Infertility: What You Need to Know

When should a couple investigate any infertility issues?

If the couple has not conceived within a year despite having frequent free contacts.

If the woman is over 35 years old then this waiting period is limited to six months.

If the woman's period is irregular.

If the woman or her partner already know they have an infertility problem.

What are the most common causes of infertility?

The most common causes of male infertility are:

Varicose veins, prostatitis, phimosis, hypospadias (some forms), hyperprolactinemia, hypogonadotropic hypogonadism, antisperm antibodies and some genetic causes that may affect sperm quality.

The most common causes of infertility in women are:

A) Problems with ovulation. This happens when the eggs do not grow in the ovaries or when the ovaries fail to release a mature egg. Possible symptoms are no or reduced periods, unusually light or heavy blood flow, or lack of swelling. One possible solution is to achieve a normal weight if you are overweight or very thin.

B) Endometriosis: occurs when uterine tissue grows outside, usually in the abdomen or pelvis. Some women have no symptoms while others have quite painful periods or pain during intercourse, heavy blood flow and general pelvic pain. One possible solution is to surgically remove the tissue.

C) Poor egg quality: The decline in egg quality starts after the age of 35. There are no symptoms and the most common solution is fertility drugs.

D) Polycystic ovary syndrome: Characterized by hormone imbalance and unpredictable ovulation patterns. Periods are erratic, there is a lot of hair growth, acne and obesity. Possible solutions are a change in diet and exercise and taking fertility drugs.

Is it usually due to the man or the woman?

The causes of infertility are 40% male, 40% female and 20% unexplained infertility, or infertility due to both partners, or other causes.

Does age affect both sexes or only the woman?

Fertility gradually declines with age in both women and men. In women, fertility declines faster due to changes that occur naturally in the ovaries. Unlike men, who continue to produce sperm throughout their lives, women are born with all of their reproductive material. At birth there are about 1 million follicles containing eggs in the ovaries. By puberty this number drops to around 300,000 eggs, which will be gradually depleted until menopause and only around 300 of these will ovulate during reproductive age. Most follicles will never release an egg due to a process called 'follicular atresia'. Atresia is a degenerative process that leads to the destruction of approximately 1,000 follicles each cycle to leave only one egg mature, ready for fertilization. This happens regardless of regular menstruation, the presence or absence of pregnancy, the use of contraceptives or infertility treatments.

According to the American Society for Reproductive Medicine, while a 20-year-old woman has a 20% chance of conceiving during a cycle, a 40-year-old woman has only a 5% chance. After the age of 35, the decline in fertility accelerates significantly and shows a downward curve. In general, a woman's reproductive capacity is expected to be completed 5-10 years before menopause.

As for the man, with age the quality of the sperm gradually decreases. Usually after 40-45, there is a gradual decrease in sperm count and motility, which reduces reproductive capacity.

But because this decline is very gradual, there are several cases of men having children at a very old age – even in their 70s or 80s.

What tests should a couple who wishes to have a fertility test undergo?

A) For the man: Examination of the man's sperm (spermogram: after 3-5 days of abstinence). From the sperm chart, the following factors are of interest: a) Number of Sperm, b) Motility, c) Morphology

B) For the woman: i) Ultrasound examination of ovaries, ii) Hormonal examination of the woman (Anti-Mullerian Hormone, FSH, LH, estradiol, testosterone, prolactin, TSH, T3, T4, Anti-thyroid antibodies), iii) Hysterosalpingography

What medical specialty controls fertility?

Fertility testing must be done by a Gynecologist specializing in Assisted Reproduction.

You can find Dr.Alexandros Traianos, at the address Patriarchou Ioakeim 2 (behind I. N. St. Sophia) Thessaloniki, Tel: 2310 277032