There are a number of factors which can affect fertility in both men and women. These include:
- Weight – being overweight reduces both male and female fertility. In women, both being overweight and severely underweight may impair the production of mature eggs.
- Sexually transmitted infections (STI’s) – there are several STI’s which can cause subfertility. The most common is Chlamydia which can damage the fallopian tubes in women and cause swelling and tenderness of the scrotum (pouch of skin containing the testes) in men
- Smoking – not only does smoking affect general and long-term health, it can also affect fertility by reducing the function of eggs and sperm
- Occupation and environmental factors – Exposure to certain pesticides, metals and solvents can affect fertility in both men and women
- Stress – if either you or your partner are stressed, it may affect your relationship. Stress can reduce libido (sexual desire) therefore reducing the frequency of sexual intercourse. Severe stress can also affect female ovulation and can limit sperm production.
About 85% of couples will conceive naturally after one year of unprotected sexual intercourse. If couples have not conceived in that time, they should seek advice. If you are worried about your fertility, or are a woman over the age of 35, then you should seek advice sooner. Fertility testing and investigation can be performed very rapidly to reassure and advise couples on the best options tailored to their own individual needs and wishes. It is often best for a couple to seek advice together because in 30% of cases both partners may have factors affecting their fertility.
The process of trying to conceive can be a very emotional one and it is important that you try and support each other as stress is just one of the many factors that can affect fertility.
When you visit the clinic, a medical, sexual and social history will be taken as may a physical examination in order to identify any possible factors that may be causing fertility problems. Questions may be asked about:
- How long you have been trying to conceive.
- Whether or not your your partner have had any pregnancies in this or any other relationship and what the outcome of those pregnancies was. Information about any miscarriages may be important as this could help identify a cause for the problem.
- The timing and frequency of sexual intercourse in relation to ovulation.
- Previous contraceptive use and the length of time since stopping contraception as this may be affecting your ability to conceive. Sometimes it can take a while for certain types of contraception to stop working
- Medication – some medication can affect fertility. Any medication including any non-prescription or herbal medication you are taking should be disclosed and in case there is a suitable and more appropriate alternative.
- Lifestyle – smoking, weight, alcohol consumption and stress can all affect fertility. Adjustments to your lifestyle may have a considerable positive influence on your ability to conceive, your long term health and the health of any children.
A physical examination may include:
- Measurement of your height and weight to calculate your body mass index
- An examination of your abdomen and pelvic area to check for any abnormalities such as ovarian cysts, fibroids, endometriosis, infection etc.,
- Some diagnostic tests may be requested such as:
- Pelvic ultrasound scan. This uses high frequency sound waves to create an image of an organ in your body, in this case an image of your womb and ovaries
- Progesterone test – this blood test checks to see if you are ovulating. Tests should be taken 7 days before you expect a period
- Chlamydia test – Chlamydia can affect fertility. If you have Chlamydia, your GP will be able to prescribe antibiotics to treat it. It is also advisable to treat the male partner at the same time
- Rubella immunity and Varicella (Chickenpox) immunity
- Thyroid function test –this may be tested if you have an irregular menstrual cycle as this could be a cause for your menstrual cycle to be irregular and for you not to be producing eggs
- Hysterosalpingogram (HyFoSy) – this is a type of ultrasound test that checks your fallopian tubes. This is performed as an out patient procedure in clinic. A small tube is passed through the cervix (neck of the womb) and a foam is injected into the uterine cavity. This foam is visible on ultrasound and should be seen to pass down the fallopian tubes.
- Laparoscopy – this is an investigation performed under general anaesthetic where a small telescope is normally inserted just below your umbilicus (belly button) in order to have a look directly at your womb, tubes and ovaries. Often, dye is injected into the fallopian tubes through the cervix (entrance to the womb) to see if there area any blockages.
A semen test will need to be requested. These tests can be arranged prior to an appointment so that the results are available on the day of an appointment.If there any abnormalities, a physical examination may be performed to:
- Check your testicles for any lumps or deformities
- Check your penis to look at its shape and structure and look for any abnormalities.
- Further testing can include:-
- Blood tests to check chromosomes and cystic fibrosis.
- Ultrasound scan