Infertility or subfertility affects one in six couples for a variety of reasons, both male and female, and often a combination of both. Some lifestyle factors contribute and these are often the easiest to treat. Medical problems in women can lead to infrequent or absent ovulation (egg release) or pelvic disease, which reduces the chance of pregnancy. Blocked tubes after infection, endometriosis, fibroids, advancing age, genetic and endocrine problems can all interfere with successful pregnancy.
Male factors are not always evident. Some men just don’t produce enough sperm or they may not swim well enough or not be formed normally. Other problems include congenital issues, such as undescended testes, accidents or illnesses (mumps), trauma, surgery or swollen veins in the scrotum (varicocoele). Genetic conditions affecting chromosomes are rare but occasionally explain poor sperm counts and can affect offspring.
Generally speaking couples under 35 years of age should conceive a pregnancy within 12 months of trying if periods are regular and no other obvious problems are present. If they haven’t conceived in this time frame investigation is appropriate. If the female partner in a couple is over 35 years of age investigations are started after 6 months ideally. This is because the monthly chance of pregnancy declines noticeably after 35 and treatments if required need to be considered sooner rather than later. Risks of miscarriage and genetic problems such as Down’s syndrome become more common as women age.
For women a thorough history and physical examination is required initially and an ultrasound to check for anatomical problems. Certain preliminary blood tests help us check “egg reserve” and X-rays can check for “tubal patency”. Some women may need exploratory surgery (Laparoscopy) to diagnose and treat conditions such as endometriosis, fibroids and adhesions.
Men are generally much easier to assess, with a semen analysis after three days abstinence generally indicative of male fertility. Some adverse lifestyle influences can still affect the function of sperm even if numbers are adequate. Other testing is generally reserved for men with significant abnormalities on the semen test.
A particular issue occurs for men wishing to father children again after vasectomy. When the time from this operation approaches ten years we know reversals are rarely effective and IVF with testicular sperm retrieval is required.
Treatments for infertility vary with the underlying diagnosis, duration of infertility and ages of the couple. Some couples may need lifestyle adjustment and advice while others may need treatments such as ovulation induction with timed insemination which will suit some conditions while more serious problems and those with advancing age will require IVF with or without ICSI (when the sperm is injected into the egg).
Women in their forties often prove the greatest challenge as “take home baby rates” will be between 10 and 20% per IVF attempt and success rates fall to nearly zero after women turn 44. This occurs because women’s ovaries fill with eggs (oocytes) before they are born and these will progressively age and reduce in number and quality, most noticeably after 35. In a perfect world all women would have their babies between 18 and 30 years of age when they are most fertile, however the reality is often far from this. Careers, lack of a suitable partner during optimal fertile years, economic factors, second marriages and many other circumstances lead to deferral of childbearing plans.
There are many underlying causes of infertility, which can be overcome with the appropriate use of Assisted Reproductive Technologies that can lead to couples fulfilling their dreams of having a family. It all starts with the first step.
Male factors are not always evident. Some men just don’t produce enough sperm or they may not swim well enough or not be formed normally. Other problems include congenital issues, such as undescended testes, accidents or illnesses (mumps), trauma, surgery or swollen veins in the scrotum (varicocoele). Genetic conditions affecting chromosomes are rare but occasionally explain poor sperm counts and can affect offspring.
Generally speaking couples under 35 years of age should conceive a pregnancy within 12 months of trying if periods are regular and no other obvious problems are present. If they haven’t conceived in this time frame investigation is appropriate. If the female partner in a couple is over 35 years of age investigations are started after 6 months ideally. This is because the monthly chance of pregnancy declines noticeably after 35 and treatments if required need to be considered sooner rather than later. Risks of miscarriage and genetic problems such as Down’s syndrome become more common as women age.
For women a thorough history and physical examination is required initially and an ultrasound to check for anatomical problems. Certain preliminary blood tests help us check “egg reserve” and X-rays can check for “tubal patency”. Some women may need exploratory surgery (Laparoscopy) to diagnose and treat conditions such as endometriosis, fibroids and adhesions.
Men are generally much easier to assess, with a semen analysis after three days abstinence generally indicative of male fertility. Some adverse lifestyle influences can still affect the function of sperm even if numbers are adequate. Other testing is generally reserved for men with significant abnormalities on the semen test.
A particular issue occurs for men wishing to father children again after vasectomy. When the time from this operation approaches ten years we know reversals are rarely effective and IVF with testicular sperm retrieval is required.
Treatments for infertility vary with the underlying diagnosis, duration of infertility and ages of the couple. Some couples may need lifestyle adjustment and advice while others may need treatments such as ovulation induction with timed insemination which will suit some conditions while more serious problems and those with advancing age will require IVF with or without ICSI (when the sperm is injected into the egg).
Women in their forties often prove the greatest challenge as “take home baby rates” will be between 10 and 20% per IVF attempt and success rates fall to nearly zero after women turn 44. This occurs because women’s ovaries fill with eggs (oocytes) before they are born and these will progressively age and reduce in number and quality, most noticeably after 35. In a perfect world all women would have their babies between 18 and 30 years of age when they are most fertile, however the reality is often far from this. Careers, lack of a suitable partner during optimal fertile years, economic factors, second marriages and many other circumstances lead to deferral of childbearing plans.
There are many underlying causes of infertility, which can be overcome with the appropriate use of Assisted Reproductive Technologies that can lead to couples fulfilling their dreams of having a family. It all starts with the first step.
Dr Gary Swift
MBBS (QLD) FRANZCOG MReprodMed(UNSW)
Infertility Specialist Virtus Health
Dr Gary Swift is an Obstetrician & Gynaecologist specialising in IVF, infertility and advanced laparoscopic surgery. He graduated from Queensland University in 1988, completed specialty training in Obstetrics and Gynaecology in 1999 and a Masters in Reproductive Medicine from the University of New South Wales in 2011. He has been a senior clinician with QFG Gold Coast now part of the Virtus Health Group since 2001. To seek an expert opinion with regard to Infertility and IVF treatments contact the Gold Coast rooms on 0755646017.
Access to infertility and IVF services will become that much easier from August 2014 when Dr Gary Swift from the Virtus group starts consulting regularly from rooms in Bangalow. Chosen as a centrally positioned and easily accessible location, specialist consultations, testing and some treatments will commence regularly. The Virtus group includes Queensland Fertility Group, IVF Australia (Sydney), Hunter IVF and Melbourne IVF and is the largest reproductive services group on the east coast of Australia.
MBBS (QLD) FRANZCOG MReprodMed(UNSW)
Infertility Specialist Virtus Health
Dr Gary Swift is an Obstetrician & Gynaecologist specialising in IVF, infertility and advanced laparoscopic surgery. He graduated from Queensland University in 1988, completed specialty training in Obstetrics and Gynaecology in 1999 and a Masters in Reproductive Medicine from the University of New South Wales in 2011. He has been a senior clinician with QFG Gold Coast now part of the Virtus Health Group since 2001. To seek an expert opinion with regard to Infertility and IVF treatments contact the Gold Coast rooms on 0755646017.
Access to infertility and IVF services will become that much easier from August 2014 when Dr Gary Swift from the Virtus group starts consulting regularly from rooms in Bangalow. Chosen as a centrally positioned and easily accessible location, specialist consultations, testing and some treatments will commence regularly. The Virtus group includes Queensland Fertility Group, IVF Australia (Sydney), Hunter IVF and Melbourne IVF and is the largest reproductive services group on the east coast of Australia.
Infertility? originally appeared in the Spring 2014 issue of Northern Rivers Family magazine.
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