Health in the City: Fertility and Infertility

London Mums have joined forces with BMI Healthcare to encourage women in London to be more aware of the issues surrounding their health and wellbeing in the capital. In this article we look at the issues of fertility and infertility.

 

fertility and infertility woman close shot.

Subfertility and infertility can broadly be described as a couple or individuals inability to conceive. It is not uncommon for a couple that desires to have a family to encounter difficulties. The last 30 years have seen great improvements to the investigations and management options offered to the subfertile. Consequently, the number of couples coming forward and receiving successful help has dramatically increased. 1 in 5-7 couples have difficulty conceiving after trying for one year or more. It is therefore very important to access comprehensive streamlined effective fertility services to optimise your chances.

 

What stops a couple conceiving? – Causes of Subfertility

There are two types of infertility: ‘primary’ – trying to conceive for the first time and ‘secondary’ where a woman has had one or more pregnancies or babies in the past but now has problems conceiving. The most commonly recognised problems involve the production of sperm, the release of eggs, or the mechanism where the two meet

for fertilisation. Broadly speaking, a third of infertility problems are female-related, a third are problems in men and a third are due to a combination of the two. A small group of couples fall in the ‘unexplained subfertility’ category where no clear cause is found. In women, these problems can include blocked fallopian tubes due to infection particularly Chlamydia, ovulatory problems – many associated with polycystic ovaries, endometriosis, conditions affecting the uterus like polyps and fibroids, and other gynaecological problems such as previous ectopic pregnancies or complicated miscarriages. Female fertility also declines with age.

 

In men, problems with semen account for 75% of all male fertility problems. These may include a very low sperm count, or no sperm at all, sperm that are malformed or that aren’t sufficiently ‘strong swimmers’ to reach an egg and problems with erections or ejaculations. Inflamed testicles, past bacterial infections and previous surgery (for example for a hernia or undescended testicles) may also create problems. For both men and women, lifestyle factors particularly smoking, alcohol and drugs can all be a factor.

 

Next steps

At BMI Healthcare we treat more than 2,000 couples for infertility problems every year. The first step is an initial consultation, during which we gain a thorough understanding of the couples history and their fertility problems. We conduct an in-depth social, medical, gynaecological and fertility history study. At this consultation we may also carry out and arrange a number of initial tests for both the man and woman.

 

Counselling is offered, as the repeated experience of failing to get pregnant, when many of your friends seem to conceive with no problems, can become increasingly painful. A whole range of emotions – ranging from frustration and anger to guilt and shame – may surface. Counselling can help, with someone impartial who can support a couple through the emotional rollercoaster of infertility. At the second consultation, the consultant will discuss the test results and recommend the best way forward. This may be to carry out further tests or procedures, or to begin assisted conception treatment itself. The various options are discussed in considerable detail and also explained in writing. At every stage we encourage the couple to ask questions, share worries and generally make sure they feel they are in the best frame of mind.

 

Every year, BMI Healthcare treats 2,000 couples with fertility issues. Subfertility and infertility can broadly be described as a couple or individuals inability to conceive. It is not uncommon for a couple that desires to have a family to encounter difficulties. The last 30 years have seen great improvements to the investigations and management options offered to the subfertile. Consequently, the number of couples coming forward and receiving successful help has dramatically increased. 1 in 5-7 couples have difficulty conceiving after trying for one year or more. It is therefore very important to access comprehensive streamlined effective fertility services to optimise your chances.

 

What stops a couple conceiving? – Causes of Subfertility

There are two types of infertility: ‘primary’ – trying to conceive for the first time and ‘secondary’ where a woman has had one or more pregnancies or babies in the past but now has problems conceiving. The most commonly recognised problems involve the production of sperm, the release of eggs, or the mechanism where the two meet for fertilisation. Broadly speaking, a third of infertility problems are female-related, a third are problems in men and a third are due to a combination of the two. A small group of couples fall in the ‘unexplained subfertility’ category where no clear cause is found. In women, these problems can include blocked fallopian tubes due to infection particularly Chlamydia, ovulatory problems – many associated with polycystic ovaries, endometriosis, conditions affecting the uterus like polyps and fibroids, and other gynaecological problems such as previous ectopic pregnancies or complicated miscarriages. Female fertility also declines with age.

 

Treatment options, there are a number of techniques and options available to subfertile couples.

 

Ovulation Induction

This is the stimulation of ovulation by medication, which needs appropriate monitoring. Minimally invasive surgical procedures to promote natural conception; for example hysteroscopic resection of polyps and fibroids and laparoscopic surgery to treat endometriosis and scarring around the tubes.

 

Assisted Conception: In Vitro Fertilisation (IVF)

Following stimulation of the ovaries with medication, the eggs are retrieved from the woman ovaries and added to the best sperm in the laboratory for fertilisation to take place. The fertilised eggs(s) or embryo(s) are replaced in the womb using a very fine catheter through the cervix for implantation to occur. In this way, the first IVF (‘test tube’) baby was conceived in 1978.

 

Intracytoplasmic Sperm Injection (ICSI)

Recommended for couples where there is sperm problems or low number of eggs produced. In the laboratory, a specially trained embryologist injects a single sperm directly into the egg.

 

Intrauterine insemination (IUI)

This straightforward treatment is suitable for some couples with no obvious cause for their delay in conceiving. It involves monitoring the woman’s cycle, with ultrasound, to pinpoint the best time for insemination. A sample of the partner’s sperm is prepared and the best concentrate is placed directly into the uterus, through the cervix. Mild stimulation of the ovaries is sometimes offered.

Donor insemination (DI)

Donor insemination (DI) uses sperm from a donor to help the woman become pregnant. Strict legislation governs donors, who are selected only after screening for health, medical history, family history and fertility.

 

For more information on the women’s health services available at BMI Healthcare please visit: www.bmihealthcare.co.uk/womens_health or call: 0808 101 0337

 

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