Trying To Conceive - But It’s Not Happening?
Current figures estimate that around 1 in 6 couples globally seek medical advice at some time in their lives regarding difficulties in getting pregnant. The time it takes to conceive naturally varies and age can be an important factor, both women’s and (to a lesser extent) men’s fertility gradually declines as they get older. There are many reasons why a couple may be having difficulty conceiving. It could be hormonal, due to PCOS (polycystic ovary syndrome), endometriosis or fallopian tube damage. These are just a few of the possible causes. In men, a fertility problem is usually because of low quantity, morphology or poor quality sperm. For up to a quarter of people, no reason can be found for their fertility problems. This is known as unexplained infertility.
Below, we have listed some of the most common causes of infertility.
Tubal Damage — Damaged Fallopian Tubes
Blocked or damaged tubes cause infertility because they stop egg meeting sperm or fertilised eggs (embryos) reaching and implanting in the uterus. Surgery to remove adhesions or unblock the tubes can be done. If the problem cannot be solved with tubal surgery, IVF may be the only possible treatment.
Abnormal or Low Sperm Count
Male infertility can often be treated. The sperm may still be capable of fertilising an egg even if the sperm count is low or the quality is poor. Intracytoplasmic sperm injection (ICSI) involves ‘washing’ sperm and injecting the highest quality sperm available into the egg. The fertilised egg (embryo) is then transferred to the woman’s womb. Some men have very low levels of hormones that stimulate the production of sperm and drugs can be used to improve fertility. If you have zero sperm count, you may want to consider donor sperm insemination (DI).
Difficulty Ovulating
During a natural menstrual cycle, ovulation should occur about 10-16 days before you next period is due. There are occasions however when this isn’t quite happening as you would like.
Polycystic ovary syndrome (PCOS) is a common disorder which can cause hormonal imbalances, increased androgens (male hormones), insulin resistance, cysts on the ovaries and infertility. These ‘cysts’ are in fact follicles that are trying to grow and reach ovulation however are unable to due to the varying hormonal imbalances in the body. For more information on PCOS, check out our PCOS article. Treatment for PCOS comes in the form of lifestyle modifications (don’t underestimate these), and medications that can be given to bring on ovulation. Irregular cycles can make it difficult to know when you are ovulating. There are many ways to assess when ovulation is happening often called Fertility Awareness Methods often coined ‘FAM’. These are ways to predict fertile and infertile times in your cycle. They look at
The Temperature Method: you take your temperature in the morning every day before you get out of bed.
The Cervical Mucus Method: you check your cervical mucus (vaginal discharge) every day.
The Calendar Method: you chart your menstrual cycle on a calendar.
For more information on FAM based methods, check our article here.
Uterine Polyps and Fibroids
Uterine polyps do not usually show any symptoms and yet can in fact increase the chances of miscarriage, or in some cases prevent implantation dependent on their location. Both polyps and fibroids in the uterine cavity can cause occasional cramping and several types of abnormal uterine bleeding, including: heavy menstrual bleeding, spotting between periods, or bleeding after intercourse. They are almost always benign but may need to be removed to improve chances of implantation.
Different Types of Uterine Fibroids
Subserosal fibroids are located beneath the serosa (the lining membrane on the outside of the uterus).
Submucosal (submucous) fibroids are located inside the uterine cavity beneath the inner lining of the uterus.
Intramural fibroids are located within the muscular wall of the uterus. A simple trans-vaginal or abdominal ultrasound scan can detect polyps and fibroids.
Pain and infertility from endometriosis
Endometriosis is the name given to the condition where cells like the ones in the lining of the womb (uterus) are found elsewhere in the body. Endometriosis is the name given to the condition where cells like the ones in the lining of the womb
(uterus) are found elsewhere in the body. Each month these cells react in the same way to those in the womb, building up and then breaking down and bleeding. Unlike the cells in the womb that leave the body as a period, this blood has no way to escape. It is a chronic and debilitating condition that causes painful or heavy periods. It may also lead to infertility, fatigue and bowel and bladder problems. Around 1.5 million women in the UK are currently living with the condition. Endometriosis can affect all women and girls of a childbearing age, regardless of race or ethnicity. Fallopian tubes or ovaries can be damaged (mentioned above). There’s sadly no cure, but it may be treated with surgery or hormone treatments. If pregnancy doesn’t happen after treatment, IVF can often be the best option.
Scarring of the Cervix or Vagina
If the cervix or vagina have been scarred (usually after surgery), this may increase the risk of infertility or miscarriage. The cervix is like a tunnel from the vagina to the uterus. Because it is so narrow, even the slightest scarring can obstruct the tunnel. IVF can be helpful because embryos are placed directly into the uterus and avoid the cervix area.
Thyroid Issues
Infertility can also be caused by either an under (hypothyroidism) or over active thyroid (hyperthyroidism) issue and thyroid dysfunction is one of the leading endocrine disorders. If the thyroid is under (or over) active, it can stop you ovulating, lead to miscarriages and prevent the reproductive system working properly and so it’s so important to get this checked out.
Multiple Factors Causing Infertility
A couple can sometimes have many reasons for their infertility and IVF can often be the best treatment. For example, there could be a minor sperm problem and scarring of the fallopian tube. In this case, IVF could greatly increase the chances of fertilisation and pregnancy. If there’s a risk of a disease such as cystic fibrosis or muscular dystrophy passing on to the child, embryos can be screened to detect one that is free of defects and then transferred to the uterus. The same treatment can be used for women who have abnormal chromosomes that cause miscarriages.