Infertility I  Mate matapā

Infertility is defined as the inability to conceive after one year of regular, unprotected intercourse. It affects both men and women and can result from a variety of underlying conditions and factors.

Approximately 1 in 4 New Zealanders experience infertility and 1 in 8 require some form of medical assistance to achieve a pregnancy.

Causes of infertility

In women:

Fertility problems can be caused by problems with ovulation (the monthly release of an egg from the ovaries) and by damage to the fallopian tubes. This includes the following:

• Pelvic infections, eg, chlamydia can damage the fallopian tubes.
• Polycystic ovarian disease or other ovulatory problems may stop you ovulating or mean that you ovulate less frequently.
• Age: Fertility naturally declines with age, particularly after the age of 35.
• Endometriosis can damage the ovaries or fallopian tubes.
• Premature ovarian failure – this is when the ovaries stop working before the age of 40 years. However, fertility reduces in women after the age of 35.
• Fibroids (non-cancerous growths of the wall of the uterus) can sometimes contribute to infertility.
• Medications can impact fertility. For example, some chemotherapy can damage the ovaries and antipsychotic medications can stop you ovulating.

In men: ‍

Fertility problems can be due to low or absent sperm numbers, or abnormal sperm movement or shape. Some causes include:

1. Medical conditions: Diabetes, hormonal imbalances, and infections can affect sperm production and function.
2. Lifestyle factors: Smoking, excessive alcohol consumption, drug use, and exposure to environmental toxins can impair sperm health.
3. Physical problems: Conditions like varicocele (enlarged veins within the scrotum) can affect sperm quality.
4. Damage to the testicles: An infection of the testes, testicular cancer, surgery or injury to the testes
5. Medications, eg, anabolic steroids or chemotherapy

A cause of abnormal sperm is not always found.

Diagnosing infertility

For women:

1. History: Detailed history including menstrual, sexual, and pregnancy histories, and past medical history
2. Ovulation tracking: Monitoring menstrual cycles and using ovulation kits can help assess whether ovulation is occurring regularly.
3. Hormonal tests: Blood tests can measure hormone levels related to ovulation and reproductive health.
4. Imaging tests: Ultrasounds and hysterosalpingography (HSG) can identify structural abnormalities or blockages in the reproductive organs.
5. Laparoscopy: A minimally invasive surgical procedure to examine the pelvic organs can diagnose conditions like endometriosis.

For men:

1. History: Detailed history including a sexual history, possible exposure to any environmental toxins, and previous genital surgery.
2. Physical examination: To detect any anatomical issues or varicocele.
3. Semen analysis: A primary test to evaluate sperm count, motility, and morphology.
4. Hormonal tests: Blood tests to check hormone levels affecting sperm production.

Treatment options

A range of treatments for fertility problems is available. Success rates vary depending on the treatment and the cause of infertility.

Medical treatments:

1. Medications:some text
   • Clomiphene citrate: Stimulates ovulation.
   • Metformin: Helps with insulin resistance in women with PCOS.
   • Hormonal therapies: Address specific hormonal imbalances in either partner.
2. Surgical procedures:some text
   • Laparoscopy: To remove blockages or treat endometriosis.
   • Varicocelectomy: Surgery to correct varicoceles in men.
3. Assisted reproductive technologies (ART):some text
   • Intrauterine Insemination (IUI): Directly placing sperm into the uterus around the time of ovulation.
   • In vitro fertilization (IVF): Combining eggs and sperm outside the body and then implanting the embryo into the uterus.

Lifestyle changes:

1. Maintaining a healthy weight: Being overweight or underweight can reduce your fertility
2. Avoiding harmful substances: Limiting alcohol, quitting smoking, and avoiding illicit drugs such as marijuana can enhance fertility.

When to seek help

If you’re having difficulty getting pregnant, talk to your GP or other health specialist about being referred to a specialist fertility clinic for help. The clinic will help you work out what treatment might be best for you, and whether you’re eligible for a publicly funded treatment.

For further information and support, consider reaching out to reputable organisations and healthcare professionals who can provide personalised guidance on your journey toward conception.

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