Infertility: Common causes, fertility treatments, IVF and more

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Couple lying in bed, infertility
If you're having trouble getting pregnant, you could be feeling very upset and isolated. But 25 per cent of couples experience a period of infertility that can last up to a year with about 1 in 10 will need medical help.

So although it's a hard thing to go through, you're not alone, and support is available. While it may seem that people all around you are falling pregnant at the drop of a hat, it can take time to conceive. You only have a 20% chance of getting pregnant each month. After a year of having unprotected sex, one in seven couples won't have conceived, but 90 per cent of couples conceive within two years.

If it's not happening for you, there are some practical things you can do to help. Both you and your partner need to sex, of course!

Try to pinpoint when you ovulate (release an egg) each month, so you can make sure you're having sex at the optimum conception time. It's normally halfway through your cycle. You can buy an ovulation kit from the chemist, or you may know yourself when you ovulate - many women feel a pain in their ovary when an egg is released mid-cycle and you produce a clear, stringy mucous discharge.) Our ovulation calculator may also help you to determine your cycle.

If you're under 35 and haven't become pregnant after a year of unprotected, regular sex, then you should see your GP for fertility advice. If you're over 35, see your doctor after six months and ask for tests.

What is infertility?

Infertility is when a healthy couple can't conceive. This is called primary infertility if you've never been pregnant and secondary infertility if you've conceived in the past, but are having problems getting pregnant now.

Few couples are completely infertile. Most are subfertile, which means they have problems making a baby together, but it is possible with medical intervention. Although fertility treatment, such as IVF, offers hope for many couples, success rates are fairly low, and you may need many attempts before getting pregnant. Unfortunately, some couples do not succeed.

Common causes of infertility in women

About 50% of infertility cases happen because of problems with the woman's fertility and there are many different reasons for this - her are a few of the main ones:

Ovulation problems: trouble with releasing eggs account for about 30% of infertility problems. You can stop ovulating because of medical conditions such as an early menopause, hormone problems, ovarian cysts, and polycystic ovary syndrome (PCOS). Being overweight or underweight can affect your hormone balance and ovulation, as can too much exercise. Some medication and drugs, such as cannabis, can interfere with egg production as can herbicides, insecticides, and fungicides, too.

Implanting problems: sometimes the egg is released from the ovary successfully but doesn't implant in the womb. This can be due to of pelvic inflammatory disease where an infection damages the fallopian tubes. Scarring can then block the egg from getting through to the womb. Large cysts or fibroids in the womb can stop an egg from implanting too.

Endometriosis: this is a very common condition that causes 1 in 20 cases of infertility. It's where tissue from the lining of the uterus is found outside the uterus in the pelvic. This can cause scarring and heavy bleeding and affect the ovaries and uterus, so affecting your fertility.

Age: older women are less fertile. The chance of a woman conceiving after aged 35 - 39 is about half of women aged 19 - 26.

Common causes of infertility in men

About 20% of infertility cases happen because of a problem with male fertility.

Sperm disorders: these are the most common cause of male infertility. Sperm counts in the average British male have fallen by almost half in the past 60 years. A low sperm count can be caused by a number of factors from illness and side effects of medication to hormone problems. Environmental and lifestyle factors can affect sperm count too, e.g. too much heat to the testes can lower sperm count as can exposure to certain chemicals. Alcohol and drug misuse and some sexually transmitted diseases can also affect sperm count.

Testicle problems: some men have problems with sperm production because they have injured or had an infection or tumour of the testes. Some men are born with testes that can't make sperm, or make very little.

What if you need treatment?

See your GP if you're concerned. You may just need a simple hormone drug to stimulate your ovaries, or your doctor may recommend further treatment to investigate your fertility. Tests can show your hormone levels and blood count. A semen sample from your partner can be checked for sperm levels.

Other treatments, from donor sperm, to assisted conception techniques such as in vitro fertilisation (IVF) or intracytoplasmic sperm injection (ICSI), where a single sperm is injected into the egg and then the embryo is placed back in the womb, will then be discussed with you.

Superovulation drugs
Suitable for: Women with ovulation problems; 'unexplained' infertility.
What happens? Clomid (taken as a pill) or Gonal-f, Menogon and Menopur (administered by injection) will be prescribed to force the ovaries to produce more eggs than usual.
Side effects: Hot flushes, mood swings, nausea and Ovarian Hyperstimulation Syndrome (OHSS), a rare but potentially fatal condition.
Private cost: Clomid costs less than £10 for a prescription; the injectable drugs are around £200 per cycle.

Intrauterine insemination (IUI)
Suitable for: Women for whom superovulation alone hasn't worked; mild to moderate factor male infertility; unexplained infertility; PCOS; if using donor sperm.
What happens? You take superovulatory drugs and have ultrasound scans to track the development of your eggs. Once your eggs are mature, you will be given a shot of the hormone HCG to trigger ovulation; you usually have the IUI performed the day after. Your partner produces a semen sample and, an hour later, you'll have it inseminated into the uterus - this takes about 10 minutes and is pretty painless.
Private cost: Around £500, plus the cost of any superovulatory drugs.

IVF treatment

Around 24,000 couples opt for IVF (in vitro fertilization) treatment every year in the UK. About 8000 babies are conceived through IVF procedures, which involve removing eggs from the woman's ovaries and mixing them with either her partner's or a donor's sperm to fertilise. The fertilised eggs are then put back in the womb.

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Do keep in mind that NHS treatment availability varies throughout the UK. You're entitled to at least one NHS cycle of IVF, but you may have to fund subsequent treatments yourself, which can be expensive. You could need several IVF treatments before you conceive and there's no guarantee then that you will end up with a baby. IVF treatment is quite gruelling and can take a lot out of a couple, so get as much help and support from family and friends or support groups as you can, and do be prepared for disappointment. Only about one in three women will become pregnant with IVF and some of these pregnancies will fail. Choose a clinic that is licensed by the Human Fertilisation and Embryology Authority (HFEA), which regulates and inspects all clinics.

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