Infertility - “An introduction”
It is estimated that one in six couples in Ireland are affected by infertility. It is a medical and social condition that can cause considerable social, emotional and psychological distress. It is medically defined as a lack of conception following at least one year of regular unprotected sexual intercourse.
Main causes of infertility: Low sperm count, blocked fallopian tubes, endometriosis, age, obesity, drug abuse.
It is estimated that a third of cases are due to male factors such as low sperm count. Another third of cases are due to female factors such as blocked fallopian tubes, Polycystic Ovary Syndrome or severe endometriosis. The final third of cases are due to unexplained infertility or a combination of male and female factors.
There is a perception that infertility is on the increase because of social and/or medical reasons. For example, a desire to delay parenthood to pursue career and financial security. Postponement of pregnancy has led to an increased incidence of ‘unexplained infertility’ due to a decline in the quality and number of eggs as a women ages. Another issue is an increase in obesity levels in Ireland. Obesity can affect fertility by causing hormonal imbalances and problems with ovulation.
Female age is the most important determinant for spontaneous conception. Fertility begins to decline, in females, from the early 30s, however, the decline is greatest in women in their late 30s and early 40s. Any women in their mid 30s having difficulty in getting pregnant, trying to conceive for six months, should be referred to a fertility specialist.
There is a significant association between smoking and reduced fertility among female smokers. Smoking has been linked to delay in conception due to its effect on the embryo implanting into the lining of the uterus, increased risk in spontaneous miscarriage and also a quicker depletion of ovarian reserve.
As explained earlier, obesity can influence fertility. The time it takes to conceive is longer in women with a Body Mass Index over 25. Obesity can also have an effect on pregnancy outcomes such as gestational diabetes and high blood pressure. However, if the female is underweight with a BMI under 19, this can also affect fertility. A BMI between 19-25 is the ideal range and this should be maintained if possible.
Physical activity is beneficial to general health and helps with fertility. Regular exercise promotes a healthy weight which improves insulin sensitivity which improves ovarian function and subsequently conception. It also helps combat stress which can also be a factor in fertility.
Caffeine and alcohol have been linked to problems with fertility and so should be reduced or stopped while trying to conceive.
The psychological and emotional repercussions of infertility are considerable. While most people struggling with infertility do not experience severe or clinically significant upset, some do. Infertility issues can exacerbate conditions like depression, anxiety, sexual anxiety, relationship problems with partner/family and a sense of blame and guilt.
Supplements that assist in conception: Folic Acid, Evening Primrose, Serreptapeptase & Agnus Castus.
There are many supplements on the market to help aid conception. The most important of these are Folic Acid 400mcg daily. It won’t help fertility but it will prevent spinal tube defects in babies and is recommended for all women trying to conceive. Evening Primrose Oil is a useful supplement to help thin out the cervical mucus. Sperm requires an adequate amount of clear fluid to protect it from the acidic environment of the vagina and transport it to the upper genital tract. Agnus Castus is a homeopathic remedy marketed for pre-menstrual symptoms but it also has a role in fertility as it helps to balance out the reproductive hormones especially Progesterone which is vital for implantation. Finally, Serreptapeptase is a supplement used widely in Europe to reduce inflammation. It is useful in this instance for those who experience spotting during their cycle or those who have been diagnosed with chronic uterine inflammation. It is a remedy used in Greece for generations.
Reflexology and Acupuncture are available complementary therapies to help aid conception. They are also beneficial in helping those who suffer from stress which can often be a consequence of infertility.
What to do next?
It is important to know the reasons behind your infertility, if possible. There are numerous clinics across Ireland that will perform tests to identify if there is a reason behind your fertility struggle.
For the male partner, they will analyse the sperm and look for the sperm count, the motility of the sperm and the morphology (appearance, size and shape of sperm).
For the female partner, the clinic will perform an AMH level. This is a blood test called Anti Mullerian Hormone test and it looks at the ovarian reserve i.e. shows how well a woman’s ovaries are still working with regard to egg production and quality. If the level is low, a couple will find it more difficult to conceive. A low level would indicate a degree of urgency to seek fertility treatment. The clinics may also perform scans to look at how many follicles are present on the ovaries. This is an Antral Follicle Count.
Every story of infertility is unique and subsequently treatment plans are individual. Treatments available to couples are often complex. In order to make informed decisions on fertility treatments, couples need to understand the options available to them. There is a huge volume of research on fertility, often which is poor quality, making it difficult to access reliable and relevant information that will help. This makes the emotional decision making process even more of a challenge.
Infertility treatment does not come cheap and can cause an additional strain on an already stressed couple. For example, in Ireland, a cycle of own egg IVF would cost in the region of €4,000-€5000.
If anyone would like to speak to me about their own fertility, please do not hesitate to contact me on 071 9142276 or firstname.lastname@example.org
Information is from Infertility Treatments in Women, a review of the biomedical evidence. Department of Health and Children (The Women’s Health Council)