Requirements for a successful pregnancy

  1. The production of healthy sperm by the man and healthy eggs by the woman;
  2. Open fallopian tubes that allow the sperm to reach the egg;
  3. The sperm’s ability to fertilise the egg;
  4. A genetically healthy embryo;
  5. The ability of the embryo to implant into the uterus.

Fertilisation and Implantation

  • Normal sperm can survive for 2 – 3 days.
  • However, an egg can only be fertilised for 12 – 24 hours post release.
    • Therefore, couples should have intercourse every 2 – 3 days.
      • For women with a 28-day cycle, ovulation usually occurs on day 14. This is because the second half of the menstrual cycle is consistently 14-days. Therefore, if a woman has a 35-day cycle, ovulation would most likely occur on day 21.
      • Couples should be having intercourse in the week leading up to and a few days after prdicted ovulation.

Definition of Infertility

  • By 1-month, approximately 20% of couples are pregnant; 83% by 12-months; 92% by 24-months.
  • Therefore, infertility is defined as 1-year of unprotected intercourse without successful conception and affects 1 in 6 couples. It is recommended that couples are investigated at this point. There are some circumstances where earlier investigation is warranted:
    • Known (or suspected) problems with fertility (e.g. tubal damage).
    • Female age > 35 years. The chance of spontaneous monthly conception diminishes with age. Investigation at 6-months will not do harm and may uncover potential impediments to conception. This will enable timely intervention.

Causes of Infertility

  • Female factor (40 – 55%)
    • Ovulatory dysfunction
    • Tubal blockage
    • Uterine anomaly (congenital or acquired)
    • Endometriosis
  • Male factor (25 – 40%)
  • Male and female factor (10%)
  • Unexplained (10 – 15%)

Goals of Your Infertility Apponitments

  1. Find a cause;
  2. Provide treatment options;
  3. Present a realistic prognosis.

What Will Happen at your Appointment?

First Visit

Your first visit will usually last 1-hour.

A thorough history (+/- examination) of you and your partner will take place. Careful review of any previous investigations or treatments will also occur.

A series of investigations will be ordered.

 

Female

  • Antenatal screen: Blood group and antibody screen; Rubella, Chicken pox, Syphilis, Hepatitis B / C, and HIV serology;
  • Hormonal profile: AMH (assessment of ovarian reserve), and thyroid function tests; further profile if clinically indicated;
  • Ultrasound: detailed examination of ovaries and uterus; tubal patency if clinically indicated;
  • Genetics: Karyotype (chromosomes), Thalassaemia and Cystic Fibrosis screen.

Male

  • Antenatal screen: Syphilis, Hepatitis B / C, and HIV serology;
  • Semen analysis
  • Genetics: Karyotype (chromosomes) +/- Thalassaemia and Cystic Fibrosis screen.

Second Visit

Your second visit will usually last 30 minutes.

Results of investigations will be reviewed and discussed.

A cause of infertility and the potential treatment options will be explained in detail.

 

Management Options

Initial management includes education, addressing lifestyle issues (weight, smoking, and alcohol), ensuring screening tests (including pap smears) are up-to-date, and recommending folic acid supplementation.

Potential management options include:

  • Continue with timed intercourse;
  • Surgery e.g. excision of endometriosis or tubal reversal;
  • Ovulation Induction (OI) +/- Intra-Uterine Insemination (IUI);
  • In-vitro fertilisation (IVF);
  • IVF with Pre-implantation Genetic Testing (PGT);
  • Use of donor gametes;
  • Surrogacy;
  • Adoption;
  • Cessation of treatment.

Counselling

Professional counselling is invaluable in helping couples come to terms with their diagnosis and cope with proposed management options. Counselling is available to all Genea patients.