Infertility is the inability to get pregnant after a year of unprotected intercourse. About one in seven couples in the UK are affected by infertility. Both men and women can be infertile.
Although often considered a female problem according to the Human Fertilisation and Embryology Authority (HFEA), approximately a third of the time a diagnosis of infertility is due to male problems. In other cases there are multiple male and female factors and for around one in four cases the reason remains unexplained.
How does age affect fertility?
The number of infertile couples rises with increasing age. Women are born with a finite number of oocytes (eggs). Thus, as the reproductive years progress, the number and quality of the eggs diminish.
The chances of having a baby decrease as women get older. This decline increases after the age of 35, mostly due to a lower quality of eggs released by the ovaries.
What causes female infertility?
Female infertility can be caused by a number of factors, including the following:
- Damage to fallopian tubes. Damage to the fallopian tubes (which carry the eggs from the ovaries to the uterus) can prevent contact between the egg and sperm. Repeated pelvic infections, endometriosis and multiple pelvic operations may lead to scar formation and fallopian tube damage.
- Hormonal causes. Some women have problems with ovulation. Synchronised hormonal changes leading to the release of an egg from the ovary and the thickening of the endometrium (lining of the uterus) in preparation for the fertilised egg do not occur. These problems may be detected using basal body temperature charts, ovulation predictor kits, and blood tests to detect hormone levels.
- Cervical causes. A small group of women may have a cervical condition in which the sperm cannot pass through the cervical canal. Whether due to abnormal mucus production or a prior cervical surgical procedure, this problem may be treated with intrauterine inseminations (see below).
- Unexplained infertility. The cause of infertility in approximately one in four couples will not be determined using the currently available methods of investigation.
How is the cause of infertility determined?
If male infertility is suspected a semen analysis is performed. This test will evaluate the number and health of his sperm. A blood test can also be performed to check his level of testosterone and other male hormones.
If female infertility is suspected, your doctor may arrange several tests, including:
- A blood test to check hormone levels
- An ultrasound scan to look at your uterus and ovaries.
Two diagnostic tests that may be helpful in detecting pelvic adhesions (scar tissue) and tubal obstruction are hysterosalpingography and laparoscopy.
- Hysterosalpingography (HSG). This procedure involves a series of X-rays taken of the reproductive organs. A dye is injected into the cervix and travels up to the fallopian tubes. The dye enables the X-ray to reveal if the fallopian tubes are open or blocked.
- Laparoscopy. In this procedure, a laparoscope (a slender tube fitted with a fibre optic camera) is inserted into the abdomen through a small incision near the belly button. The laparoscope enables the doctor to view the outside of the uterus, ovaries and fallopian tubes to detect abnormal growths, as in endometriosis.