Infertility

What is infertility?

Fertility is your natural ability to have a child. Infertility is when a couple has had regular unprotected intercourse for a year but have not become pregnant. For a woman to become pregnant, a man's sperm needs to meet with a woman's egg. The fertilised egg then implants in the lining of the woman's uterus and starts to grow into a baby.

Infertility can be caused by problems in:

• Ovulation - the woman's body may not release an egg from one of her ovaries
• Fertilisation - a man's sperm may not be strong enough to travel to a woman's fallopian tubes or there may not be enough sperm, or they may not be healthy enough, to fertilise the egg
• Implantation - the fertilised egg may not implant in the lining of the uterus

How common are infertility problems?

About 16% of Australian couples have problems with fertility.

• about one third of infertility problems are because of fertility issues with the woman
• about one third of infertility problems are because of fertility issues with the man
• about one third of infertility problems are because of fertility issues with both the man and the woman or the cause of infertility is unknown

Fertility can be affected by:

• medical illness
• age
• weight
• smoking, taking drugs or drinking alcohol
• sexually transmitted infections (STIs)
• not having sex regularly or at the correct time in the menstrual cycle

How common are infertility problems?

Problems with ovulation - Not releasing an egg from either ovary is the most common reason for female infertility which is often due to polycystic ovary syndrome (PCOS). If you are over 35 years old, the number and quality of your eggs is reduced making it harder to become pregnant.

Blocked fallopian tubes - This can be due to scar tissue from endometriosis, pelvic inflammatory disease (PID) or previous pelvic surgery for conditions such as appendicitis or ectopic pregnancy.

Structural problems - Large fibroids within the uterus may stop a fertilised egg from implanting into the uterus.

Medical conditions - medical conditions including autoimmune diseases such asystemic lupus erythematosis, thyroid disease and diabetes can affect fertility.

What are the causes of infertility in men?

While men make sperm throughout their adult lives, the quality of the sperm lessens as they get older. There are higher rates of miscarriage in pregnancies where the man is over the age of 45 years. Other factors can affect male fertility, they include:

• obesity
• smoking, alcohol and drugs
• genetic causes
• testicular problems - undescended testes, varicose veins of the scrotum, testicular torsion
• infection
• trauma
• anti-sperm antibodies
• inability to get or keep an erection

If a man has had a vasectomy, he may have fertility problems even if the vas are successfully reconnected by reversal surgery.

How can I improve my chances of pregnancy?

Age

Age is the most important factor in fertility. Women are born with all of their eggs already formed in the ovaries. Women are most fertile below the age of 35 years and usually find it harder to conceive after this age as they have fewer eggs and the eggs are getting older. Men experience a decrease in sperm quality as they age. It takes longer to get pregnant if the man is over 40 years and there are higher rates of miscarriage where the man is over 45 years.

Some women may consider freezing their eggs but this can be costly – talk to your doctor if you want more information about this.

Timing of sexual intercourse

Having sex every 2-3 days, particularly during the week before ovulation, increases the likelihood of sperm already being present when the woman releases an egg from her ovary.

Lifestyle factors

Being either overweight or underweight can affect fertility. Aiming for a healthy weight, eating a healthy, balanced diet with folate supplements and taking moderate exercise can help. Alcohol can reduce fertility and can greatly increase the time it takes to get pregnant. Australian guidelines recommend that women who are planning pregnancy shouldn't drink alcohol. Smoking tobacco (including passive smoking) can decrease both female and male fertility.

A year after you give up smoking, all of the negative effects are gone. Recreational drugs, including cocaine, heroin, cannabis and ecstasy, have also been shown to affect fertility and should be avoided if you want the best chance of getting pregnant.

When should I start to think about being investigated for infertility?

If you have been having unprotected sex for more than 12 months without getting pregnant (6 months if the woman is over 35 years), talk to your doctor or visit a Family Planning NSW clinic as soon as possible. Investigations ordered by your doctor may include:

• For women - hormonal blood tests and a pelvic ultrasound
• For men - semen analysis to look for the number and movement of the sperm

Your doctor will also advise you about how to prepare for a healthy pregnancy and will do tests to check you are immune to rubella (German measles) and varicella (chicken pox).

What will happen if I am referred to an infertility clinic?

You may have more tests and the following options may be discussed:

• Insemination of a partner's sperm into uterus
• Insemination of donor sperm into the uterus
• In vitro fertilisation (IVF) - this involves removing eggs from the ovary and mixing them with sperm (from a partner or donor) for between 2 and 6 days in the laboratory. An embryo is then put into the uterus. Extra embryos can be frozen and stored for up to 10 years. Frozen embryos can be thawed and used in later IVF cycles.
• Intracytoplasmic sperm injection (ICSI) – this is where a single sperm is injected into an egg which has been removed from the ovary and is then put back into the uterus. ICSI may be used when there is a problem with the sperm.

Tissue from the ovary is sometimes frozen for women undergoing cancer treatment. Eggs from the ovary can also be frozen which can then be fertilised later using IVF. For most women the chance of a successful pregnancy using frozen eggs depends on their age at the time of freezing. Assisted reproduction can involve sperm donation, egg donation or surrogacy. A surrogate is a woman who gives birth to a child on behalf of another person. The services of a surrogate may be used by a couple where the female is unable to carry a pregnancy, by single men or by a male couple who wish to become parents. There are laws in Australia to control these processes.

For more information

Family Planning NSW Talkline – www.fpnsw.org.au/talkline or 1300 658 886
National Relay Service (for deaf people) – 13 36 77
TIS National's interpreting service – 131 450
Visit your nearest Family Planning NSW clinic – www.fpnsw.org.au/clinics
Family Planning NSW Fact Sheets on Pre-pregnancy Planning and Healthy Pregnancy and Maximising Natural Fertility
Victorian Assisted Reproductive Treatment Authority – www.varta.org.au
Fertility Coalition – www.yourfertility.org.au