We spend so much of our lives trying to prevent pregnancy that , when we try for one we tend to have unrealistic expectations about the chances of being successful. The general fertility rate for a couple in the middle of the reproductive years is about 16% per cycle. This means that after one month of trying 84% aren't pregnant. The subsequent months as can be seen on the graph in red result in about 15% not achieving pregnancy in the first year. A woman's age is well known to be important and the variation in rates between 20 year olds and forty year olds can be seen.



Other things influence the fertility rate. Extremes of body weight, smoking, and poor general health all have an impact on the fertility rates. Whilst they may not themselves be the cause of a couple’s infertility, they certainly have an impact on success rates of treatment. The principle is that investigations are performed to try to find why a couple’s fertility rate is less than that expected from the above graph. Treatment is directed to correcting that cause. Basic investigation can be completed in 2-3 visits. That enables a diagnosis to be made. There may not be just one cause of infertility in a particular couple. There may be a number of components.

In general the components are male factor (sperm problems), ovulatory (problems producing eggs), tubal (distortion or blockage in the Fallopian tubes including previous sterilisation operation), functional (mechanical problems with intercourse). If a couple has a tubal problem, the treatment options include surgery to correct the anatomy or IVF to bypass the defect. Even in those patients who are requesting Reversal of Sterilisation Mr Shaw will need to consider both of these options in relation to which is most likely to achieve a pregnancy. For example, if there is a poor sperm count which on its own does not account completely for the infertility it may be that it would be better to use IVF as this will deal with both problems.

If IVF is mentioned, Mr Shaw will discuss terms like ICSI, TeSE and Assisted Hatching with you if they are advised.

Further information is provided at your first appointment.

The following general health advice to couples concerned about their fertility is derived from the evidence based guidance from the National Institute for Clinical Excellence (NICE)

Timing and frequency of sexual intercourse
Sexual intercourse at least every two to three days optimises the chance of pregnancy.

Alcohol and smoking
Alcohol consumption within the Department of Health's recommendations of 3 units per day is unlikely to affect fertility. Excessive alcohol intake can harm semen quality. Women who smoke may reduce their fertility. Men who stop smoking will improve their general health. Even passive smoking may affect your chance of getting pregnant.

Body weight
Women who have a body mass index of more than 30 may take longer to conceive. Weight loss may increase their chances of conception, particularly if exercise is involved with the programme.
Women who have a body mass index of less than 18 and who have irregular menstruation should be advised that restoring body weight may improve their chance of conception.

Other Factors
A number of prescription, over the counter and recreational drugs and psychological stress may affect your relationship, libido and interfere with male and female fertility. Many complementary treatments for infertility have not been properly evaluated and that further research is needed before these can be recommended.

Folic acid supplementation
To reduce the risk of having a baby with neural tube defects (anencephaly, spina bifida) women intending to become pregnant should supplement their diets with folic acid tablets. The recommended dose is 400 micrograms per day (4 mg daily if you have previously had an infant with a neural tube defect or if you have epilepsy and are taking medication.

Susceptibility to rubella
To prevent rubella infection in pregnancy and to reduce the risk of having a baby with a congenital birth defect, rubella immunity could be confirmed. Women who are susceptible to rubella are advised about immunization before becoming pregnant.

Cervical cancer and chlamydia screening
The treatment of cervical intracellular neoplasia is more complicated during pregnancy. To avoid such delays you should attend your general practitioner to ensure your cervical smear is up to date. If it is due, you could have it done before you come to the fertility clinic; a chlamydia screening test could be done with the smear.

Investigation and Treatment of Infertility

Initial investigation is to establish the presence of sperm and eggs. Subsequent Tubal patency testing may be undertaken.  The principle is to establish a reason for the difficulty in conceiving. If the reason is found, Mr Shaw may be able to correct or bypass it for you.  In Vitro Fertilisation (IVF) has a lot of publicity and so sometimes seems to the public to be the only treatment. When the problem has been found there may be other options.  Mr Shaw will discuss these things when you attend for consultation. 

 

There is so much information around that it can be confusing. There is a useful summary of the scientific basis that guides doctors when decisions are made about your investigation and the advice given. This link covers many different aspects in relation to fertility. In spite of all this information, there sometimes simply isn't enough to give absolute clear direction. When the evidence conflicts it is important to discuss the pro's and con's with your doctor. Mr Shaw is happy to discuss any aspects of your fertility. Please bring any websites you may have read to your consultation.

 

When IVF and other Assisted Conception techniques are to be undertaken it is important to understand what is involved. If you are going to see Mr Shaw for this it may be helpful to follow the link on the embryo below: