No one knows for sure how many couples have difficulty conceiving, since some will decide against seeking medical help. In the UK, however, about one couple in seven does turn to doctors for help with getting pregnant.
It makes sense to go to the doctor as a couple when you first seek help with conceiving. Either one of you may have a fertility problem. Sometimes, you may both have a problem without realising.
The main causes of infertility are:
- Male factors, such as poor quality sperm or ejaculation problems (30 per cent).
- Ovulatory problems in the woman (25 per cent).
- Tubal damage in the woman (20 per cent).
Endometriosis is the cause of female infertility in about five per cent of cases, as it can cause both ovulation problems and tubal damage. Other less common problems can also affect fertility, such as uterine abnormalities and problems with the lining of the uterus. Sometimes there are repeated problems at the fertilization stage or with the embryo which leave couples childless, too.
In about 40 per cent of cases problems are found in both the man and the woman. For about 25 per cent of couples the cause of infertility remains unexplained.
What causes ovulation and egg problems?
There are several different types of ovulation problem. The most common is triggered by polycystic ovary syndrome (PCOS), which can cause irregular ovulation or even no ovulation. The condition is caused by hormonal imbalances.
- absent or infrequent periods
- abnormally light or heavy bleeding
- weight gain and extra body hair growth
Ovulation and egg production can be caused by problems with the pituitary gland and can also be affected by your age. Your egg quality starts to deteriorate from the age of 30 years, becoming more marked from the age of 35.
- fertility drugs
- in vitro fertilisation (IVF)
- the use of donor eggs
What can cause blocked fallopian tubes?
Your two fallopian tubes provide safe passage for your eggs to travel from your ovaries to your uterus. The following can lead to blockages in your fallopian tubes:
- pelvic inflammatory disease (PID)
- scar tissue, adhesions and damaged tube ends (fimbria)
Even if you ovulate regularly, having blocked tubes means your egg can’t get to your uterus, and your partner’s sperm can’t get to your egg.
You may have no symptoms at all. Or, depending on the cause, you may have painful periods, deep pain during sex and general pain in your pelvis.
The main treatment is usually IVF. However, if the blockage is only in a small area, it may be possible to clear it with a minor operation.
Infections such as chlamydia tend to damage the whole length of the tube. This means it’s harder to repair by surgery. Your doctor can carry out a laparoscopy, which is a keyhole operation to look inside your pelvic area and at your fallopian tubes. This will help your doctor to advise the best course of treatment.
A less common cause of fertility problems is fibroids. If you’re under 30 you may have no symptoms at all. Otherwise, you may have painful and heavy periods, and a feeling of fullness in your belly. Treatments to help you conceive are not always needed, but include hormones (gonadotrophins) or surgery to remove the fibroid.
What can cause problems for men?
In men, infertility can be the result of a blockage in:
- the coiled tubes which store and carry sperm from the testes (epididymis) or
- the two tubes that carry sperm from the epididymis ready for ejaculation (vas deferens)
Other causes include:
- poor sperm quality
- sperm not moving well (poor motility)
- not having enough (or any) sperm to begin with
There may be no symptoms at all, unless it’s something obvious, like an erection or ejaculation problem. Certain injuries may cause pain in the testicles. And some conditions, such as swollen veins in the scrotum (varicoceles) or untreated undescended testicles, may give a clue that there’s a problem.
Just as women can undergo surgery to open blocked fallopian tubes, men may have an operation to clear their blocked tubes. Depending on the problem, fertility drugs may boost sperm production. Other drugs can help retrograde ejaculation, which is when sperm shoots into the man’s bladder instead of his penis. Or healthy sperm can be chosen for a course of intra-uterine insemination (IUI).
However, the option that has become most popular for the treatment of male fertility problems is intracytoplasmic sperm injection (ICSI).
ICSI involves injecting sperm directly into the egg as part of an IVF treatment. The use of donor sperm remains the best solution for some couples. However, the number of ICSI treatments has been overtaking donor insemination treatments.
How can we pinpoint the cause?
As a couple, you’ll need to have a full assessment, including hormone tests. These tests will hopefully give you answers about why you’re not conceiving. The results will also help your specialist to advise the best course of treatment.