Fertility Problems

If you think you may have fertility problems – for example, if you’ve been trying for a baby for a long time with no results, it’s probably a good idea to speak to your doctor, who can refer you to a fertility clinic. There may be nothing wrong with either you or your partner, but the clinic can help you both rule out physical problems that might be easy to treat.

The staff at the clinic will take you both through the options available to you to find the best treatment for you and to give you the best chance of becoming pregnant. This will depend on a number of things such as the age of the female partner and the medical history of both partners.

Sperm problems

Some men experience minor problems with their sperm, such as a low sperm count (called oligospermia) or slow-moving sperm (called asthenospermia). The good news is, these conditions can sometimes be remedied with simple lifestyle changes, such as losing excess weight or stopping excess drinking.

If these measures don’t work, a procedure called intra-uterine insemination (IUI) can be effective. This is when a sample of sperm is taken from the man and healthy sperm are chosen from it. These are then inserted into the woman’s womb around the time when she is ovulating. Often, to increase the chances of the egg being fertilized, the woman is given a small dose of a fertility drug.

If this fails or if the sperm are too poor in quality, there is another procedure that can be used called intracytoplasmic sperm injection (ICSI). For this, eggs are removed from the woman’s body and a single sperm is injected into each egg in a laboratory. This is a very complicated treatment and the woman has to go through drug stimulation to ensure she produces several eggs and the egg collection before this can be carried out. In some cases, the man is incapable of ejaculating sperm and then they are collected directly from the testes.

If the man produces no sperm, then donation is the next option available to the couple.

Ovulation problems

If you find that, following tests, you are not ovulating as you should, your doctor and a health clinic or hospital will offer tests to discover the cause. One of the most common causes of ovulation problems is a condition called polycystic ovarian syndrome (PCOS), in which the ovaries are covered with many cysts which can prevent the egg from being released into the fallopian tubes. In addition to failure to get pregnant, there are several other symptoms of this condition, including irregular or light periods, weight gain, acne and excessive hair growth. It can be treated, for example by losing weight, offering hormone and drug treatments, using fertility drugs, or in some cases, offering laser surgery to the ovaries.

Weight can also affect ovulation; if you are overweight, losing some will increase your chances of conceiving. But being underweight can affect fertility too. If you are underweight or have a history of anorexia, you should see your doctor and dietician to give you some tips on eating healthily whilst trying to conceive and when – hopefully – you are pregnant.

For other ovulation problems which are not thought to be as a result of PCOS, women are typically offered fertility drugs either as tablets or injections or occasionally surgery to stimulate your ovaries to produce eggs. Fertility drugs may be used on their own but are usually offered with other treatments, such as intrauterine insemination (IUI) where a sperm is injected directly into the fallopian tube, or IVF.

Blocked fallopian tubes

The fallopian tube connects the ovary with the uterus (womb) and is the tube along which the egg passes to reach the womb. It can in some cases become blocked, perhaps through scarring from an operation, or from an infection, endometriosis or a fibroid. This means that either the egg finds it hard to get along the tube (which might result in an ectopic pregnancy, where the foetus starts to grow within the fallopian tube) or the egg may be prevented from travelling down the tube at all. If the blockage is fairly simple, it can sometimes be treated by surgery when part of the tube is removed. If only one tube is affected, your chances of getting pregnant are halved, as the egg will only be able to reach the womb every other month.

If the blockage is more serious, in vitro fertilisation (IVF) may be the most effective treatment. This is when the woman’s eggs are collected in a simple keyhole procedure and, in a laboratory, are mixed with a sperm sample from the male partner (or a sperm donor if necessary). The fertilised eggs are then placed directly into the womb.

Endometriosis

Inside your uterus is a type of tissue called Endometrium. In some women, this tissue starts to grow, through reasons that aren’t properly understood, as the tissue can start to grow outside the uterus, usually on the ovaries and sometimes in the lining of the abdomen. This is called endometriosis and can cause pain, especially before and during a period and can affect your fertility.

While there are drugs that have been developed to treat endometriosis, these will not improve fertility though they may help with the symptoms. Surgery to remove the endometriosis from your internal organs can improve your fertility, however.

If endometriosis has caused damage or blockage to your ovaries or fallopian tubes, you may be offered IVF to be able to get pregnant.

Fibroids

These are growths in your womb and in most cases they are benign, or non-cancerous. They may cause heavy periods, abdominal pain and pain during sex. You may have one or several and they can vary in size, though they tend to grow if left untreated.

They do not usually cause infertility but they can change the shape of the womb which makes pregnancy difficult or impossible.

Drugs can be used to shrink your fibroids and they may also be then removed with a simple surgical procedure, either through the vagina or through a small incision in the abdomen. This will usually cure all the problems you have had with them.

Non-specific fertility problems

In around 20% of cases, doctors cannot find a cause why either partner cannot conceive. This can be extremely frustrating for those who are diagnosed in this way, as for many, having a definite cause for infertility at least offers some form of solution or treatment.

If you have unexplained infertility, you will probably be offered IVF as the preferred treatment.