Infertility
What is infertility?
Infertility is considered the inability to achieve pregnancy after 12 months of normal sexual intercourse without contraception. Infertility may affect either the man or the woman or both.
What affects fertility?
Women are at their most fertile in their 20s, but will cease producing eggs (ovulating) when they reach menopause in their late 40s or early 50s. However, men can continue to produce sperm into their 70s but the quality of the sperm deteriorates with age. There are also other factors that may affect fertility including:
- general health concerns such as obesity, thyroid disease or uncontrolled diabetes;
- psychological factors such as stress, tension and anxiety;
- excessive smoking and alcohol intake; and
- some types of medicines.
What causes female infertility?
- Failure to produce eggs.
- Failure for the ovaries to develop, as seen in conditions such as Turner's syndrome.
- Endometriosis, a condition that causes abnormal growth of the endometrium tissue, often causing scarring and inflammation in the reproductive organs.
- Blocked fallopian tubes (the tubes that take eggs from the ovaries to the womb). This is often caused by scarring following infections such as pelvic inflammatory diseases (PIDs) or sexually transmitted diseases (STDs) such as chlamydia or gonorrhoea.
- Womb tumour or scarring that prevents fertilised eggs from implanting.
- Certain hormonal imbalances.
- 'Hostile' mucus at the cervix (neck of the womb) which does not allow sperm to enter.
- In rare cases, some women may have a reaction to their partner's sperm.
Assessing infertility
Doctors can assess infertility in both partners by:
- taking a detailed medical history including menstrual problems, exposure to sexually transmitted diseases or mumps, the use of certain drugs and medicines, timing and regularity of sexual intercourse;
- physical examinations of both partners;
- conducting blood tests to exclude certain hormonal imbalances;
- semen examination to see if there is sufficient healthy sperm;
- testing to ensure the woman is producing eggs;
- checking for blocked fallopian tubes and abnormalities of the uterus with either a hysterosalpingo-contrast-sonography (HyCoSy), an ultrasound test involving injection of fluid through the cervix), or a laparoscopy (a small tube inserted into the lower abdomen to directly examine the ovaries and uterus); and
- checking the cervical mucus.
How your doctor will treat infertility
- Prescribe fertility medicines that will induce ovulation.
- Treat any conditions that may be affecting fertility and help manage weight if you are overweight or underweight.
- Recommend the best time for sexual intercourse by plotting the woman's ovulation times.
- Treat endometriosis.
- Treat any pelvic infections with antibiotics.
- Treat any hormonal imbalances that may have been found.
- Refer for surgery to clear blocked tubes.
- Some couples may be referred to in vitro fertilisation (IVF) programmes or gamete-intra-fallopian transfer (GIFT) programmes.
- Refer for artificial insemination or donation of sperm or eggs from another man or woman.
What can I do?
- Stay fit and healthy with a well-balanced diet and regular exercise.
- Avoid smoking and excessive alcohol intake.
- Avoid anxiety about getting pregnant. Learn how to relax and manage stress and anxiety.
- Keep a temperature chart. On waking every morning your temperature can be noted, as there is normally a rise in temperature for the second half of the cycle after the egg has been released from the ovary. This helps to plot when you are most fertile.
- You can also learn how to monitor changes in your cervical mucus, which can indicate when you are most fertile.
Last Reviewed: 16 December 2009
- 1. Royal Australian and New Zealand College of Obstetricians and Gynaecologists [website]. College statement: Ovarian stimulation in infertility (published 2008, November). Available at: http://www.ranzcog.edu.au/publications/statements/C-gyn2.pdf (accessed 2009, Dec 17)
2. Patient leaflets from the BMJ Group [website]. Fertility problems: what goes wrong? (last published 2009, Aug 6). Available at: http://bestpractice.bmj.com/best-practice/pdf/patient-summaries/female-infertility-what-is-it.pdf (accessed 2009, Dec 17)
3. Patient leaflets from the BMJ Group [website]. Fertility problems: what treatments work? (last published 2009, Aug 6). Available at: http://bestpractice.bmj.com/best-practice/pdf/patient-summaries/female-infertility-what-treatments-work.pdf (accessed 2009, Dec 17)
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