It is estimated that 1 in 6 couples in Ireland will experience difficulty conceiving. Couples who have not conceived after one year of regular intercourse without contraception may wish to have some tests to see if there is a reason why they are not pregnant.
In some instances, such as women over age 35, or a past history of pelvic infection or testicular problems in men, it is advisable to start investigations earlier – after six months, instead of waiting for one year. Since low fertility can affect men and women equally it is important that both partners are tested.
To find out more about Fertility Investigations at the Dublin Well Woman Centre, visit our services section and make an appointment.
Reduced fertility in women
Ovulation problems are the most common reason for low fertility in women. Since ovulation controls the menstrual cycle women who have irregular or infrequent periods may not be ovulating.
If the fallopian tubes are blocked the egg cannot travel from the ovary into the uterus. Conditions such as endometriosis or pelvic inflammatory disease can block the fallopian tubes. Inflammation caused by appendicitis can have the same effect.
Structural problems with the uterus such as fibroids can occasionally cause a problem with implantation of a fertilised egg.
Fertility decreases with age because the quality of the eggs reduces so the chances of getting pregnant are lower and due to increasing genetic faults the risk of miscarriage increases.
Reduced fertility in men
Sperm count is low or nil. This can be due to a genetic condition or caused by infection or injury.
Sperm quality is poor so not able to reach or fertilise an egg. This can be a reflection of the man’s general lifestyle. Smoking and drinking reduces sperm quality. Or it may be due to an illness or medication.
Male fertility also decreases with age.
Adopting a Healthy Lifestyle
For both men and women the chances of achieving a healthy pregnancy are improved if they have a lifestyle which includes the following:
- No smoking – either tobacco or recreational drugs such as cannabis
- Minimal alcohol
- A healthy diet, including a broad range of foods
- Maintain a normal weight – either under or over weight reduces fertility
- Avoid over exercising
- Control stress
- Review any regular medication with a doctor
All women of reproductive age should take folic acid if pregnancy is a possibility
Timing of Intercourse
Most women will have cycles that are about 28 days long but there is quite a variation in what is normal. The range is from 23 days up to 35 days with 2 to 3 days variation between cycles also normal. For example, a woman who has periods every 25 days but sometimes 24 day cycles or 27 day cycles is considered to have a regular cycle.
Regardless of cycle length, ovulation happens 14 days before the start of a period. The egg only lasts for 24 hours so trying to time intercourse to coincide with ovulation can be difficult. Fortunately sperm are active for about five days so having intercourse in the five days leading up to ovulation can also result in conception.
Regular intercourse every two or three days throughout the cycle is less stressful than trying to concentrate all your efforts on when you think ovulation is happening. Frequent intercourse over a short period of time can also cause the sperm count to be much reduced.
In any one cycle the maximum chance of pregnancy is 20 – 25%.
In a Fertility Consultation in Well Woman, we take 2 sets of blood tests. The first set is taken between day 2 and day 5 of the cycle and the second set is taken approximately 7 days before estimated date of next menstrual period.
The blood tests check to confirm ovulation is happening and also a number of other hormones including thyroid and prolactin levels.
A blood test for ovarian reserve, the Anti – Mullerian Hormone (AMH) test, is also advised particularly in women over age 35. This is sent to a private laboratory and incurs an extra charge.
We provide a referral letter for a semen analysis in a public laboratory or private fertility clinic.
Regular intercourse every two or three days produces the best sperm counts. Avoid intercourse for three days before producing the sample for laboratory analysis to maximise the result.
If the sperm count is not normal it is worthwhile repeating in three months because it can vary depending on stress, smoking and drinking.
Some studies suggest that sperm production is reduced if the testes are too warm so avoid tight underwear, hot baths, lycra when running or cycling and sitting with a laptop on your knee.
Following Initial Tests
Depending on the results of the blood tests and the partner’s sperm count there are a range of possible options.
Treatment may include thyroid supplements if warranted on the blood results or metformin if polycystic ovary syndrome is present. Both are tablets that are taken every day.
We can refer to a hospital radiology department for a test to check that the uterus and ovaries are structurally normal and that the fallopian tubes are open.
Referral to a private fertility clinic or a public gynaecology hospital may be advised.
Private fertility clinics have an average waiting time of 3 months.
Public gynaecology clinics have a waiting time of one year but they do prioritise women over age 40.