Primary infertility is diagnosed when conception does not occur after 12 months or more of “trying” to conceive; that is, having sexual intercourse without contraception. Multiple miscarriages with no sustainable pregnancy is also a form of infertility.
Infertility can be due to physiological issues in either or both partners that are trying to conceive.
When to get help?
It is quite normal for couples to take up to a year to conceive naturally. In the absence of other medical issues, a doctor will generally investigate for medical causes of infertility if you have been trying for longer than this. In some cases, such as when a woman is older than 35, investigations may commence if conception has not occurred after six months of trying.
Other reasons to investigate your fertility even if you have not been trying for the above periods of time are:
- Older age
- Irregular or absent menstrual cycles
- Painful periods
- Known history of fertility problems
- History of pelvic inflammatory disease
- Multiple miscarriages
- History of chemotherapy and radiation
- History of other drugs where infertility is a known possible side effect
What are the causes?
Infertility can be present from birth (congenital) or can be acquired as you age. Some of the more common causes include:
- Problems with ovulation: Certain conditions, like polycystic ovarian syndrome (where the ovaries secrete excessive amounts of testosterone) and hyperprolactinemia (where they produce high amounts of prolactin, a hormone that induces the production of breast milk), can prevent your ovaries from releasing eggs.
- Damaged fallopian tubes: Fallopian tubes carry the eggs from the ovaries to the uterus. Any damage to them can affect the fertilization of the egg by the sperm.
- Pelvic surgeries, adhesions and infections: These can cause the formation of scar tissue, which can damage your fallopian tubes or other pelvic organs.
- Abnormalities of the cervix and uterus: Abnormal mucus production in the cervix, problems with the cervical opening, abnormal shape of the uterus, and the presence of benign tumours in the uterus, can all contribute to infertility.
- Premature menopause: Mostly caused by a condition known as primary ovarian insufficiency, premature menopause occurs when menstruation stops before the age of 40. The exact cause of this condition is unknown, though various treatments for cancer and abnormalities with the immune system have been known to contribute.
- Other medical conditions: Diabetes, endometriosis, thyroid disorders, sickle cell disease and kidney diseases can all affect women’s fertility.
- Medications: Certain medications have been known to cause temporary infertility. Ceasing such medications can restore fertility but this should only be done in consultation with your doctor.
Who is at risk?
Your risk for infertility increases with age. You are at a greater risk if you smoke, consume excess alcohol, or if you are overweight, obese, or underweight.
Female infertility can be confirmed with the following tests:
- Blood tests measure your hormone levels and determine if you are ovulating.
- Biopsies may be obtained to evaluate the inner lining of your uterus.
- Ovarian reserve testing may be performed in order to determine the number and quality of eggs ready for ovulation.
- Imaging studies such as a pelvic ultrasound may be performed to obtain a detailed view of your fallopian tubes and uterus.
- Hysterosalpingography involves obtaining an x-ray image after injecting a contrast material into your cervix which travels up to your fallopian tubes. This can help identify any blockages in your fallopian tubes.
- Laparoscopic evaluation involves inserting a thin tube fitted with a camera through an incision in your abdomen, in order to detect any abnormalities in your reproductive organs, such as the ovaries, uterus, and fallopian tubes.
How is infertility treated?
Your doctor will suggest a treatment suitable for your condition. This can involve medication or referral to a fertility specialist.