Are you struggling to conceive? These common health conditions may be the cause...
The struggle to get pregnant can be heartbreaking. Áilín Quinlan looks at some of the causes and treatment options for the purported one in five couples affected by infertility
Almost one in five couples are now affected by infertility, which can be caused by a wide range of conditions. But what are the most common factors causing difficulties for couples who are trying to start a family.
Endometriosis affects about one in 10 women of child-bearing age and can be a cause of painful periods. This condition results when the endometrium (the mucus membrane that lines the inside of the womb) grows outside the womb, usually in the fallopian tubes and the ovaries, causing inflammation and scarring.
The inflammation and scarring can cause a malfunction or blocking of the fallopian tubes. This in turn can damage the ovaries, thus reducing the overall quality and/or number of eggs in the woman's egg stores.
It is important to establish whether or not you have the condition, and undergo tests to determine how severe it is, says Dr Stathis Diakos, clinical director of ReproMed Ireland Cork and a consultant gynaecologist.
"Once the severity of the case has been established, the best way to proceed must be discussed with the patient - is the best option to proceed with fertility treatment or to have surgery?"
Explains Dr John Waterstone, medical director of the Waterstone Clinic:
"For women with a severe case of this condition, it can impact in a major way on their fertility.
"My advice for women with severe endometriosis, especially if there are cysts in the ovaries, is that they need to go to a fertility clinic as they may need specialised surgery.
"It is important that such work is carried out by a specialist working in an IVF unit who is experienced in this form of surgery.
"If you are aware that you have a severe case, and surgery has been suggested, ensure that you see someone who is in an IVF unit and does this surgery," he emphasises.
Fibroids in the womb is another condition which can affect female fertility. "This is a common condition in the womb," says Dr Waterstone, who explains that fibroids are benign, solid, round growths.
They may not be of any relevance for some patients, but in other patients they can be a problem. Such people will need specialised surgery done by someone familiar with, and experienced in, removing fibroids.
In some cases, he says, another procedure, embolisation, may be recommended.
This procedure is carried out by a radiologist and involves the release of particles that blocked some of the blood supply to the womb.
However, he emphasises, this is not recommended for women who wish to preserve their fertility.
"If you know you have fibroids and want to preserve your fertility, embolisation is not the way to go, because it involves reducing the blood supply to the whole womb and not just to the fibroids."
Polyps are benign tissues growing inside the womb, explains Dr Diakos - however, he explains, they take up crucial space needed by an embryo when it implants.
"Endometrial polyps must be investigated through an ultrasound scan, and removed by surgery before a couple attempts fertility treatment.
Polycystic Ovarian Syndrome
PCOS is an endocrine system disorder characterised by an imbalance of certain hormones which can cause a deterioration in egg quality.
"These ovaries contain a lot of follicles, but the women will have high egg numbers," Dr Waterstone explains, adding that doctors are not overly concerned about polycystic ovarian syndrome.
Although such patients may experience difficulty in achieving pregnancy, they generally do have babies, even if it is achieved with fertility treatment.
"These patients may have difficulty in conceiving naturally but with help, it is expected they will conceive and have a baby. They usually respond well to treatment and most will manage to have babies.
"For us this is something we can fix."
Weight is an important factor which can affect patients, says Dr Waterstone.
However, as he points out, excess weight is also something which is within the patient's control. "There is no doubt when people are significantly overweight that it can have a negative impact on their fertility.
"For some patients, being overweight is a problem and if they lose weight they may become pregnant naturally without intervention.
"If a patient can get her weight down to a level which is normal for their height it will boost their chances," he said, adding that in some cases patients who are extremely overweight may even be turned away by fertility clinics, "because treatment can be difficult or even dangerous".
That can be upsetting for patients but if they are very overweight or obese it can sometimes be impossible to treat them, he explains, adding that, for example, when a patient is extremely overweight, a scan "will literally not be able to see their ovaries".
"It is important to be able to see them properly, to understand what is going on and treat appropriately."
Previous History of Undescended Testes
A previous history of undescended testes as a child can affect a man's sperm quality, says Dr Minna Geisler, consultant in Reproductive Medicine at the Waterstone Clinic, who advises that men in this situation have a semen analysis performed early on in a couple's fertility investigations.
Doctors will need to assess whether there is any sperm in the ejaculate, she explains.
"If there is no sperm, you need to investigate the causes of that. It may not be related to undescended testes," she says, adding that a series of tests including hormone profile and genetic testing can be carried out.
Adds Dr Diakos: "A semen analysis has been used as the gold standard test for determining a man's fertility for the past 350 years.
"However, this test does not provide any information about the DNA of the sperm, which is essential for normal embryo development.
"If a sperm with damaged DNA fertilises an egg, important genetic information may be missing, which can result in poor fertilisation rates, poor embryo development and higher rates of miscarriage.
"For this reason we recommend a DNA Fragmentation Analysis, the result of which will tell us what steps we need to make to either treat the problem in itself or what fertility treatment is best for the couple to help them achieve a healthy pregnancy regardless of this problem.
"We encourage our patients to opt for this test early in their fertility journey, but also to keep as healthy as possible by reducing alcohol intake, reducing their BMI, giving up smoking and maintaining an appropriate temperature for their testicles, all of which will greatly reduce the degree of DNA fragmentation and improve their chances of conceiving without intervention."
If a man's sperm is found to have low motility (mobility) and there is also a low concentration of sperm, Dr Geisler says, a couple may need to undergo a process called Intracytoplasmic Sperm Injection (ICSI) which involves injecting a single sperm directly into each egg.
A more advanced form of ICSI is now available, adds Dr Efstathios Diakos.
This is Physiological Intracytoplasmic Sperm Injection, or PICSI, he explains, a technique which pre-selects the highest quality, and most efficient sperm for injection into the egg, to facilitate the highest possible success rate in terms of fertilisation.
However, Dr Geisler explains, some men may have had undescended tested corrected at an early age in life, and if that is the case it will not have had any impact on sperm quality.
Smoking and the consumption of alcohol can negatively impact the quality of a man's sperm, explains says Dr Geisler.
"However, these are all things which can be changed - they are modifiable life factors," he says.
Health & Living