Planning to start a family is a time of great hope and optimism. Minds turn to the impending pregnancy journey, eventual birth, and the mystery of what life with a new human in the house will be like. However, for a significant number of people, their journey will include a significant hurdle, the issue of infertility. But what is it, how common is it and what causes it? In this article, we will explore what infertility is, its prevalence, some of the known factors associated with male and female infertility, and what to do if you suspect you are experiencing infertility issues.

Starting a family is a journey as unique as the person/couple embarking on it. For some, the outcome of pregnancy is the result of careful planning, for others, it comes as a complete surprise and/or shock. For the vast majority of couples, pregnancy occurs naturally within 12 months of trying to conceive. 

Unfortunately, this outcome is neither guaranteed nor certain with current data suggesting that one in six Australian couples will experience infertility. Infertility is currently defined as the inability to conceive after 12 months or more of unprotected sex. 

Types of Infertility

Whilst there are many reasons for a diagnosis of infertility (canvassed further below), the types of infertility experienced fall into the following groups:

  • Male infertility 
  • Female infertility
  • Presenting infertility issues in both partners, and 
  • Unexplained infertility – a term used when there is no medical explanation as to why the couple can’t conceive.

According to the Victorian Assisted Reproduction Treatment Authority (VARTA), male infertility is prevalent in 20 percent of infertility issues, female infertility is prevalent in 30 percent, presenting issues for both partners accounts for 30 percent of couples, and for 20 percent of cases, there is no apparent cause of infertility (idiopathic or unexplained infertility).

Causes of male and female infertility

The Fertility Society of Australia and New Zealand (FSANZ) which is the peak body representing scientists, doctors, researchers, nurses, consumers and counsellors in reproductive medicine in Australia & New Zealand identify the more prevalent causes of male infertility and female infertility as follows:

Causes of male infertility 

  • Poor quality semen and sperm
  • Damaged testicles
  • Ejaculation disorders
  • Sterilisation
  • Hormonal issues
  • Medicines and drugs
  • Lifestyle factors (smoking, drinking, stress, obesity etc)

Causes of female infertility

  • Ovulatory disorders (like Premature ovarian insufficiency (POI) or Polycystic ovarian syndrome (PCOS)
  • Ageing
  • Endometriosis
  • Fallopian tube damage
  • Uterine fibroids
  • Autoimmune disorders
  • Lifestyle & Environmental factors (smoking, drinking, stress, obesity etc)

A note on PCOS and endometriosis

  • Women with PCOS often take longer to fall pregnant and are more likely to need treatment than women without PCOS. Despite this, studies show little difference between the number of children born to women with PCOS than those without.
  • Women with endometriosis will experience difficulties getting pregnant 30 percent of the time. However, most women with endometriosis become pregnant without the need for treatment.

Whilst a GP will be able to do an initial assessment to check for things that may be causing fertility problems (and advise on what to do next), a fertility specialist is best placed to conduct a more comprehensive fertility health check through preconception testing and diagnosis.

Advice – for those who have been unsuccessful in falling pregnant for a period greater than 12 months, make an appointment to discuss this with your GP. For those where the partner carrying the pregnancy is over 35, make an appointment after six months.

What if you have trouble falling pregnant?

Once in contact with your GP, they will commence your fertility investigation by collecting your medical history and conducting a physical examination of both partners (which may include some basic tests to make sure the woman is ovulating and the man is producing sperm. 

Pending the outcomes of your tests, your GP may advise you to keep trying, or, they may recommend a referral to a fertility specialist who will conduct specialised tests designed to establish the cause of infertility and determine the best type of fertility treatment required.

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