Fertility, our natural capability to produce offspring, is influenced by so many factors. Our sexual behaviours, nutrition, culture, hormones, timing, economics, lifestyle and our emotions ALL contribute to our fertility.
So, how on earth do so many people out there make it look so easy?!
It is our purpose as animals to procreate. Yet, society lifestyle and culture have changed in the last generation quite drastically. Now, it is not uncommon to have problems conceiving and there are multiple reasons why, as well as multiple ways to manage them. As a population, we are delaying starting a family, and it is not uncommon for our first child to be conceived aged 40 and over. This is due to many of us putting careers over motherhood, wanting to travel the world, or figure out what we want in life before bringing a little one into the world. This has also become very culturally acceptable, when in previous decades it definitely was not. With this in mind, when planning a family or thinking about getting pregnant, what do we need to know?
Let’s start with a few “fertility facts” to set the scene…
- Getting pregnant (conception) happens when a man's sperm fertilises a woman's egg.
- 80-90% of couples get pregnant within one year of trying.
- You are most likely to conceive if you have sex around ovulation.
- This is when your ovary releases an egg… and happens about 14 days after the first day of your last period (*if your cycle is 28 days long). But unless you’re actively tracking your fertility, it is very tricky to know exactly when you’re ovulating.
- The best way to increase your chances of getting pregnant is to have sex every 2-3 days.
- Female hormones, including oestrogen and progesterone control our cycle and the release of an egg from the ovary.
What constitutes ‘infertility?’
Infertility is when a couple can't get pregnant despite regular unprotected sex, and it affects approximately 3.5 million people in the UK alone.The two types of infertility are primary and secondary. Primary infertility is where someone who has never been pregnant has difficulty conceiving; whilst secondary infertility is where someone has previously been pregnant is having difficulty conceiving again.
How is it diagnosed?
Once you see a doctor about having difficulty getting pregnant, they will take a thorough history and carry out a set of investigations, depending on your personal circumstances. It is always best to be seen by a specialist as a couple, because at the end of the day, the issue you’re trying to solve needs both of you to succeed! Your doctor will ask about any medical history, previous pregnancies, menstrual cycle and much more. They will likely check your height and weight (to calculate Body Mass Index), carry out a pelvic examination to assess your cervix and uterus, as well as taking routine STI screening swabs.
They may then order further investigations, which usually include:
- Pelvic ultrasound scan: this assess whether there is any structural issues causing infertility
- Blood tests: this can look at maternal health problems including thyroid disease, as well as hormones at certain times of your cycle to check whether you are ovulating.
- X-ray of your fallopian tubes: a hysterosalpingogram is a type of x-ray investigation that looks at whether your tubes are patent or if there is any blockage causing infertility
- Keyhole surgery: laparoscopy is sometimes considered later down the line of investigations, to have a look inside your pelvis for reasons behind infertility, such as scarring from previous infections.
For men, there is also a thorough history, as well as possible genital examination and semen analysis. Once these tests have been carried out, we can diagnose any problems, if there is indeed something found to be causing infertility.
What are the causes of fertility problems?
There are many causes of infertility, but it is worth noting that in 25% of cases, no cause is ever identified, highlighting the complexity of the problem.
In women, the main causes of infertility include lack of ovulation or irregular ovulation (so few eggs are released, therefore decreasing the likelihood of conception), blocked fallopian tubes (the tubes that carry the egg from ovary to womb), and endometriosis (a condition where tissue from the lining of the womb is found outside of the womb). In men, the most common cause of infertility is having poor quality semen, but other factors come into play such as ejaculation problems.
As mentioned, so many lifestyle factors influence our ability to conceive and affect our ovulation/ quality of semen. Being underweight, overweight, stresses, drinking or smoking too much, taking recreational drugs… the list is almost endless! So a good rule is to live healthily and look after yourself to give yourself the best chance of falling pregnant.
Risk factors for infertility?
Certain factors increase your risk of fertility problems:
- Age: sorry girls but fertility drops in your 30’s and dramatically after 37. Increasing age is also a problem for men, but to a lesser extent.
- Smoking: tobacco or marijuana, both can affect fertility in men and women.
- Excess alcohol- can reduce your chances of conceiving and affect the quality of men’s semen.
- Being overweight or underweight: both extremes of weight can affect ovulation.
- Sexually Transmitted Infections: STIs, such as chlamydia, can cause internal scarring and affect your chances of getting pregnant.
- Stress: can cause reduced libido and in extreme cases it can affect ovulating for women and semen quality for men
How do you treat infertility?
Sometimes it is simple as having more sex, changing your lifestyle, stopping smoking, eating better, or losing/gaining weight. If your investigations show up anything abnormal, then this can be treated or managed appropriately. If you have an infection, we would treat this. If your blood tests show you have a thyroid disease, we would treat this. If your bloods highlighted that you don’t ovulate, we can stimulate your ovaries to produce more eggs, with fertility medication. If you have endometriosis or scarring internally, this may require surgery, or indicate the need for IVF, and so on…
What is assisted conception?
This is whereby we control the way your sperm and egg are brought together so that you’re more likely to conceive, outside of sexual intercourse. These procedures are done when investigations show that the couple are unable to (or having difficulty) conceiving naturally. The methods include intrauterine insemination (IUI), in vitro fertilisation (IVF) and Intracytoplasmic sperm injection (ICSI).
IVF is a technique whereby one or more of the woman’s eggs are collected and mixed with sperm in a laboratory setting. You may need to take medication to stimulate your ovaries to produce several eggs at once. Once the eggs are fertilised in the lab (usually after 2-3 days), they are placed in the woman’s uterus.
IUI involves taking a sample of sperm and placing it inside the woman’s uterus close to the time of ovulation. It is often combined with stimulating the woman’s ovaries to increase her number of eggs, and therefore increasing chance of conceiving.
ICSI is a procedure, which injects a single sperm directly into an egg in a laboratory. The resulting embryo (fertilised egg) is transferred to the woman’s uterus.
All types of assisted conception have their risks, such as multiple pregnancy, over-stimulation of the ovaries, ectopic pregnancy and more. At the point of having such procedures, you will be in good hands of a specialist, and monitored closely for such complications. Don’t hesitate to talk through any concerns with your doctor. Living with infertility can be emotionally draining, and affect your relationship as well as your mental health.