Fertility and having trouble conceiving a pregnancy is an increasingly common dilemma facing women and their partners. There are many reasons why you may experience infertility problems: some of them medical and some of them social. At the other end of the spectrum, some couples don’t give themselves enough time either. Fortunately, in the modern era, many advances in medical treatment and technology have improved the chances of falling pregnant when it just isn’t happening naturally.
What is the normal human fertility rate?
Having often spent many years taking strict precautions not to fall pregnant, women are often surprised that human beings are not especially fertile as a species. If 1000 couples have unprotected sex regularly for 12 months, then about 85% will conceive.
This may increase to around 90% over 2 years. In other words, at least 10-15% of women find it difficult to fall pregnant. So, it’s important to realise you are not alone.
Why is infertility so common nowadays?
Infertility is nothing new in human history, but it is true that a greater percentage of women are faced with this challenge. There are many causes. Approximately 40% of couples have a problem with semen analysis (called male factor infertility) 30% have problems with egg release (ovulation and egg quality) 20% may have a gynaecological disorder affecting the pelvis such as endometriosis or scarring of the fallopian tubes.
10% of couples’ fertility currently remains unexplained.
Is getting older a problem for conceiving?
The average woman’s fertility is biologically strongest from the late teens to early thirties. From the mid-thirties onwards, fertility rates steadily decline, and rapidly so after your 40th birthday.
Our society has slowly evolved such that with study, career, travel, establishing yourself financially, or lack of a suitable partner, the average age women are starting their families in Australia has been getting later every year. This trend has been continuing for decades. In other words, egg ageing is a big factor. However, it’s not just about the woman’s age. Male fertility declines with age also at a gentler downwards curve. It is well documented that average semen quality in males seems to be declining in recent decades in general. No-one is 100% sure why this is.
What should I do if I’m not having any luck getting pregnant?
If you have had no luck after 12 months of trying (or six months if you are 35 or over), see your GP and obtain a referral. It is best to come for your appointment as a couple if possible. A thorough history is taken of both partners health, menstrual history, the timing of intercourse in relation to the cycle, and any pelvic symptoms the woman may be having. An examination and a gynaecological ultrasound is performed to look for any obvious abnormalities.
What tests do we need?
I then usually arrange investigations: these usually include excluding infection, checking ovulation with a simple blood test, and arranging a semen analysis. If these are all normal or there are strong gynaecological symptoms then a small operation to check the woman’s pelvis internally, via a laparoscopy, may be required.
What treatments might I need?
This will depend on your age, how long you have been trying for, and whether we find any specific abnormalities in you or your partner. Sometimes all that is required is a bit longer time frame of regular sex at the right time of the cycle if, for example, you are a healthy couple and have only been trying for six months and you are still young. On occasion laparoscopy finds treatable conditions and many women fall pregnant promptly in the months following. If you have not been ovulating (releasing an egg) regularly, there is an effective medication to stimulate ovulation available. Sometimes, however, IVF and other assisted reproductive technologies are required. I am happy to discuss all the options and guide you to a suitable course of action.
What if I have no partner or am in a same-sex relationship?
Due to modern advances related to IVF technology and changes in legislation in Australia, you can access the same help as any male-female couple through certified infertility clinics.
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