Statistically, even if neither of you have any fertility problems, about 80% of the couples conceive at the end of one year of regular unprotected sexual intercourse.
With this in mind, most doctors will refuse to investigate possible infertility until you have been trying for a baby for at least one year.
Women reach the peak of their fertility at 24 years of age and this diminishes after 30, and steeply declines after the age of 37, with pregnancy rarely occurring over the age of 50. Peak male fertility is at age 25 and declines after the age of 40. This means the older you are the harder it can be to conceive, so if you are over 35 years of age and have been trying to get pregnant for more than six months your doctor may consider investigating possible infertility early.
In up to 40% of cases there are difficulties in both partners, for example, the woman only ovulates infrequently and her partner has a low sperm count. Further investigations at the hospital will depend on any problems that have been identified. It is thought that one out of every seven couples is infertile and will need some kind of medical intervention to achieve a pregnancy.
Generally 1/3rd of the cause of fertility could be due to a problem in female partner, 1/3rd due to male partner and the remaining 1/3rd is unexplained. In 40% of the couples there can be a combined issue in both partners.
Female subfertility - In women there are many factors and ailments that can upset the fine balance of fertility; Polycystic Ovary Syndrome (PCOS), pelvic inflammatory disease (PID); endometriosis, fibroids; sexually transmitted diseases (STDs) such as chlamydia; chronic illnesses like diabetes; previous treatment for cancer and thyroid disease are just some. If you are either overweight or underweight or if you smoke (tobacco or marijuana) this will also affect your fertility and reduce your chances of conception. It should also be mentioned that both stress and alcohol can seriously affect your ability to conceive.
The main causes of female subfertility are damage to fallopian tubes and inability to release egg (anovulation) in every menstrual cycle. The fallopian tubes could be damaged mainly due to any previous infection such as chlamydia and sometimes due to previous surgery such as appendicectomy. Conditions such as sever endometriosis can also damage the fallopian tubes. Polycycstic ovary syndrome is the most common reason of anovulation. It is a misnomer as there are no cysts in the ovary, however due to still unclear reasons, ovary in such women fail to release egg every month. The treatment for this condition can be very simple and will be adviced by your clinician. Rarely women fail to release egg due to defect in pituitary gland in your brain which does not release adequate amount of hormones of FSH and LH. Further rare is a situation, where the women have no more eggs left in the ovary due to ageing or sometimes due to early menopause.
Male subfertility - Also in men as with women, overall health and lifestyle including diet, smoking, alcohol consumption and being overweight can play a significant role. Sperm production problems account for the majority of male infertility. As the sperm count is reduced if the testicles become overheated, for example by wearing tight briefs, using electric blankets, hot tubs, saunas and even through cycling, it’s important to keep the testicles cool. There could also be an underlying medical problem that needs to be identified.
Sometimes there can be a blockage in the tubes that transport the sperm to the penis. These blockages may have been caused by an earlier sporting trauma to the testicles, STDs or previous surgeries such as vasectomy reversals or hernia repairs. About 10% of men with blocked tubes will have been born with the condition. Occasionally, genetic disorders can be the cause of infertility in men. These chromosome irregularities can disrupt cell division and sperm production and therefore prevent you from becoming pregnant.
As with women, men can suffer from hormone irregularities and deficiencies. Deficiency of FSH and LH hormone or overproduction of prolactin hormone can also reduce fertility. Having previously had mumps, which could lead to damage to testicles can also lead to fertility problems.
Unexplained subfertility is a situation when the female has ovulatory cycles (she is successfully releasing egg every cycle, her fallopian tubes are patent and the male partner has normal sperm. But in spite of this the couple are unable to conceive even after 2 years of trying to conceive. Even though there is always a chance of natural pregnancy in such couples the best treatment in this situation is IVF.
Approved by Dr Jyotsna Pundir, Consultant Reproductive Medicine Specialist and Minimal Access Surgery,
Centre of Reproductive Medicine at St Bartholomew’s Hospital, London, U.K