Every couple wanting to start a family hopes the process of conceiving a child will be easy for them. According to the NHS* however, one in seven couples struggle with natural conception. Their struggle can be due to a number of reasons including issues lifestyle factors (such as smoking or the consumption of too much alcohol), and key anatomic issues which many people may not be aware of when considering their fertility.
IVI Fertility is a European leader in assisted reproduction, and to date has helped over 100,000 children to be born all across the globe. With 40 clinics, in 10 different countries, IVI are pioneers within the fertility industry and are at the forefront of medical development and advancement within the field.
Here, leading fertility specialist Dr Ernesto Bosch from IVI Valencia shares his expert insight on three anatomic reasons why a woman may be struggling to conceive, and how the latest technology is helping fertility experts to overcome these problems.
Abnormal Uterus Cavities
Dr Bosch Says: “If a woman is struggling to get pregnant and there are no obvious symptoms which indicate a health problem that could cause an issue with her fertility, then it may be the case that the problem is due to the size of the uterine cavity. For example, if the volume of the uterine cavity differs from the norm, or a woman has a malformed ‘T-shaped’ uterus, then it can cause problems with conception, and is also associated with failed implantation, increased risk of ectopic pregnancy, and increased chances of miscarriage.
Problems such as these can be easily detected with a 3D ultrasound, which is a technologically advanced diagnostic tool we use at IVI, as this ensures we have the full picture when we are recommending a treatment plan to our patients. This is a great example of the advanced practices we use that sets the IVI clinics apart from the many fertility clinics who still do not have access to this kind of technology.
Not using the most advanced technology, such as 3D scanning, to check for problems such as small or malformed uterine cavities can lead to patients experiencing failed cycles of IVF, without any obvious problems presenting themselves. At IVI, we have found that over 70% of patients who failed to conceive before undergoing Hysterocopic Metroplasty achieved a pregnancy following the procedure, which highlights how important it is for doctors to check the size of the uterine cavity if a patient is struggling with fertility.
If a patient has an ‘abnormal’ uterine cavity, then there is a surgical procedure called a Hysterocopic Metroplasty which we can do to help rectify the problem. This is a straightforward operation where we remove the excess tissue and widen the cavity by performing a lateral incision of the uterine walls. The procedure is carried out under general anaesthetic, with full recovery expected within one month. In most cases, this procedure will offer a long term solution to the problem however, unfortunately in some cases the uterus cavity will revert to its previous size, and will require further treatment.
Obstruction of the Fallopian Tubes
Dr Bosch Says: “One of the major causes of infertility in females is one or more blockages within the fallopian tubes. If one or both fallopian tubes are blocked, the egg cannot reach the uterus, and the sperm cannot reach the egg, preventing fertilisation and therefore, pregnancy – this condition is known as ‘tubal factor infertility’.
Approximately 25% of female infertility cases can be linked to problems with the fallopian tubes – most often due to an infection such as Pelvic Inflammatory Disease, or an inflammation of the endometrium. There is also a risk that the fallopian tubes can become partially blocked, which then increases the risk of ectopic pregnancy.
To test for tubal factor infertility we usually carry out a Hysterosalpingogram (HSG). This is an X-ray technique which works by injecting coloured dye through the cervix into the uterus cavity. If the fallopian tubes are open, then the dye will flow through them into the abdominal cavity – and will be picked up on the X-ray. It is important to note that this test is not fool proof – as even if the tubes are open there could still be internal damage which is causing the fertility problems.
The options for those suffering from tubal factor infertility is tubal repair surgery, or IVF which bypasses the fallopian tubes altogether and can often prove very successful for women with this condition.”
Dr Bosch Says: “Another reason why women may find it difficult to conceive is if they are suffering from a condition called Endometriosis. The latest statistics suggest that up to 50% of women diagnosed with this condition will experience problems with becoming pregnant.
Endometriosis is a relatively common condition in which tissue from the endometrium is found outside the womb – ‘trapped’ in the lower abdomen and pelvic area. Symptoms caused by Endometriosis vary from person to person but can include heavy or painful periods, pain in the lower abdomen, pelvis or lower back, and irregular bleeding, with the typical age of onset ranging from 25-40.
Unfortunately, at present it is not known exactly what causes Endometriosis however, what we do know is that approximately 1 in 10 women in the UK suffer from the condition.
One reason why women are thought to experience issues with fertility whilst suffering from the Endometriosis is due to sections of tissue or cysts blocking or distorting the path of the ovum to the fallopian tube. The condition can also lead to scarring of the fallopian tubes, inflammation of the pelvis and alterations of egg quality – all of which can also cause fertility problems.
Endometriosis is diagnosed via a special surgical procedure called a Laparoscopy. This procedure is carried out under general anaesthetic and involves a small tube being inserted into the abdomen with a camera on the end, which relays images to a monitor screen. In some instances a small biopsy will also be taken during the procedure for lab analysis, and doctors are also able to remove endometriosis tissue during this time, which in some cases can help relieve the condition.
Unfortunately there is no miracle cure for the procedure for Endometriosis at present however, many people find that the use of painkillers, hormone treatment or having sections of Endometriosis removed via a Laparoscopy can keep symptoms under control and increase fertility.
For women suffering with more severe forms of endometriosis, there are a number of assisted reproductive treatments which can be tried in order to help achieve a pregnancy. Which treatment to choose often depends on the age of the patient and the severity of her endometriosis however, IVF is an established treatment which can prove successful for many. Younger women who suffer from irregular periods as a result of Endometriosis can also try Ovulation Induction to help regulate their periods. IUI (Intrauterine Insemination) can also be a good option for younger women who have regular periods to ensure that the sperm is inserted as close to the egg as possible to increase the chances of pregnancy.