Answer:

Infertility is when a couple fails to become pregnant despite having regular unprotected sex. Women who can get pregnant but then have repeat miscarriages may also be said to have infertility.

Pregnancy is the result of a complex chain of events. In order to get pregnant:

• A woman must release an egg from one of her ovaries (ovulation).
• The egg must travel through a fallopian tube towards the uterus (womb).
• A man's sperm must join with (fertilise) the egg along the way.
• The fertilised egg must attach to the inside of the uterus (implantation).

Infertility can be a consequence of problems that interfere with any of these steps.

Answer:

The NHS says around one in six or seven couples may have experience problems conceiving, although the number of couples who are actually infertile is around 5%.

The Human Fertilisation and Embryology Authority which regulates IVF says this means of 100 couples trying to conceive naturally around 84 will get pregnant within one year and about 92 within two years.

Answer:

No, infertility is not always a woman's problem. In about one-third of cases, infertility is due to the woman (female factors). In another third of cases, infertility is due to the man (male factors). The remaining cases are due to a mixture of male and female factors or to unknown factors.

Answer:

Infertility in men is most often caused by:

• Problems making sperm -- producing too few sperm or none at all.
• Problems with the sperm's ability to reach the egg and fertilise it - sperm with an abnormal shape or structure (morphology) are unlikely to be able to fertilise an egg.   

Sometimes a man is born with the problems that affect his sperm. In other cases, the problems start later in life due to illness or injury. For example, cystic fibrosis often causes infertility in men.

Answer:

The number and quality of a man's sperm can be affected by his overall health and lifestyle. Factors that may reduce sperm number and/or quality include:

• Alcohol
• Drugs
• Environmental toxins, including pesticides and lead
• Cigarette smoking
• Health problems
• Medicines
• Radiotherapy and chemotherapy for cancer
• Age

Answer:

Problems with ovulation account for most cases of infertility in women. Without ovulation, there are no eggs to be fertilised. Signs that a woman is not ovulating normally include irregular menstrual periods or no periods at all.

Less common causes of fertility problems in women include:

Answer:

A number of factors can affect a woman's ability to have a baby. These include:

A woman's peak fertility is in her early 20s. As a woman ages beyond 35 (and particularly after 40), the likelihood of becoming pregnant reduces. As men age, levels of testosterone fall, and the volume and concentration of sperm change.

Healthy couples younger than 30 years who have regular sexual intercourse and use no contraception have a 25-30% chance of achieving pregnancy each month.

A healthy diet is very important for women who are trying for a baby. Obesity is a major health issue in the UK. A woman who is overweight and who is planning a pregnancy would be advised to lose weight before she conceives. 

Being overweight can affect a woman’s fertility and can cause complications during pregnancy.

Weight loss with anorexia or bulimia can disrupt a woman’s cycle and thereby reduce her chances of becoming pregnant.

Exercise should be encouraged as part of normal activities, for both women and men in the pre-conceptual period. However, strenuous exercise in women may result in disruption of the ovulation cycle, thereby affecting a woman's periods. Normal exercise has not been linked to miscarriages (loss of pregnancy) but certain forms of exercise (for example, high-impact or contact sports or scuba diving) should be avoided in pregnancy.  In men, over-exercise may cause a low sperm count.

Answer:

More and more women are waiting until their thirties and forties to have children. According to the Office of National Statistics, Since the mid 70s women aged 30 to 34 are more likely to become mothers for the first time than any other age group.

Consequently, age is an increasingly common cause of fertility problems. About one-third of couples where the woman is over 35 years old have fertility problems.

Aging reduces a woman's chances of having a baby in the following ways:

Answer:

Most healthy women under the age of 35 years shouldn't worry about infertility unless they've been trying regularly to get pregnant for at least a year. At this point, women should talk to their doctor about having a fertility evaluation (sometimes also called an infertility evaluation). Men should also talk to their doctor in these circumstances.

In some cases, women should talk to their doctors sooner. One prompt is menstrual irregularities.  Women over 35 who have been trying to get pregnant for six months should talk to their doctor as soon as possible. Past this age, the chances of having a baby fall sharply. 

Some health issues also increase the risk of fertility problems. Women with the following issues should speak to their doctor as soon as possible:

No matter how old you are, it's always a good idea to talk to a doctor before you start trying to get pregnant. Doctors can help you prepare your body for a healthy baby. They can also answer questions about fertility and give you tips on conceiving.

Answer:

Sometimes doctors can find the reason for a couple's infertility by conducting a complete fertility evaluation. This usually begins with physical examinations and questions about health and sexual histories. If there are no obvious problems, such as poorly timed intercourse or absence of ovulation, tests will be needed.

Isolating the cause of infertility is often a long, complex and emotional process. It can take months for you and your doctor to complete all the necessary examinations and tests. So don't be alarmed if the problem is not found straight away.

With a man, doctors usually start by testing his semen. They look at the number, shape and movement of the sperm. Sometimes doctors will also suggest testing a man's hormone levels.

For a woman, the first step in testing is to find out whether she is ovulating every month. There are several ways to do this. A woman can track her ovulation at home by:

• Recording changes in her morning body temperature (basal body temperature) for several months
• Recording the texture of her cervical mucus for several months
• Using a home ovulation test kit

Doctors can also check whether a woman is ovulating by doing blood tests and an ultrasound scan of her ovaries. If the woman is ovulating normally, more tests will be needed.

Some common tests for fertility in women include:

Hysterosalpingography: In this procedure, doctors use X-rays to check for physical problems in the uterus and fallopian tubes. They start by injecting a special dye through the vagina into the uterus. The dye shows up on the X-ray and the doctor can see whether it is moving normally through the uterus into the fallopian tubes. A hysterosalpingography enables doctors to identify blockages that may be causing infertility. Blockages can prevent the egg from moving from the fallopian tube to the uterus. They can also keep the sperm from reaching the egg.

Laparoscopy: This is a form of surgery in which doctors use an instrument called a laparoscope to look inside the abdomen. The doctor makes a small incision in the lower abdomen and inserts the laparoscope. Using this instrument, doctors can check the ovaries, fallopian tubes and uterus for disease or physical problems. Doctors can usually find scarring and endometriosis using a laparoscope.

Answer:

Infertility can be treated with medicine, surgery, artificial insemination, or assisted reproductive technology, sometime referred to as IVF (in vitro fertilisation) . In many cases, these treatments are combined. About two-thirds of couples who are treated for infertility are able to have a baby. Most of the time, infertility is treated with drugs or surgery.

Doctors recommend specific treatments for infertility based on:

Doctors often treat male infertility in the following ways:

Various fertility medicines are prescribed for women with ovulation problems. It is important that you talk to your doctor about the pros and cons of these medicines. You should understand their risks, benefits and side effects.

Doctors also use surgery to treat some causes of infertility. Problems with a woman's ovaries, fallopian tubes, or uterus can sometimes be corrected in this way.

Intrauterine insemination (IUI) - usually referred to as artificial insemination - is another type of treatment for infertility. In this procedure, the woman is injected with specially prepared sperm. Sometimes she will also be given medicines that stimulate ovulation before IUI.

IUI is often used to treat:

Answer:

Among the medicines commonly used to treat infertility in women are:

Many fertility drugs increase a woman's chance of having twins, triplets or other multiple births. Women who are pregnant with multiple foetuses are at risk of having more problems during pregnancy. Also, multiple foetuses have a high risk of being born too early (prematurely). Premature babies are at a higher risk of health and developmental problems.

Answer:

IVF (in vitro fertilisation) involves removing eggs from a woman's body, mixing them with sperm in the laboratory, and putting the embryos (fertilised egg) back into the woman's body.

Answer:

The success rates vary and depend on a number of factors, including:

• Age of the partners - IVF success rates are around 32% for women aged under 35, but only 1.5% for women aged 45 and over.
• Cause of infertility
• Fertility clinic used (e.g. does it only accept younger couples with relatively straightforward infertility issues?)
• Type of fertility treatment used
• Whether the egg is fresh or frozen
• Whether the embryo is fresh or frozen

IVF can be expensive and time-consuming. However, it has allowed many couples to have children who otherwise would not have been conceived. Bear in mind that IVF provision funded by the NHS is limited and varies from one part of the country to another. There may be long waiting lists.

The Human Fertilisation and Embryology Authority says the NHS aims to offer women between the ages of 23 and 39 years at least one free cycle of in vitro fertilisation (IVF), providing they meet the eligibility criteria.

The National Institute for Health and Clinical Excellence’s 2004 fertility guideline recommended that couples in which the woman is aged 23-39 years at the time of treatment and who have an identified cause for their fertility problems, or who have experienced infertility for at least three years, should be offered up to three stimulated cycles of IVF treatment on the NHS.

The other option is private IVF treatment, although this can be very expensive and there is no guarantee of success.

The most common complication of IVF is multiple births. However, this can be prevented or minimised in a number of ways.

Answer:

Common methods of ART include:

• In vitro fertilisation (IVF), which means fertilisation outside the body. IVF is generally regarded as the most effective form of ART. It is often used when a woman's fallopian tubes are blocked or when a man produces too few sperm. Doctors treat the woman with a drug that prompts the ovaries to produce multiple eggs. Once mature, the eggs are removed from the woman and placed in a dish in the laboratory along with the man's sperm for fertilisation. After three to five days, healthy embryos are implanted in the woman's uterus.
• Zygote intrafallopian transfer (ZIFT) or tubal embryo transfer is similar to IVF. Fertilisation occurs in the laboratory. The very young embryo is then transferred to the fallopian tube instead of the uterus.
• Gamete intrafallopian transfer (GIFT) involves transferring eggs and sperm into the woman's fallopian tube, so that fertilisation occurs within the body.  
• Intracytoplasmic sperm injection (ICSI) is often used for couples where there are serious problems with the sperm. It is sometimes also used for older couples or for people who have failed to conceive through IVF. With ICSI, a single sperm is injected into a mature egg. The embryo is then transferred to the uterus or fallopian tube.

Fertility procedures sometimes involve donor eggs (eggs from another woman), donor sperm or previously frozen embryos. Donor eggs may be used for women who cannot produce their own eggs. Donor eggs or donor sperm are also sometimes used when the woman or man has a genetic disease that can be passed on to a baby.