In the first of a three-part series, Dr Mary McCaffrey looks at the factors affecting fertility and the tests that can be carried out by a fertility clinic.
Starting a family is not always straightforward; becoming pregnant does not happen easily for everyone. Approximately 1:6 will experience difficulties in conceiving. There are many reasons why this can happen. Thankfully, modern medicine means that investigations can identify the cause in many cases and treatments can be offered in most cases.
Factors affecting fertility
Ovulation may not occur in about 30 pc of cases of fertility issues.
A woman’s ovaries contain her lifetime supply of eggs when she is a born. This supply of eggs reduces throughout her life. In some women this may happen more quickly than in others. This supply can be affected by surgery on the ovaries such as for cysts or endometriosis, certain medical drugs, for example cancer medications, cigarette smoking or genetic factors.
In recent times we have become more aware of environmental factors such as exposure to toxin and BPAs.
In some circumstances adequate eggs may be present but may not be released each month causing “anovulation” to occur. Hormonal problems such as PCOS may cause this. Equally, being overweight or underweight can affect ovulation. Stress can affect hormones so reflecting on a busy life may be all that is necessary.
Sperm problems can occur and may account for fertility problems in approximately 30 pc of cases. An inadequate number or quality of sperm can arise due to childhood issues such as undescended testes or mumps.
Adult problems such as previous injuries, cancer or surgery in the male genitals can affect sperm.
Certain medications may impact on sperm quality or numbers.
Lifestyle is now known to have a significant impact on sperm quality. Factors such as cigarette smoking, excessive alcohol intake, and the use of cannabis, steroids and bodybuilding substances can all affect male fertility.
The testes are not meant to be exposed to excessive heat. Issues such as keeping mobile phones in trouser pockets, heated car seats, and excessive use of saunas can also be detrimental.
Damage to the fallopian tubes can prevent the egg and sperm meeting thus, fertilisation may not occur. Such damage can occur due to previous pelvic infections such as a complex appenditis or chlamydia/ gonorrhoea.
Gynaecological problems such as fibroids or polyps can interfere with otherwise healthy embryos implanting (latching on) in the womb. Conditions such as endometriosis can cause inflammatory problems in a woman’s pelvis.
However, in about a quarter of cases no reason for failure to conceive is identified. Thankfully, as medical advances occur this situation is becoming less.
Nowadays most tests can be carried out without being admitted to hospital. It is important that both partners are investigated simultaneously as it is not uncommon to encounter situations where both male and female issues arise together. Where possible a Fertility Clinic will endeavour to carry out all investigations quite quickly.
Female blood tests are performed to look Ovarian Reserve and ovulation. The most recent test AMH ( anti mullerian hormone) helps to assess the egg potential for the future. It is no longer an elite test but part of our normal assessment of women’s ovaries.
There is now a wide range of tests to assess the fallopian tubes and womb. This may be a specialist ultrasound scan (hysterosonogram), an X-ray or a laparoscopy and dye test. Where possible we will try to avoid exposing women to X-rays.
In recent years specialist 3D/4D ultrasound is becoming a routine part of fertility investigations as it can identify abnormal shapes of the womb not always seen on regular ultrasound scans. Woman can expect that their scans will be ‘internal’ or transvaginal scans as such scans provide better quality images.
Male fertility is assessed by a semenalysis which assesses sperm numbers and the percentage of sperm moving.
As medicine advances we now offer Sperm DNA Fragmentation testing which assesses potential DNA damage in the sperm; this cannot be assessed on a routine semenalysis.
Complex tests such as Immune bloods/Chicago bloods or endometrial testing are usually only performed in very specific cases such as a past history of failed fertility treatments.
September 2016 – Part Two: First Steps of Fertility Treatments