Approximately one in five couples have trouble conceiving a child. If a couple is unable to conceive after one year of unprotected intercourse, they are said to be subfertile. Around 40 per cent of fertility problems originate in the woman, with causes including failure to ovulate and abnormalities of the fallopian tubes or uterus. In most cases, the couple can be helped with assisted reproductive technologies. For around one in 10 couples investigated for infertility, no cause is found. This is known as 'idiopathic infertility'.
Diagnosis methods
Investigating suspected infertility requires a range of tests for both the woman and her partner. Some of the tests the woman may undergo include:
- Physical examination - including medical history.
- Blood tests - to check for the presence of ovulation hormones.
- Ultrasound scans - to check the health of reproductive organs.
- Laparoscopy - the reproductive organs are examined via a slender instrument (laparoscope) inserted through a small incision in the abdomen.
A range of reproductive technologies
Some of the reproductive technologies available to infertile women include:
- Surgery
- Ovulation induction
- In vitro fertilisation (IVF).
Surgery
Usually, an egg released during ovulation is ushered down the fallopian tube. If it meets with a sperm on its journey, conception may occur. Female infertility can be caused by obstructions within reproductive organs. Some of the problems that can be addressed by surgery include:
- Fibroids - non-malignant tumours growing inside the uterus.
- Polyps - overgrowths of the uterine lining (endometrium), which can be caused by fibroids.
- Endometriosis - the growth of endometrial tissue outside of the uterus. This misplaced tissue can block the fallopian tubes.
- Salpingitis - the fallopian tube becomes inflamed and scarred by bacterial infection.
Ovulation induction
Irregular or absent periods may indicate that ovulation is irregular or absent too. However, even women with regular periods may skip ovulation every now and then. Ovulation can be induced with a range of drugs in a tablet or injection form. The drug schedule includes synthesised versions of gonadotrophins, the hormones released by the pituitary gland in the brain that prompt the ovaries to release an egg every menstrual cycle. However, the drugs tend to trigger the release of a number of eggs per cycle, which means the risk of having a multiple pregnancy is about 20 per cent. Sometimes, the response to synthesised gonadotrophins may be excessive, leading to a condition known as ovarian hyperstimulation syndrome. The symptoms include oedema (fluid retention), abdominal pain and bloating. Regular blood tests are used to help fine-tune the dosage and minimise the risk of ovarian hyperstimulation syndrome from occurring.
In vitro fertilisation (IVF)
In vitro fertilisation (IVF) is conception within a test tube (or similar). The woman undergoes ovulation induction and a number of eggs are removed. This is done through the vagina under ultrasound control. The collected eggs are then mixed with previously collected sperm from the woman's partner and placed in a special incubator. The fertilised eggs are then implanted into the woman's uterus via a thin tube inserted through the cervix.
Pregnancy isn't always possible
Despite the sophistication of assisted reproductive technologies, pregnancy doesn't always happen. It depends on a range of factors, including the reasons for the woman's infertility, her age and the type of technology used.
Potential health risks
Some of the problems associated with the use of assisted reproductive technologies include:
- Ovarian hyperstimulation syndrome
- Associated risks of multiple pregnancies
- Increased risk of premature labour and low birth weight
- Increased risk of caesarean delivery.
Where to get help
- Your doctor
- Family Planning Victoria Tel. (03) 9257 0100
- Monash IVF Tel. (03) 9429 9188 or 1800 628 533
Things to remember
- Around 40 per cent of fertility problems originate in the woman, with causes including failure to ovulate and abnormalities of the fallopian tubes or uterus.
- Some of the reproductive technologies available to infertile women include surgery, ovulation induction and in vitro fertilisation (IVF).
You might also be interested in:
Conceiving a baby - tips.
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