In approximately one fifth of infertility cases the cause is unknown, in another fifth it is due to female problems, a further fifth of cases are caused by male problems, while the remaining two fifths are due to a combination of both male and female factors. In up to 50 per cent of couples there will be some male factor involved which is why it is recommended that couples attend the fertility clinic together.
Main causes in women: Lifestyle factors: age; when a woman reaches 35 her fertility starts to reduce dramatically; weight – being over- or under-weight can affect ovulation; smoking; recreational drugs; sexually transmitted infections (STIs) such as chlamydia and gonorrhea – these can affect fertility in both sexes.
Ovulation issues: The most common is Polycystic Ovarian Syndrome (PCOS), which causes women to ovulate irregularly or not ovulate at all. "They will often have very irregular periods... or have no periods at all, and it is very much dependent on weight," according to Dr Wingfield. Women with PCOS can be put on medication or fertility drugs to stimulate ovulation. If these first line treatments don't work the next step would be IVF.
Early menopause: Where women under the age of 40 stop having periods; is also a cause of infertility and in this case the only option is IVF using donor eggs. Although not very common she said women with a family history of early menopause "should be on high alert because it sometimes runs in families."
Pelvic problems: includes anything that damages the fallopian tubes, ovaries and or the womb. These include endometriosis, STIs such as chlamydia or gonorrhea, ectopic pregnancies, fibroids, ovarian cysts and repeated surgery; which can cause adhesions or scarring in the pelvic region.
Health and other general medical difficulties: For endometriosis, infection or scar tissue, surgery can be carried out to try to get the pelvis or fallopian tubes back to normal. If that doesn't work , the next option is IVF. Sexual dysfunction such as vaginismus, where women are not able to have sex, can also cause infertility. Women who have had chemotherapy or radiotherapy as part of cancer treatment or those with certain conditions such as Cystic Fibrosis or Rheumatoid Arthritis may also need fertility assistance.
Causes of infertility in men: Serious testicular injury or infection: injuries and surgery such as surgical intervention for undescended testes in childhood can cause problems. Testicular infection such as chlamydia or mumps affecting the testes. Lack of sperm: Some men have no sperm at all, and in these cases, a testicular biopsy where sperm is surgically removed from the testes can be performed. Sexual dysfunction: Issues such as erectile difficulties can also cause infertility in men. "We would see some men who have had a vasectomy but the majority of male sperm problems are unexplained," says Dr Wingfield stated. Lifesyle issues: Smoking, steroids or testosterone injections as well as recreational drugs such cannabis.
According to Dr Wingfield men are encouraged to improve their lifestyle and to consider taking some vitamins if their diet is suboptimal. However, in the majority of cases where there is a significant sperm problem, IVF would be recommended - and often ICSI, which is a type of IVF.
In a nutshell Dr Wingfield said: “the woman needs to be producing an egg so she needs to be ovulating. The man needs to have sperm and then the sperm and the egg need to be able to meet up, so they need to be able to have sex. When they do have sex the woman’s pelvis and her fallopian tubes need to be normal because the egg and the sperm meet in the fallopian tube, fertilise there and form an embryo. Then the embryo moves down to the uterus.”
Unexplained infertility In unexplained infertility Dr Wingfield said that couples may have to keep trying for a little longer to conceive naturally and if that doesn't work then the next steps would be Intrauterine Insemination (IUI) or IVF.
