Fertility problems, or concern about whether you may have a problem can be a great worry for couples planning to have a family. The information in this section is designed to answer some of the questions you may have and to give you information that will help you work out other questions you may like to ask.
Fertility and the female
Every month a fertile woman releases an egg and her body prepares for a fertilised egg to implant. Her cycle is controlled by hormones secreted by her brain and is most noticeably marked by her ‘period’.
Women have a limited number of eggs within their ovaries and these reduce in number and quality as you get older. Every month the hormone signal from the brain causes a number of eggs to start to grow. Each egg is encased within a special set of cells called the follicle which helps the egg develop and grow. In a normal cycle only one egg will develop to maturity and be released. This is why most naturally occurring pregnancies result in a single baby.
During the time the egg is growing the lining of the womb also starts to thicken. This is a highly specialised environment where the early embryo will attach and implant.
Approximately 14 days after the start of her last period (and therefore 14 days before the next) the woman will release the ripe egg in a process termed ‘ovulation’. This is therefore the best time to have intercourse and try for a baby.
The egg then enters the fallopian tubes and for about 24 hours remains at a stage in which it may be fertilised. If the egg is fertilised it will begin to develop into an embryo as it passes down the tube. Between five and nine days later the embryo will reach the womb and implant.
If the egg has not fertilised, or the embryo does not implant, then the woman will have her normal monthly ‘period’. This is where all the extra lining of the womb prepared for the embryo breaks down and is lost in a process that seems similar to bleeding.
Different problems can occur at any of these stages from ovulation not occurring, through blocked tubes to problems with the womb lining. All of these will be assessed before and during your clinical treatment.
Fertility and the male
From his teenage years until beyond the age of seventy a fertile man will produce around 1000 sperm cells per heartbeat. These are produced in his testicles and then stored in a long coiled tube on the back of the testicle until ejaculation. However, just producing sperm does not make a man fertile, what really matters about sperm is quantity and quality. This is assessed by having a sperm count.
Often fertility problems are caused by sperm not being able to swim properly or because very few sperm are produced. Some men produce semen that does not contain any sperm. This is called azoospermia. Half of azoospermic men have normal sperm production from the testes, but there is a blockage which prevents sperm from entering the semen.
This may be due to:-
1. Failure of the sperm passages to develop.
2. A blockage of the sperm transport tubes.
3. A previous vasectomy operation (male sterilisation).
All of these can potentially be treated via surgical sperm retrieval.
For the other 50% there is a failure of adequate sperm production by the testes, this could be caused by a genetic problem, as a result of previous disease or cancer treatment.
Fertility and the couple
There needs to be sufficient numbers of good quality sperm available when the woman is ovulating (producing eggs). Regular sexual intercourse around the expected time for ovulation should increase the chance of conception, you do not need periods of “sexual abstinence” to improve sperm count. In general a couple who have sex three times a week should be having sex frequently enough to catch ovulation.
Many couples are surprised that the woman does not get pregnant as soon as they try to have a baby. If a couple have no fertility problems then there is about a 25% chance of getting pregnant each month. If there is no problem requiring medical help you will generally be pregnant within two years of trying. If a woman is over 35 years old or the couple already know they are likely to have a problem then they should ask to be referred for investigations after six months of trying.