What Causes Infertility?

Irregular Menstrual Cycle & Ovulation Disorders

A regular cycle is deemed to be occurring every 21-35 days, which is a good indication that a person is ovulating regularly. If the cycles stretch longer than 35 days, this may indicate that you are not ovulating regularly, if at all. Ovulation must occur for a natural pregnancy to occur, and if your cycle is irregular or non existent, it may be incredibly difficult to fall pregnant without assistance. Some conditions such as PCOS can cause irregular ovulation and other issues which may impact on your fertility.

Age

If the female in a heterosexual couple is over the age of 35 and you have been having unprotected sex for over 6 months, it would be recommended to seek a fertility evaluation. Centuries ago, women were conceiving in their teens and twenties. These days, women are delaying childbirth until much later in life, for various reasons. As we now know, as a woman ages, egg quality, quantity and the likelihood of an egg being genetically normal, decreases.

Tubal occlusion/blockage

A history of sexually transmitted infections or pelvic inflammatory disease can contribute to a woman having blocked fallopian tubes. Tubal occlusion is a cause of infertility because an ovulated egg is unable to be fertilised by sperm or to reach the endometrial cavity. If both tubes are blocked, then IVF is your only option. If a tube is blocked and filled with fluid then minimally invasive surgery to either remove the tube or block/separate it from the uterus prior to any fertility treatments is usually recommended.

Uterine fibroids

Fibroids are very common (approximately 40% of women may have them) and the mere presence alone does not necessarily cause infertility. Your doctor will examine you carefully to determine if you have fibroids and if removal is necessary. Often, fibroids do not need to be treated and are not the cause of your infertility.

Endometrial Polyps

Endometrial polyps are small growths in the uterine cavity, which come from the lining of the uterus, called the endometrium. In some cases, polyps can decrease fertility by up to 50%. Removal of polyps by a simple procedure can in some cases double your chances of getting pregnant. Sometimes, just removing the polyp solves the infertility.

Endometriosis

Endometriosis is a condition whereby cells very similar to the ones lining the uterine cavity are found outside the uterine cavity. It is a common issue in reproductive-aged women and can be linked to infertility as well as pain during intercourse and/or painful and irregular menstrual periods. Endometriosis can only be confirmed by surgery. If endometriosis is found, it can be surgically removed by various methods, and its removal may lead to a decrease in pain as well as improvement in the ability to conceive naturally.

Male Factor Infertility

Male factor infertility has been associated as large contributing factor in many cases of infertility in heterosexual couples. If a semen analysis is confirmed to be abnormal, the male partner may be referred to a reproductive urologist. In some cases, the reproductive urologist can improve semen function by recommending certain lifestyle changes, by hormonal treatments, or by surgery. Unfortunately, in many cases, sperm function may not improve and any attempts at pregnancy may require additional assistance and even consideration of the use of donor sperm. If there is a known abnormality with the male partner, we would advise you  to seek fertility assistance and evaluation sooner rather than later if conception is not occurring through unprotected intercourse.

Circumstantial Infertility

Circumstantial infertility, sometimes referred to as ‘social infertility’, is when a person is unable to conceive naturally due to the lack of a partner with whom to conceive or due to the fact that their partner is transgender or of the same sex and they therefore need donor assistance to conceive. While years ago, those who suffered from circumstantial infertility may have been denied the opportunity to become parents, these days it is very common to treat those with circumstantial infertility and in fact, they make up a large portion of our patients.

How do we Treat Infertility?

Medication

It is possible for some couples to achieve a pregnancy through the use of fertility medications, which come in the form of pills or injections. These medications help to stimulate the ovary to develop mature eggs for ovulation. The most commonly prescribed pill to stimulate ovulation is clomiphene citrate, or ‘Clomid’. This pill generally is taken from menstrual cycle days 3 – 7 and is an anti-estrogen which binds in a part of the brain, which in turn stimulates the ovary to grow and release an egg. The most commonly prescribed injections to stimulate the ovary are called gonadotropins, such as ‘Gonal-F’. These injections are taken nightly, typically for 5 – 10 days, and act directly on the ovary to stimulate egg development. Once a follicle containing an egg reaches a mature size, another hormone injection called HCG is often given to ‘trigger’ ovulation and release the egg.

IUI

Intrauterine Insemination, also known as IUI, is a process by which sperm is washed and prepared for placement into the uterine cavity bringing motile sperm closer to the tubes and ovulated egg. The sperm is gently and painlessly injected into the uterine cavity using a very thin, soft, and flexible catheter. At least one open tube is required for IUI, and any sperm abnormality cannot be severe, otherwise the sperm will be unable to fertilise the egg.

Click here for a more detailed look at IUI.

IVF 

IVF is a process whereby eggs are collected and then fertilised by sperm outside the body, in a fertility laboratory. The development of IVF was a major breakthrough because it allowed for successful pregnancies in people that were previously deemed permanently infertile. Click here for our article on IVF.

IVF has also allowed for other great advances in the field of fertility medicine… one of these being Reciprocal IVF. This allows both partners in a same sex female relationship to both be physically involved in the process of making a baby. Click here to learn more about Reciprocal IVF.

Donor Assisted Conception

Donor assisted conception is a process whereby another person (a donor) provides sperm, with the purpose of helping another person or couple have a child. We provide sperm donation services through our Dublin Fertility Clinic in partnership with European Sperm Bank. All donors are identifiable, meaning their details will be stored on a national database and any children conceived as a result of donor assisted conception will be allowed access to their donor’s details once they reach 18. Click here to read about Donor Assisted Conception.

Many heterosexual couples will need donor assistance to conceive and many, if not all of those with circumstantial infertility will require sperm donation to conceive.

Surgery 

If you have been having trouble conceiving, either naturally or with fertility assistance your doctor may recommend surgery as a next step. One of these surgeries is called a hysteroscopy, which we can provide for you, without the need to attend a hospital. Many people will not require any surgeries such as this, but they are certainly an option to consider in conjunction with other fertility assistance in your journey to become pregnant.