Are You a Couple Trying to Conceive?
Infertility is defined as not being able to get pregnant despite having regular, unprotected sexual intercourse for at least a year. Most couples (approximately 85%) will achieve pregnancy within one year of trying. This diagnosis is therefore shared by 15% ( 1 in 6) of couples attempting to conceive. We generally recommend seeking the help of a Fertility Specialist if conception has not occurred within 12 months.
Infertility causes can affect one or both partners. In general:
- In about one-third of cases, there is an issue with the male.
- In about one-third of cases, there is an issue with the female.
- In the remaining cases, there are issues with both the male and female, or no cause can be identified (unexplained infertility).
It can be difficult to know when to visit a specialist to seek infertility treatment, as this can often depend on the individual but one of the most important factors in determining when is right to get support, is age.
The ages and lengths of time trying to conceive before visiting a specialist are shown below:
|Women under 35||After 1 year without success|
|Women 35-39||After 6 months without success|
|Women or men over 39||As soon as possible|
Contacting ReproMed according to the above table will allow for any fertility problems to be identified and acted upon as early as possible.
However, there are various scenarios where one may be advised to seek help earlier. These include:
- Infrequent or irregular menstrual periods: If a woman has cycles at intervals of greater than 35 days, it may indicate that she is not ovulating regularly, or even at all. Therefore, we recommend an evaluation if menstrual cycles are infrequent or irregular in a couple attempting pregnancy.
- A history of pelvic infections or sexually transmitted diseases: Sexually transmitted infections, such as chlamydia or gonorrhea, can cause inflammation and permanent scarring of the fallopian tubes in women and a decrease in quality and motility of the sperm in the men. We recommend immediate evaluation for a couple attempting pregnancy when either partner has a prior history of pelvic infection.
- Known uterine fibroids or endometrial polyps: Uterine abnormalities, such as fibroids that indent the endometrial cavity and endometrial polyps, can impair how the endometrium (the lining of the uterus) and embryo interact and reduce implantation and pregnancy rates. These abnormalities can also cause irregular bleeding between menstrual cycles. Evaluation should be pursued after 6 months of trying to achieve a pregnancy in women with a known history of these abnormalities or a history of bleeding between menstrual cycles.
- Known male factor semen abnormalities: If a male partner has a history of infertility with a prior partner, then we advise earlier fertility evaluation, ideally within 6 months of attempting pregnancy.
Before Your Initial Consultation
Before you have your initial consultation we recommend that you have the two tests that will give your consultant the best idea of what problems they need to address.
- AMH (Anti-Mullerian Hormone) is produced only in small ovarian follicles. The higher the number of eggs remaining in the ovaries, the higher the level of AMH in the bloodstream. AMH does not change during your menstrual cycle, so the blood sample can be taken at any time.
- Semen Analysis is the corner stone of male infertility. Even though this test doesn’t allow a diagnosis of infertility with absolute certainty, it does give us information on the functionality of the male reproductive system.
At initial consultation with the information provided from the previous tests your Consultant will be able to identify the most probable cause of infertility and will evaluate the need for further testing.
- TSH/Prolactin These two hormones can affect ovulation.
- Ultrasound scan is one of the key components of a full fertility assessment. By performing a scan we can assess the pelvis for signs of any underlying gynecological conditions that may impact on fertility. Ultrasound can detect uterine abnormalities such as fibroids and polyps, distal fallopian tube occlusion, and ovarian abnormalities including ovarian cysts. We can also assess the ovarian reserve (an indirect measure of how eggs you have left) by counting the number of follicles present in that cycle.
- Saline Infusion Sonography (SIS/HyFoSy): A small of amount of fluid is gently injected through the cervix into the uterus and this fluid separates the walls of the lining of the uterus and makes it easier to see abnormalities such as fibroids, polyps or scar tissue within the uterine cavity. With this test the permeability of the Fallopian tubes is assessed.
Some specialised testing may also be required depending on circumstances:
- DNA Fragmentation
- Chromosomal and Genetic Testing
- Immunological Testing