What are the main causes for couples having difficulty conceiving?
In a third of couples attending a fertility clinic, the woman has blocked or damaged fallopian tubes. This can often be due to past exposure to chlamydia, which may have led to a silent, unknown infection at some time.
In a third of couples, the man has an abnormal semen analysis with a reduced sperm count or a reduction in the percentage of sperm which are moving. Occasionally, there may be no sperm seen at all in the sample.
One in five women has problems with ovulation, meaning they do not release an egg every month.
One in ten women has endometriosis. It is a condition in which tissue from the lining of the womb grows in the pelvis or on the ovaries, causing scarring and reducing the chance of falling pregnant.
There is a small number of rarer causes that can lead to difficulties in conceiving naturally.
For one in five couples, no cause can be found, and they will be described as unexplained subfertility.
What treatment might we be offered?
For the woman, if you are not ovulating regularly and you have a BMI between 19-35, you may be offered clomifene citrate or letrozole, which are the tablets that can trigger ovulation and regulate periods. In some cases, injections may be used to stimulate the ovaries.
If your fallopian tubes are blocked or damaged by adhesions, you may be offered tubal surgery or assisted conception in the form of in-vitro fertilisation (IVF) may be recommended. Endometriosis may be treated by keyhole surgery.
If the sperm count is abnormal, you may be offered IVF treatment. If there is no identifiable reason found for your delay in conceiving naturally, you may be offered assisted conception in the form of intrauterine insemination (IUI) or, most commonly, IVF treatment. Some other forms of treatment may be offered in rarer disorders, and the doctor in the fertility clinic will explain these if they are relevant to you.
In each case, the doctor will explain the benefits and risks of each treatment and agree on a treatment plan with you.