Infertility can be a highly emotional journey fraught with uncertainty and an ongoing rollercoaster of hope and disappointment. Here’s a basic outline of what you need to know.
What is Infertility?
Infertility is defined as the inability to conceive within a 12-month period while actively trying. About 1 in 6 couples experience infertility and it can be a very lonely and truly heart wrenching experience, particularly when you don’t know why you can’t get pregnant and you start to wonder if you’ll ever be able to have a baby.
Generally speaking, there are two main umbrellas of infertility – Primary, where you are trying to have your first child, and Secondary, where you already have one (or more) children and you are unable to fall pregnant again.
It is often wrongly assumed that when a couple is having difficulty conceiving, the issue lies with the woman. However, approximately 30% of fertility problems originate with the woman, and 30% with the man. A third of couples will have a combination of male and female factors contributing to their inability to conceive. In around 10% of couples, no cause can be found and this is called Unexplained Infertility.
Causes of Infertility
There are many potential causes of infertility, therefore it is suggested that if you are aged 35 or older and have not become pregnant within a 6-month time frame, it is recommended that you consult with your GP who may send you and your partner for some initial screening tests. If you are under 35, it is generally recommended that you wait until you have been trying for more than 12 months – unless of course you have a pre-existing condition that you are already aware of.
Unexplained infertility occurs in about 20% of cases where couples who have been actively trying to become pregnant for 12 months or more, have not been able to do so and no reason has been found as to why. It can be extremely frustrating because there is no ‘reason’ that can be ‘treated’, leaving you feeling powerless.
It then becomes a process of elimination as thorough testing is undertaken in both the man and the woman, which can be both lengthy and in some cases fruitless.
Most couples turn to IVF at this point as it can improve your chances of pregnancy by bypassing many of the steps in the conception process. In some cases, a fertilization issue can be discovered, only becoming apparent in the IVF lab as the process is watched under a microscope. In other cases, poor egg quality or inadequate embryo development will be found as a cause. It may be an implantation issue whereby the woman’s uterus is not receptive to the embryo. Couples may move onto PGD, so that their embryos can be tested for chromosomal anomalies. In some cases this may provide the answer.
Other couples may turn to natural/alternative therapies and find that they become pregnant this way. For others still, their number may finally come up and they will become pregnant without ever finding out what the cause of their troubles was.
Sadly though, for some couples, after many many failed cycles, still no reason will be found for their infertility and no baby will result from all that they’ve been through. In these cases, next steps need to be discussed, which may include donor eggs, surrogacy, fostering, adoption (though this is a long and expensive road), or even deciding to put trying to have a baby behind them.
Secondary infertility is the inability to become pregnant despite already having one or more children and conceiving them without difficulty. In many cases, no reason can be found for this secondary infertility, putting it under the ‘unexplained’ umbrella.
Where a cause is able to be found, the most common reasons include:
- A woman’s age and therefore her egg quality or ovarian reserve
- Pelvic adhesions or scar tissue from a previous surgery (including a Caesarean birth)
- A build-up of endometriosis
- A decline in the quality of the man’s sperm
Secondary infertility is often very upsetting and hard to understand, particularly if you became pregnancy fairly easily previously.