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Understanding Infertility and its Treatment

If you are struggling to conceive a child, the first steps towards assessing and treating your infertility can be confusing and overwhelming. There are complex medical terms that need to be understood and daunting decisions that have to be made. In addition to learning this new fertility language yourself, you might feel that need to explain your problems and treatments to friends and family. The following article hopes to provide some explanation of common infertility problems and treatments, and help smooth the entry into this sometimes confusing world.

Fertility problems
The most common problems causing infertility in women are:
• Endometriosis – a disorder where the normal lining of the uterus (womb) leaks back through the fallopian tubes into the pelvic cavity. Symptoms can include heavy, painful and long menstrual periods.
• Uterine fibroids – these relatively common non-cancerous growths in the uterus, but they do sometimes cause fertility problems, and require surgical removal.
• Ovulation disorders – abnormal ovulation can occur for a range of reasons, and is usually apparent due to absent or irregular menstrual periods (a regular period is 24-32 days).
• Blockage of the fallopian tubes – this can result from past pelvic surgeries or  infections and can interfere with the sperm reaching the egg and proper embryo development and implantation in the uterus.
• Polycystic ovarian syndrome – polycystic ovaries contain many small follicles containing immature eggs. Sometimes help is required to control symptoms and assist ovulation.
• Age – fertility decreases with age, particularly in women (peak female fertility is between the ages of 15 and 24).
• Both graphs are for women with normal reproductive function, after having unprotected intercourse for one year. Sources: Management of the infertile woman ( Helen A. Carcio). The Fertility Sourcebook (M Sara Rosenthal).
The most common problems causing male fertility are related to:
• Low sperm count
• Abnormalities in the size, shape or movement of the sperm.
Several factors are necessary for a man’s sperm to successfully fertilise an egg, including sperm volume, sperm count/density, sperm morphology (shape), and sperm motility (movement). Even with a low sperm count, many men with high quality (viable and motile) sperm can still be fertile.

Unexplained fertility
Approximately 20% of couples will not be given a clear reason for their infertility, despite exhaustive investigations of both partners.

Fertility treatments
There are a variety of causes of infertility problems, and similarly, there is a broad range of available treatments.
• Hormonal treatment: For many couples infertility results from a hormonal imbalance affecting either (female) ovulation or (male) sperm development. Hormonal stimulation can be an appropriate treatment in this instance.
• Surgery: If the cause of infertility is related to scarring or adhesions (often associated with endometriosis, fibroids or other uterine/tubal problems), then surgery may be necessary, usually in a laparoscopic procedure.
• Artificial insemination: Specially prepared sperm is transferred into the woman’s uterus. The woman usually undertakes hormonal stimulation to promote ovulation. Treatment includes careful monitoring of follicle development to ensure sperm transfer coincides with ovulation.
• IVF (in vitro fertilization): This is effective in overcoming a variety of fertility problems, particularly those related to tubal or sperm problems. IVF is a four stage treatment, which commences with the stimulation of follicles in the ovary. Once mature, stimulated eggs are removed from the ovaries using a fine needle (under general anaesthetic). The eggs are then transferred to a laboratory dish where they are fertilized by the partner’s sperm. The final stage involves transfer of the fertilized embryo(s) back into the woman’s uterus.
• ICSI (intracytoplasmic sperm injection): ICSI is an additional procedure possible with IVF where a single sperm is injected into each egg.  This technique is particularly useful in overcoming male infertility. Just like regular IVF, once the egg is fertilized, the resultant embryo can be transferred to the woman’s uterus.
• FET (frozen embryo transfer cycle): A transfer of embryos that were frozen from an IVF cycle is also possible. Usually, hormones are used to help prepare the uterus fro embryos. Embryos are then thawed and transferred at a time when the uterus is ready.
Remember, whatever problem you are facing, and whatever solution you choose, you are not alone. In the year 2000, 5466 pregnancies followed assisted conception treatment in Australia and New Zealand. This accounted for nearly 2% of all births! An essential part of you managing your infertility and getting that desired baby is to be part of the treatment decision-making. The first step in this is understanding your problem, and the solutions that are being offered to you.

Narelle Dickinson

Health Psychologist

 
Suite 9A, Administration Building
Greenslopes Private Hospital
Newdegate Street Greenslopes QLD 4120