Making babies – an expert explains the basics of infertility

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Cesar Diaz, Medical Director of IVI London, talks about infertility

Infertility is when a couple cannot conceive despite having unprotected sex.

Some women get pregnant quickly, but for others it can take longer. Around one in seven couples in the UK may have trouble conceiving.

If you have not conceived after one year of trying, we recommend that you see your GP. Women aged 36 and over and couples with known fertility problems should see their GP sooner.

For women under 35, there is around a 25% chance of becoming pregnant when the woman is ovulating. After the age of 35, women’s reproductive potential decreases and after the age of 40 the chances of becoming pregnant naturally fall to 10% during ovulation.

To diagnose infertility, the IVI clinic will obtain a full medical history and complete a physical examination of both members of the couple.

For women, the basic tests are a basal hormone study, an ultrasound scan and a hysterosalpingography (an x-ray to investigate the uterine cavity and fallopian tubes). The range of tests may be extended, depending on the patient.

For men, there is an assessment of semen quality via a seminogram test.

Primary infertility refers to couples who have not been able to conceive despite having regular unprotected sex for at least one year. Secondary infertility, in contrast, refers to couples who were able to conceive before, but are having problems or are unable to conceive or get pregnant again.

Ovulation, or a woman’s fertile period, occurs around halfway through each cycle, on roughly the fourteenth day in a supposed 28-day cycle. It has been proven that 24 hours after ovulation there is a rise in base body temperature of between 0.4 and 0.6 degrees. This is the signal on which the control method is based, marking the days on which ovulation occurs.

Once the ovum (egg) has left the ovary it survives for around 48 hours and it is only during this time that it can be fertilised by spermatozoa, which maintain their capacity for fertilisation for a maximum of 72 hours.

It is better not to be obsessed with monitoring ovulation, because anxiety about pregnancy is counterproductive to getting pregnant and it can even damage a couple’s relationship. Nevertheless, the probability of a spontaneous pregnancy after one year of trying decreases greatly, even with careful scheduling of sexual relations.

Many women are choosing to have children later in life, but fertility decreases over time. Female fertility decreases more rapidly after 35 and male fertility gradually decreases after the age of 40. Men and women are most fertile in their early 20s.

There is no legal limit that prevents a couple from having fertility treatment. Outcomes depend on the circumstances of each couple, on their health and physical condition. For women, 50 is a reasonable limit beyond which fertility treatment is not typically recommended.

There can be many reasons why couples fail to conceive. In 30% of cases there is a male factor involved; in 30% of cases there is a female issue. In some cases, the fertility problem is unexplained and it may not be possible to identify the precise cause.

The main causes of fertility problems in women are:

  • Damage to one or both of the fallopian tubes
  • Advancing female age. From 35 onwards reproductive potential drops and after the age of 40 there is less than a 10% chance of getting pregnant naturally in any given month
  • Endometriosis: where cells that are usually found in the lining of the womb are outside the womb
  • Other risk factors: fibroids; sexually transmitted infections; chronic diseases such as diabetes, cancer, thyroid disease, asthma or depression; specific medication such as antidepressants

The main causes of infertility in men are:

  • Genital tract disorders which prevent semen from being deposited at the back of the vagina
  • Erectile dysfunction
  • Reduced sperm count and motility of the sperm
  • Extreme obesity
  • Undescended testicles
  • Trauma or surgery to the testicles

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