Infertility Factors

Polycystic Ovaries (PCO) is a common female hormone imbalance, which can result in ovarian cysts and cause irregular (unpredictable) ovulation. Some women with PCO only have a period every second or third month making it very difficult to predict ovulation and ultimately making it difficult to become pregnant. Symptoms include weight gain, excess body hair and skin problems, such as acne. Although the cause is not known, it does seem to have some genetic links. Some women with PCO have Polycystic Ovarian Syndrome (PCOS), where the features mentioned above are also accompanied by disturbances in sugar balance, rather like diabetes. This is known as insulin resistance and is associated with a number of metabolic disturbances.

PCO is diagnosed primarily by an ultrasound scan of the ovaries, as well as blood tests to measure the hormones associated with ovarian function. It may also be necessary to test sugar and insulin levels if PCOS seems to be present.

Endometriosis is a term used to describe unnatural growth patterns of endometrial tissue. This tissue is meant to grow within the uterus to protect a fertilised egg early in pregnancy but can grow in other areas interrupting the function of the fallopian tubes or causing growths in the ovaries called endometriomas that effect follicle growth.

Symptoms of endometriosis include pelvic pain before and during menstruation, pain with intercourse, discomfort during urination or heavy periods.

Endometriosis can only be diagnosed definitely by laparoscopy, which involves putting a telescope into the abdomen under anaesthesia. Ultrasound scanning may suggest the presence of endometriotic cysts, in which case the diagnosis can be assumed.

The fallopian tube is where fertilisation of the egg occurs. During a natural pregnancy, the sperm and the egg join together to form an embryo, while in one of the fallopian tubes. If there is tubal damage, this is unlikely to happen or, in some cases, the fertilised egg may actually implant into the tube – this is an ectopic pregnancy, which can lead to serious complications.

Causes of blocked fallopian tubes include:

• Pelvic infections
• Endometriosis
• Previous pelvic surgery

If you have had two or more consecutive miscarriages it is essential that you seek medical advice to determine the cause of them and seek treatment to prevent further miscarriages from occurring. Fetal loss is the most common pregnancy complication occurring in 25-30% of recognized pregnancies. Recurrent miscarriages are especially difficult, because the initial excitement of a confirmed pregnancy is repeatedly followed by great disappointment when the miscarriage occurs.

The most common cause of miscarriage or early pregnancy loss is chromosomal abnormalities in the fetus, which account for at least 50-60% of all first trimester losses. Chromosomal abnormalities are typically the result of errors that occur as the embryo divides and grows. The chance of these errors occurring generally increases with the age of the mother due to poorer egg quality.

Genetic testing of the embryos produced in an IVF treatment can help to reduce the risk of miscarriage as only chromosomally normal embryos would be replaced into the uterus.

Secondary infertility is when a couple who has already naturally conceived a child experiences difficulties in becoming pregnant again. When a childless couple is unable to conceive, they tend to seek advice or treatment. However, couples who already have children ,and may be affected by secondary infertility, are much less likely to do so because of the misconception that they are fertile.

Several lifestyle tendencies, injuries or diseases, which may have occurred since the past pregnancy, could impact fertility the second or third time around. All of the same fertility factors listed in this section should be taken into consideration when assessing secondary infertility.

Having an irregular menstrual cycle is typically because of a hormonal imbalance which effects the predictability of what should be a recurring 28 – 35 day menstrual cycle. Women with irregular menstrual cycles generally do not ovulate or produce eggs regularly which makes planning for a pregnancy very difficult. Fortunately, the majority of factors that cause irregular menstrual cycles are treatable.

These factors include: PCO and PCOS, significant weight loss or weight gain, hormonal imbalance and co-existing medical problems, such as thyroid disease or diabetes.

The ovarian reserve refers to the capacity of your ovaries to produce healthy, viable eggs. The ovarian reserve and the quality of available eggs naturally begins to decrease after the age of 35 though eggs are still produced up until menopause.

Symptoms of an impending menopause include hot flashes, irregular periods, night sweats, irritability, difficulty concentrating or decreased sexual drive. Though a diminishing ovarian reserve is something that occurs naturally as women age, external factors like environmental toxins and lifestyle choices can also play a role.

Fibroids, polyps and adenomyosis are different types of growths that can occur on the reproductive organs of a woman, negatively affecting her fertility. Fibroids are non-cancerous tumors that range in size and grow in or around the uterus. Polyps are small, typically non-cancerous growths uterine lining, cervix and vagina. Adenomyosis occurs when endometrial tissue grows into the muscular layer of the uterus.

Symptoms of fibroids, polyps and adenomyosis can include irregular or heavy menstrual bleeding, pain or spotting during intercourse.

Obstructive Azoospermia occurs when sperm is being produced in the testes but cannot be found in the semen because of a blockage in the male reproductive tract. In most cases of obstructive azoospermia, sperm can still be retrieved by a form of surgical sperm retrieval or SSR procedure such as Testicular Sperm Aspiration or TESA.

Causes of obstructive azoospermia can include sexually transmitted disease, scar tissue, congenital or genetic conditions or previous surgeries.

Non-obstructive Azoospermia is when mature sperm are not found in the semen because of a problem with their production. This can occur at different stages of the male reproductive cycle and in some cases a form of surgical sperm retrieval or SSR can be used to retrieve mature and viable sperm.

Causes of non-obstructive azoospermia can include radiation, certain types of medications, infections or hormonal imbalances. Micro-TESE would be advised in cases of non-obstructive azoospermia followed by In-vitro fertilisation (IVF) with Intra-cytoplasmic sperm injection (ICSI).

Retrograde ejaculation is when semen is mistakenly directed back into the bladder as opposed to out of the body through the urethra. Causes of retrograde ejaculation can include diabetes, medication, injury or past surgeries.

In most cases of retrograde ejaculation, sperm can be recovered from a urine sample and used during an In-vitro fertilisation (IVF) / Intra-cytoplasmic sperm injection (ICSI) cycle. In other cases, sperm can be obtained through a surgical sperm retrieval or SSR procedure such as Testicular Sperm Aspiration or TESA.

Oligospermia refers to when the semen has low concentration of sperm; often this low concentration of sperm is also accompanied by decreased sperm morphology or motility.

Oligospermia can be caused by aging, poor health, varicocele, surgeries, chemotherapy or radiation. Depending on the cause, you may be a candidate for a supplemental hormone regime to help improve quality of sperm before undergoing an In-vitro fertilization (IVF) / Intra-cytoplasmic sperm injection (ICSI) treatment cycle.

A varicoceles is a collection of enlarged veins within the scrotum. It may begin to cause reproductive issues if the valves within the testes cause blood to pool within the scrotum. This pooling of blood affects the circulation and temperature of the testes, leading to decreased motility and poor morphology. As many as 15% of the general population have a varicoceles. If large, it may cause discomfort but often there are no symptoms.

A varicocele can be remedied through Micro Varicocelectomy