Various causes of Infertility
The cause may be related to one partner or both partners. The cause of the problem is a male factor in 40% and a female factor in 40% of couples. Twenty percent of couples have mixed male and female factors. Unexplained infertility is uncommon.
In women common problems would be:
- failure to ovulate (not releasing eggs)
- damage to the fallopian tubes after pelvic infection
- endometriosis which can interfere with reproductive function and cause pelvic pain
- uterine problems (for example fibroids growing on the womb)
- poor ovarian function due to advanced age or premature ovarian failure
- problems with the cervix
Treatment by Fertility Specialists
The assessment and treatment of couples with fertility problems is best done by fertility specialists – people who are used to performing advanced endoscopic surgery and IVF (in vitro fertilization). The reason for this is that they will have the necessary experience and equipment needed for your therapy. All the correct treatment options can also be discussed outlining which procedure would be best for you. Sometimes the investigations may be done in conjunction with your referring gynaecologist. A fertility specialist must be registered with the Health Professional Council of South Africa (HPCSA) as a sub-specialist in Reproductive Medicine.
Investigations will be done according to the likely causes of the fertility problem.
They may include:
- Semen analysis for the male partner.
- Blood tests for HIV, hepatitis B and C, syphilis, thyroid function, prolactin, rubella, day 21 progesterone (to check for ovulation).
- A pelvic transvaginal ultrasound to visualise the uterus and ovaries.
- Additional tests will be requested depending on the history and findings and the type of treatment needed.
- Assessment of the pelvis will include a hysteroscopy and laparoscopy (to check the uterine cavity, fallopian tubes and the pelvis for endometriosis or scar tissue). A hysterosalpingogram X-ray may also be requested.
Starting Fertility Treatment
Once a diagnosis has been made, the treatment will be started immediately. The doctor will advise you when to see him/her at the start of a period to commence treatment.