedicated team will be there to take you through your options, and help you make the best choice for you.
Polycystic ovary syndrome
Polycystic ovary syndrome (PCOS) is the most common cause of the absence of ovulation.
Stress of infertility
Coping with infertility and its treatments can feel like a rollercoaster, due to the huge ups and downs that couples and individuals go through. Those who have unsuccessful attempts at pregnancy have to deal with the emotions of deciding what to do next. It is therefore essential to have a strong support system in place, which is exactly what Aurora has to offer. We’ll be there with you from your initial consultation to the end of journey, no matter its outcome.
Getting to treatment
Most people do not expect fertility problems. Suddenly, something you considered a natural and relatively straightforward part of life seems off limits to you. Initially, denial of a problem may delay getting help. You may grapple with various unpleasant emotions, including denial, anger or guilt, but these feelings are completely normal. Talking the problems over with sympathetic family members, friends or the trained counsellors at Aurora can help you to cope better. Remember: infertility does not, in any way, make you a failure.
If you decide to have treatment, you need to take into account that it may be a lengthy process. It is easy to get disillusioned if you do not get results quickly, but it’s important to understand that there may not be a ‘quick-fix’.
Infertility can create stress that can lead to relationship difficulties. It is often two-sided and it is important to avoid laying blame. Some forms of treatment (like IVF) may be very stressful as well.
Counselling is an important and often overlooked help for couples going through infertility. We provide access to specialist counsellors so you always have someone you can talk to in confidence. Research shows that couples that go through the whole process together from the first consultation, are better able to cope with the problem and its treatment.
- Try to take things one step at a time
- Don’t leave it too late to get help
- Try to talk to someone who’s been through it
- Keep supporting and talking to each other; make time to talk
- Try not to put life on hold; find enjoyment in other things
- Find out relevant information and discuss them with your healthcare providers
- Keep asking questions about the condition
- Use the services that are provided, especially counsellors and support groups
- Try to reach difficult decisions together