Infertility is the inability to conceive after having regular unprotected sexual intercourse (every 2-3 days). The usual time period that is quoted for infertility to be a diagnosis is 12 months. Helping a couple achieving a pregnancy after infertility brings an enormous amount of satisfaction to Mr Penman. There cannot be anything more satisfying than hearing a patient you have been treating for infertility is pregnant.
- Slightly over half the cases of infertility is the result of female conditions.
- The remaining conditions that cause infertility are either male in origin or never identified.
- 84% of couples will conceive naturally within 1 year.
- Of the remaining 16%, 92% will manage this after 2 years.
Fertility Basics 101
To achieve a pregnancy, unprotected sexual intercourse at the right time of your cycle is imperative. The system that produces the eggs and the sperm need to be working at optimum levels, the fallopian tubes need to be patent.
→ Live eggs last 12-24 hours after ovulation.
→Sperm can stay alive and active in your body for 12-24 hours after ejaculation.
→It only takes one sperm and one egg to achieve a pregnancy.
→Millions of sperm are released in one ejaculation, few survive the journey through the cervix, uterus and fallopian tubes.
→No fertilisation, no implantation, the egg breaks down, the endometrium is shed and you have your period.
→It is estimated that 1 in 7 couple have trouble conceiving a pregnancy.
When Should You Seek Advice?
Some women get pregnant easily, others take longer. It can become very stressful when you’re not getting pregnant and you think you should be. Stress only makes it worse, you seem to notice all the strollers being pushed around the streets, everywhere you look there is a pregnant belly sticking out. It is the hardest thing to try and not get upset and worried about it. But if after a year of trying to achieve a pregnancy, a appointment with your GP is a good idea.
If however, you have had previous gynaecological problems, over 36 years of age or have irregular periods, Mr Penman’s advice is to get an appointment in the early stages to correct any irregularity easily before you embark on trying for a pregnancy. Your GP has the facilities to do various initial tests which will highlight what the next step should be.
Causes of Infertility
There are two types of infertility. Primary Infertility is infertility suffered by a couple if they have never conceived a child and Secondary Infertility is infertility suffered by a couple who have conceived a child in the past but are having problems conceiving now.
Causes of infertility can be female related or male related or occasionally no cause of the infertility is ever found.
- Lack of regular ovulation – such as in PCOS
- Blocked Fallopian tubes – damage due to previous pelvic infections.
- Lifestyle – significantly over or underweight
- Previous gynaecological problems
- Medical conditions such as diabetes, thyroid issues, blood clotting conditions.
- Low sperm count
- Poor quality sperm
- Problems with damage to the tubes that carry the spermm
- Problems with erections
- Problems with ejaculation
Getting Help for Infertility
It is emotionally upsetting to not get pregnant when you want to. All the elements are put together at the right time of the month, but two weeks later, you come on your period. Not to worry, try again next month, it will work then. This goes on, month after month, with no positive pregnancy test. The worry sets in and emotions take over for both of you. If you are over 35, it is wise to seek medical support earlier than the year recommended as fertility drops in women between 35 and 38 years.
Mr Penman treats infertility in his gynaecology clinic. If you wish to make an appointment to see him and discuss your options either complete the gynaecology appointment form or telephone the hospital where you would like to make an appointment, all details are on the contact page.
It is a lengthy process for female diagnosis of infertility, but whilst this is ongoing, your male partner will have a semen analysis to ensure that the sperm count is normal and the sperm quality is good. Should these be found to be low/poor quality, Mr Penman would refer onto a urologist, who will be able to manage your ongoing treatment to improve your sperm count and quality.
Female Diagnosis could involve any or all of the following tests:
- History of menstrual cycle
- Medical history including sexual history
- Blood tests and hormone profile
- Ultrasound scan
Treatment and Management
Mr Penman will collate all the test results and discuss the findings with you. He will recommend treatment and ongoing management depending on the results.
If you are not ovulating regularly, if you have Polycystic Ovary Syndrome ( please follow the link for further information) he may recommend a laparoscopy or treatment with Clomiphene under controlled circumstances to try and kick start ovulation.
Or if you have been found to have endometriosis,(please follow the link for further information) he may recommend various forms of treatment for this, including laparoscopy or treatment with Zoladex.
It may be that all tests are normal, in which case Mr Penman will recommend a hysteosalpingogram to check the patency of your fallopian tubes. This can be done as an outpatient, it is a simple test performed under ultrasound control where a liquid opaque to ultrasound is injected through the cervix and so through the uterus and fallopian tubes. It is not painful. Mr Penman can track the route of the liquid and follow it through the fallopian tubes ensuring that they are patent.
Mr Penman will then recommend you continue trying for a pregnancy for the next few months as sometimes when no other cause for the infertility can be found, following the hysteosalpingogram, a pregnancy will ensue, possibly the liquid during the hysteosalpingogram has cleared fine blockages within the fallopian tubes that may be the cause of previous problems with fertility.
If the fallopian tubes are found to be blocked, Mr Penman will discuss what further options you have for achieving a pregnancy.
Mr Penman will continue to monitor your progress with fertility treatment, adapting the programme as necessary to achieve ovulation.
Invasive Fertility Treatment
Mr Penman does not do IVF or any invasive fertility treatment, so should you reach this point, achieving ovulation but not achieving a pregnancy or if on hysteosalpingogram, you are found to have blocked tubes, he will discuss the onward management and treatment to achieve a pregnancy for you.
If you have never had any children, you may well be eligible for IVF or similar treatment on the NHS, in which case he will explain all this to you and complete a full review letter back to your GP with recommendations that they refer you straight on for NHS funded IVF.
If you do already have a child and have secondary infertility, he will advise you as to the options open to you, which may be self funding IVF and he can refer you onto his colleagues that perform IVF privately.
Many NHS trusts have certain criteria for accepting patients for NHS funded IVF, these may include:
- Not having any children already, both from current or previous relationships.
- Being a healthy weight
- Non Smoker
- Within a certain age range.
- If aged 40-42, further criteria may be imposed.
- In some cases only one cycle is offered.
Each NHS trust have different criteria.
Improving Fertility Chances
There are steps you can take to improve your fertility and give yourself a better chance of achieving a pregnancy, regardless of whether you are having fertility problems or not. But for those that are experiencing fertility issues, this will help. All sensible advice to give yourselves the best chance of achieving a pregnancy.
- Balanced Diet
- Good weight control
- If you are actively trying for a baby, the woman should take 400mg Folic Acid every day to reduce the risk of neural tube defects such as spina bifida where the spinal cord does not form properly leading to physical disability in the baby.
- Regular exercise (at least 30 minutes/day)
- Reduce the amount you drink. Alcohol can have a negative impact on semen quality and for women, this will have a serious effect on a developing fetus, so a good opportunity to manage this.
- Some prescription medications can lessen the chances of conception, so talk to your GP or Mr Penman.
- No recreational drugs of any kind.
- Quit smoking. This is linked to infertility and early menopause. It is a factor in premature birth and low birthweight babies. It is also linked with sperm problems in men.
- Keep the testes cool. No clear studies on this but some definitely show that avoidance of saunas and hot showers, along with loose fitting underwear may be beneficial.