Infertility is defined as the inability to achieve a successful pregnancy after 12 months of unprotected intercourse if the woman is under 35, or after 6 months if she is 35 or older.
There can be several reasons such as hormonal imbalances, fallopian tube issues, or conditions like endometriosis. Infertility is more common than many realise, and numerous couples experience challenges in their journey to conceive.
Some of the causes we look into when it comes to female infertility are:
Both the egg quantity and quality reduce over time. At birth, the ovaries hold about one million eggs. By puberty, this drops to around half a million, and by the time a woman reaches menopause (generally between 45 and 55), fewer than 1,000 eggs remain.
As the number of eggs decreases, so does their quality. This decline in quality has a significant impact on fertility, leading to lower chances of natural conception, reduced success rates with fertility treatments, and a higher risk of pregnancy loss. The primary reason for this decline in egg quality is an increase in chromosomal abnormalities that come with age.
Lifestyle choices like smoking, alcohol, drug use, and weight can significantly impact fertility. Smoking and recreational drugs may disrupt hormonal balance and ovulation, raising the risk of miscarriage, while alcohol and caffeine consumption can affect cycle regularity. It’s worth noting that after substance use, fertility can take up to a year to fully recover.
Your weight can also have a significant impact on fertility. If you’re underweight it may cause irregular cycles, and being overweight can lead to hormonal imbalances and conditions like PCOS.
Ovulation is the release of the egg from the ovary. In order for ovulation to successfully occur, hormonal signals from the brain need to correctly interact with the ovary. The pituitary is a pea-shaped and sized gland found at the base of the brain. It releases two hormones that enable a follicle (a small cyst structure that produces hormones and contains an egg) to develop within the ovary and eventually ovulate.
When this hormonal balance is disrupted, ovulation may not occur regularly, making it harder to conceive. Common causes of these disruptions include thyroid dysfunction, elevated prolactin levels, and hormonal conditions like Polycystic Ovarian Syndrome (PCOS).
The fallopian tubes are responsible for capturing the egg after it is released from the ovary, and bringing the egg close to sperm for fertilisation, which then propels the early embryo into the uterus. The fallopian tubes may be damaged by prior infection - especially Sexually Transmissible Infections (STIs) e.g Chlamydia; prior pelvic surgery or endometriosis.
When tubes are damaged, surgical repair may restore function although there are risks of recurrence and ectopic pregnancy. In cases of severe damage, IVF can bypass the tubes altogether.
The uterus is where embryo implantation and development take place, making it essential for a healthy pregnancy. Structural abnormalities like fibroids or polyps or congenital (born with) abnormalities like a septate uterus, can interfere with embryo implantation and increase miscarriage risk, or pregnancy complications like early delivery.
Scarring from surgeries or infections like Asherman’s syndrome may also reduce the uterine lining’s ability to support a pregnancy.
Endometriosis is a condition where tissue similar to the uterine lining grows outside the uterus. It affects about 10% of women and is common among those being investigated for pelvic pain or infertility. The severity of endometriosis doesn’t always match the level of pain experienced, but even mild to moderate cases can reduce fertility by causing pelvic inflammation or anatomical changes that affect eggs, sperm, and embryos.
Unexplained infertility refers to the inability to conceive despite normal results in standard fertility tests, such as ovulation tracking, hormone evaluations, and assessments of the uterus and fallopian tubes. For women, this diagnosis can be particularly challenging as it offers no clear reason for difficulties in conceiving.
The treatment option chosen will depend on a number of factors: Age of the female and male partner; Female ovarian reserve; desired family size; duration of time the couple have been trying or the couple's thoughts regarding the use of assisted conception.
If your periods are inconsistent, too light, or too heavy, it might suggest hormonal imbalances or other underlying issues affecting ovulation.
Feeling a lot of pain during your menstrual cycle can be a sign of conditions like endometriosis, which might impact female fertility.
If you’re not getting your period at all, it’s worth consulting a healthcare provider. This can indicate issues with ovulation or other hormonal factors.
A noticeable decrease in libido can sometimes be linked to hormonal imbalances that may affect fertility.
If you’ve had multiple miscarriages, it may be a sign of underlying fertility problems.
Conditions like PCOS, thyroid disorders, or unexplained weight changes can also contribute to fertility challenges.
While these symptoms don’t always mean infertility, they warrant further evaluation to identify and address any underlying issues. A great resource that provides further information on female infertility can be accessed here: https://www.fertilitysociety.com.au/female-infertility-australia-new-zealand
During this chat, we’ll discuss your medical history, any symptoms you’ve noticed and how long you’ve been trying to conceive. It’s important that we allocate enough time during the consultation to get a clear picture and work out the best way forward.
Blood tests are a common next step. They check hormone levels and look at how well your ovaries are functioning. Ultrasounds can also be done to take a closer look at your reproductive organs and spot any issues like cysts or fibroids that could affect your chances of conceiving.
If the initial tests suggest there might be a problem, we will look at doing more advanced testing. For example, a Hysterosalpingo-Contrast-Sonography (HyCoSy) can check for blockages in the fallopian tubes, while a laparoscopy will be able to assess the pelvic area to check for conditions like endometriosis.
If you’ve been trying to conceive for over a year (or six months if you’re over 35) and you haven’t been able to conceive or maintain a pregnancy, then I would generally recommend seeking advice from a fertility specialist. Age related infertility is best dealt with as soon as possible.
Additionally, if you experience irregular or absent menstrual cycles or have known health conditions like PCOS or endometriosis, it’s a good idea to book a consultation. A fertility specialist can help you understand any potential complications and guide you through your fertility journey.
Cycle tracking is used to monitor a woman’s menstrual cycle to identify her most fertile days and evaluate ovulation. It involves tracking hormone levels through blood tests to confirm ovulation and detect potential hormonal imbalances.
IUI is a simpler procedure where sperm is placed directly into the uterus when you're ovulating. This method can be helpful for couples who aren't sure why they're having trouble getting pregnant or for those with mild male fertility issues. Since it’s less invasive than IVF, IUI can be a good first step in your fertility journey.
Ovulation Induction (OI) is a fertility treatment aimed at helping women with irregular or absent ovulation by stimulating the ovaries to produce and release eggs. This is commonly recommended for conditions like polycystic ovary syndrome (PCOS) or other hormonal imbalances.
IVF is a well-known fertility treatment The process starts by retrieving eggs from the ovaries and fertilising them with sperm in a lab. Once the embryos develop, one or more are placed back into the uterus. Two weeks later, you'll have a blood test to check for pregnancy.
PGT is a procedure performed during IVF to screen embryos for genetic abnormalities before transfer to the uterus, improving the chances of a successful pregnancy. There are three main types of PGT: PGT-Aneuploidy (PGT-A), which checks for chromosomal abnormalities like aneuploidy that can cause miscarriage or conditions like Down syndrome; PGT-Monogenetic Disorders (PGT-M), which screens for inherited single-gene conditions such as cystic fibrosis; and PGT-Structural Rearrangements (PGT-SR), which detects chromosomal structural issues like translocations that can lead to implantation failure.
Egg and sperm donation can help individuals and couples conceive when using their own reproductive cells is not possible. Donor arrangements are governed by legislation that varies by country and state, with two primary types of donation: de-identified (clinic-recruited) and known (patient-recruited).
Both donors and recipients must undergo thorough medical assessments. Donors are screened for infectious diseases, genetic conditions, and, for sperm donors, semen quality. Recipients undergo antenatal investigations and pelvic ultrasounds to ensure readiness for treatment.
Surrogacy is an option for individuals or couples unable to carry a pregnancy themselves due to conditions such as the absence of a uterus, uterine anomalies, or medical disorders that make pregnancy unsafe. It may also be considered after recurrent pregnancy loss or repeated implantation failure.
In Australia, commercial surrogacy, including overseas arrangements, is not lawful, and all surrogacy agreements must follow strict legal and ethical guidelines.
Surgical procedures, such as hysteroscopy and laparoscopy, are key options for diagnosing and treating fertility issues like fibroids and endometriosis. Surgery often improves fertility outcomes, particularly for mild to moderate cases, but it may carry risks like bleeding, infection, or a reduced ovarian reserve. Tailored surgical approaches offer hope for many women, providing effective solutions to address underlying conditions and enhance fertility.
Infertility can be a disheartening and isolating experience, but you don’t have to face it alone. My team and I are committed to providing personalised support throughout your fertility journey. Our goal is to help you feel empowered and informed at every step, ensuring you feel cared for and confident in your decisions.
Our goal is to optimise your treatment plan and give you the best possible chance of success, all while delivering the highest standard of care.
Still have questions? Chat to us!
Those treatments that hopefully result in a successful pregnancy (e.g. ovulation tracking, ovulation induction (OI), intrauterine insemination (IUI), and in vitro fertilisation (IVF) will typically take 1-month.
Egg freezing cycles typically will take 2-weeks.
Cycles that require chromosome/ genetic testing of embryos and then their subsequent transfer will take 2-months.
Dr Anthony Marren partners with Genea Fertility. Patient Relationship Coordinators (PRCs) will provide a quote based on the treatment plan plus Medicare/ insurance status.
For further information on costs of fertility treatment in Sydney: https://www.genea.com.au/treatment-costs.
Depends on a number of factors such as:
For further information on IVF success rates: https://www.genea.com.au/pages/success-rates-MCHRO6PVH3QNEJZKBQPOTGEWCLNE
Understanding the emotional journey couples endure when they have difficulty conceiving or recurrent pregnancy loss is essential to my approach.
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