A study published by the European Society of Human Reproduction (ESHRE) contains the stark statistic that 25 million EU citizens, or one in six couples, experience some form of infertility. The reasons for this are a complex weave of social, economic and medical factors but the fact remains that for each and every individual making up the statistical total, the experience of fertility problems can be both bewildering and heart breaking.
In this IVI blog article, we look at women’s concerns about infertility, such as whether fertility problems can be hereditary. We review the main fertility problems in women which we, in our daily IVI clinical practice throughout Europe, come across and diagnose every day. Happily, in most cases, we can recommend and carry through a treatment that is effective and allows the misery of infertility to be replaced by the joy of parenthood.
What is infertility?
If you’ve never tried getting pregnant before, perhaps you have assumed that as soon as you have unprotected sex it will happen. In fact, human beings are not all that fertile: in the absence of any health or fertility problems, there is around a 25% chance of conception from sex while the woman is ovulating. However, those chances multiply over the course of a year and most couples will conceive during that time. Most authorities recommend that if you are not pregnant after 12 months of regular unprotected sex, you might begin to suspect you have a fertility problem and consult a specialist. However, if the woman is over 35, the recommended time is six months, so that there is maximum time available for treatment.
When a couple experiences infertility, generally the cause is with the woman in 30% of cases, with the man in another 30% and for the remaining 40%, it could be a combination of both or unexplained. But here we look in more detail at infertility in women.
What are the main fertility problems in women?
Most fertility problems that women experience can trace their source to the absence of a healthy egg that is available to be fertilised. This in turn has two main causes: an imbalance of hormones leading to irregular or absent ovulation, preventing a mature egg from being produced by the ovaries, or a physical obstruction that prevents the egg from travelling down the fallopian tube to be fertilised by a waiting sperm. There are several ways in which this can come about:
Age-related decline in fertility
Advanced age is the most significant factor in fertility problems for women. Not only does a woman’s reserve of eggs becomes depleted after the age of 35, it is also estimated that around 40% of the remaining eggs will have some sort of chromosomal abnormality which raises the chances of miscarriage or having a baby with a genetic disease. In addition, women over 35 are statistically more likely to suffer from endometriosis or uterine fibroids, making it more difficult to conceive.
Endometriosis, in which endometrium-like material is found outside the womb, is frequently associated with infertility. The endometrium is the womb lining which is shed each month during menstruation and when outside the womb, it is sensitive to the hormonal changes of the monthly cycle, which can sometimes make the condition very painful. If this tissue develops in neighbouring organs such as the intestine, bladder or rectum, it can result in structural changes in the pelvic cavity which obstruct the fallopian tubes, resulting in infertility.
In the common condition of uterine fibroids, non-cancerous growths develop inside the uterus. In many cases they do not affect fertility, but sometimes they can distort the cervix and uterus, with a negative impact on embryo implantation and foetal movement. They could also block the fallopian tubes or lead to fertility problems by damaging the receptivity of the uterine lining.
Polycystic ovary syndrome (PCOS)
PCOS can be a cause of infertility for a woman when it results in irregular or completely absent menstruation. This is an indication of a lack of ovulation, in which case conception and pregnancy cannot take place.
This is a term which covers any injury or lesion of the fallopian tubes, and it is the cause of 25% of women’s infertility. Partial damage due to an adhesion or complete blockage resulting from an obstruction prevents the passage of an egg down the fallopian tube, meaning that fertilisation cannot take place. Tubal damage can result from infections, usually STDs, spreading from the uterus or cervix and causing Pelvic Inflammatory Disease.
Can infertility be hereditary?
There are many chromosomal abnormalities which can be inherited, often without the inheritor knowing that they are a carrier. Many of these can cause infertility if a couple is made up of two carriers, when it is possible that the majority of embryos resulting from natural fertilisation would either fail to implant or result in miscarriage or, in the worst scenario, the transmission of the genetic disease to the baby. The possible solution in such cases is for the couple to undergo compatibility genetic testing or IVF with Preimplantation Genetic Testing.
How is infertility diagnosed?
The first step to finding out which, if any, of these conditions is the underlying cause of any problems is to consult a specialist fertility clinic. If you make an appointment with one of our IVI clinics, it will be helpful to know what to expect from your first visit. The diagnostic process will include a complete medical history and physical examination. This will involve a basal hormone study, an ultrasound scan and a hysterosalpingography as standard for all patients. The range of tests could be extended in accordance with your particular circumstances and symptoms.
What are the options for treatment?
Your options for treatment depend entirely on the results of our diagnostic tests. Do remember that in most cases we can find a solution and the experience of fertility problems can be overcome. Take a look at the fertility treatments available with IVI and when you feel ready, get in touch.