- Causes of Female Infertility
- Causes of Male Infertility
- Unexplained infertility
- Recurrent Pregnancy Loss
- Recurrent treatment failure
Problems with Ovulation
Polycystic ovaries
The commonest cause of ovulation problems is Polycystic Ovaries. This is a common condition, affecting one in ten women. It usually presents as irregular periods, weight gain and hirsutism (excessive hair growth). On transvaginal pelvic ultrasound scan it is possible to see the small cysts (around 0.5 cm. diameter each) around the ovaries. The diagnosis is made on the physical findings, hormone blood tests and a pelvic scan. Many women who have polycystic ovary syndrome do not ovulate and require treatment to help them get pregnant. This could be in the form of life-style changes to lose weight, fertility drugs (given in the form of tablets or injections), or a day-case key-hole operation called laparoscopic ovarian drilling (where the inside of the abdomen is examined with a small scope and heat is applied to both ovaries in certain points).
Other causes of not ovulating
There are many other causes of not ovulating. Investigations include pelvic scan and blood tests for hormone levels. Depending on the type of problem, other investigations may sometimes be required. Treatment is often in the form of fertility drugs and is targeted at correcting the underlying condition.
Tubal blockage
Tubal blockage can affect the tube at the point at which it joins the womb (known as proximal blockage), or at the end of the tube (known as distal blockage). If the tube is blocked at its end, it can swell up with secretions, and is called a hydrosalpinx. Tubal disease is diagnosed by either a laparoscopy (a day case key-hole surgery under general anaesthetic where the inside of the abdomen is examined with a small scope), or by an outpatient X-ray procedure called a hysterosalpingogram or HSG. If, on HSG proximal blockage is found, it can often be treated at the same time by passing a wire into the tube and through the blockage. This is called selective salpingography. Distal tubal disease can be seen on HSG, but can only definitively be diagnosed by laparoscopy. Sometimes it is possible to open the tube surgically. If it is not possible to repair the tube, then in vitro fertilisation (IVF), otherwise known as test-tube bay treatment can help.
In IVF the woman's eggs are taken outside the body and mixed with her partner's sperm in a test tube in the laboratory. The resulting embryos are transferred to her womb.Another cause of tubal blockage is previous female sterilisation. Up to 1 in 10 women who have been sterilised consider having more children, and reversal of sterilisation operation is a realistic option. The procedure involves an abdominal operation with a 3 day stay in hospital. The results are good, and depend on the method used for sterilisation, and the presence of any other fertility factors. Your consultant will discuss all these issues with you and advice you appropriately.
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Polycystic ovaries
The commonest cause of ovulation problems is Polycystic Ovaries. This is a common condition, affecting one in ten women. It usually presents as irregular periods, weight gain and hirsutism (excessive hair growth). On transvaginal pelvic ultrasound scan it is possible to see the small cysts (around 0.5 cm. diameter each) around the ovaries. The diagnosis is made on the physical findings, hormone blood tests and a pelvic scan. Many women who have polycystic ovary syndrome do not ovulate and require treatment to help them get pregnant. This could be in the form of life-style changes to lose weight, fertility drugs (given in the form of tablets or injections), or a day-case key-hole operation called laparoscopic ovarian drilling (where the inside of the abdomen is examined with a small scope and heat is applied to both ovaries in certain points).
Other causes of not ovulating
There are many other causes of not ovulating. Investigations include pelvic scan and blood tests for hormone levels. Depending on the type of problem, other investigations may sometimes be required. Treatment is often in the form of fertility drugs and is targeted at correcting the underlying condition.
Tubal blockage
Tubal blockage can affect the tube at the point at which it joins the womb (known as proximal blockage), or at the end of the tube (known as distal blockage). If the tube is blocked at its end, it can swell up with secretions, and is called a hydrosalpinx. Tubal disease is diagnosed by either a laparoscopy (a day case key-hole surgery under general anaesthetic where the inside of the abdomen is examined with a small scope), or by an outpatient X-ray procedure called a hysterosalpingogram or HSG. If, on HSG proximal blockage is found, it can often be treated at the same time by passing a wire into the tube and through the blockage. This is called selective salpingography. Distal tubal disease can be seen on HSG, but can only definitively be diagnosed by laparoscopy. Sometimes it is possible to open the tube surgically. If it is not possible to repair the tube, then in vitro fertilisation (IVF), otherwise known as test-tube bay treatment can help.
In IVF the woman's eggs are taken outside the body and mixed with her partner's sperm in a test tube in the laboratory. The resulting embryos are transferred to her womb.Another cause of tubal blockage is previous female sterilisation. Up to 1 in 10 women who have been sterilised consider having more children, and reversal of sterilisation operation is a realistic option. The procedure involves an abdominal operation with a 3 day stay in hospital. The results are good, and depend on the method used for sterilisation, and the presence of any other fertility factors. Your consultant will discuss all these issues with you and advice you appropriately.
Male factor infertility is a sensitive issue that is often ignored. Many men are not offered the explanation as to the cause of their condition, and are not made aware of their options for treatment.
Male infertility can be due to a low sperm count, poor sperm motility, low number of normal sperm or even no sperm whatsoever (azoospermia). Sperm counts do vary significantly, so it is important to repeat the sperm sample, if it is abnormal before reaching a diagnosis.
Male infertility can be due to a low sperm count, poor sperm motility, low number of normal sperm or even no sperm whatsoever (azoospermia). Sperm counts do vary significantly, so it is important to repeat the sperm sample, if it is abnormal before reaching a diagnosis.
No sperm (azoospermia)
There are two types of conditions which result in no sperm being in the ejaculate. Either no sperm is being produced by the testis, or whilst sperm is produced, there is a blockage stopping the sperm.
In some men the sperm passes into the bladder at ejaculation rather than out (retrograde ejaculation).
Other causes include hormonal imbalances, chromosome abnormalities (variations in the way the genetic material is arranged), and a special type of carrier status for Cystic Fibrosis.
Depending on the cause, treatment is either by treating the cause such as removing an obstruction or hormone treatment, or by retrieving sperm for use in IVF techniques . Obtaining sperm from the testis is done by a simple procedure under local or general anaesthetic. Such sperm is then used for a special form of test-tube baby treatment, called ICSI (intracytoplasmic sperm injection). In ICSI a single sperm is injected into the egg to fertilise it and make an embryo.
Severe sperm problems
This is where there is sperm in the ejaculate, but it is of very low count/ very slow or of poor quality. In such circumstances, we check for chromosome abnormalities. Treatment is with a special form of test-tube baby treatment, called ICSI (intracytoplasmic sperm injection).
Mild - moderate sperm problems
Treatment is either with IVF (in vitro fertilisation) or artificial insemination (AI), depending on the severity of the problem. In AI the sperm are prepared in special way and injected into the womb of the female partner at time of ovulation.
Other Male-related issues
Varicocele: This is where the veins around the testis are increased in size and engorged. They : This is where the veins around the testis are increased in size and engorged. They can be felt on examination and may lead to groin/testicular discomfort and pain. Varicocele are more common in men with infertility, but currently there is no scientific evidence that treating varicocele surgically will improve fertility, as measured by the pregnancy rate, so we don not recommend it.
Vitamins and anti-oxidants: There have been some claims in the past about the benefit of : There have been some claims in the past about the benefit of these drugs in cases of male factor infertility. However, the scientific evidence is very clear that they are of no use and will not improve fertility.
There are two types of conditions which result in no sperm being in the ejaculate. Either no sperm is being produced by the testis, or whilst sperm is produced, there is a blockage stopping the sperm.
In some men the sperm passes into the bladder at ejaculation rather than out (retrograde ejaculation).
Other causes include hormonal imbalances, chromosome abnormalities (variations in the way the genetic material is arranged), and a special type of carrier status for Cystic Fibrosis.
Depending on the cause, treatment is either by treating the cause such as removing an obstruction or hormone treatment, or by retrieving sperm for use in IVF techniques . Obtaining sperm from the testis is done by a simple procedure under local or general anaesthetic. Such sperm is then used for a special form of test-tube baby treatment, called ICSI (intracytoplasmic sperm injection). In ICSI a single sperm is injected into the egg to fertilise it and make an embryo.
Severe sperm problems
This is where there is sperm in the ejaculate, but it is of very low count/ very slow or of poor quality. In such circumstances, we check for chromosome abnormalities. Treatment is with a special form of test-tube baby treatment, called ICSI (intracytoplasmic sperm injection).
Mild - moderate sperm problems
Treatment is either with IVF (in vitro fertilisation) or artificial insemination (AI), depending on the severity of the problem. In AI the sperm are prepared in special way and injected into the womb of the female partner at time of ovulation.
Other Male-related issues
Varicocele: This is where the veins around the testis are increased in size and engorged. They : This is where the veins around the testis are increased in size and engorged. They can be felt on examination and may lead to groin/testicular discomfort and pain. Varicocele are more common in men with infertility, but currently there is no scientific evidence that treating varicocele surgically will improve fertility, as measured by the pregnancy rate, so we don not recommend it.
Vitamins and anti-oxidants: There have been some claims in the past about the benefit of : There have been some claims in the past about the benefit of these drugs in cases of male factor infertility. However, the scientific evidence is very clear that they are of no use and will not improve fertility.
In some men the sperm passes into the bladder at ejaculation rather than out (retrograde ejaculation).
Other causes include hormonal imbalances, chromosome abnormalities (variations in the way the genetic material is arranged), and a special type of carrier status for Cystic Fibrosis.
Depending on the cause, treatment is either by treating the cause such as removing an obstruction or hormone treatment, or by retrieving sperm for use in IVF techniques . Obtaining sperm from the testis is done by a simple procedure under local or general anaesthetic. Such sperm is then used for a special form of test-tube baby treatment, called ICSI (intracytoplasmic sperm injection). In ICSI a single sperm is injected into the egg to fertilise it and make an embryo.
Severe sperm problems
This is where there is sperm in the ejaculate, but it is of very low count/ very slow or of poor quality. In such circumstances, we check for chromosome abnormalities. Treatment is with a special form of test-tube baby treatment, called ICSI (intracytoplasmic sperm injection).
Mild - moderate sperm problems
Treatment is either with IVF (in vitro fertilisation) or artificial insemination (AI), depending on the severity of the problem. In AI the sperm are prepared in special way and injected into the womb of the female partner at time of ovulation.
Other Male-related issues
Varicocele: This is where the veins around the testis are increased in size and engorged. They : This is where the veins around the testis are increased in size and engorged. They can be felt on examination and may lead to groin/testicular discomfort and pain. Varicocele are more common in men with infertility, but currently there is no scientific evidence that treating varicocele surgically will improve fertility, as measured by the pregnancy rate, so we don not recommend it.
Vitamins and anti-oxidants: There have been some claims in the past about the benefit of : There have been some claims in the past about the benefit of these drugs in cases of male factor infertility. However, the scientific evidence is very clear that they are of no use and will not improve fertility.
About 1 in 3 infertile couples are told that they have unexplained infertility, when all the tests come back as normal. This is often very frustrating for the couple as they think if the doctor does not know what is wrong then the right treatment could not be offered. We understand how frustrating that situation is for the couple and there are a number of things that could be done.
Firstly we will review all the tests that the couple have had and assess if anything else needs doing. Some times, significant tests have been inadvertently missed or up to date methods have not been used.
Secondly, even if after thorough assessment no cause is found, we have a lot of experience in managing such cases. There are a number of proven treatments that could increase the chances of pregnancy, ranging from fertility tablets to intra-uterine insemination and test-tube baby technique (IVF). Of course there are many tests and treatments that may be on offer but with no proof of benefit, and our consultants will be able to expertly advise you on all those points.
Finally, many couples with unexplained infertility have a good chance of getting pregnant naturally, and the chance depends on many factors such as age and duration of infertility. Our consultants will advise you on your chance of getting pregnant naturally and with treatment.
Firstly we will review all the tests that the couple have had and assess if anything else needs doing. Some times, significant tests have been inadvertently missed or up to date methods have not been used.
Secondly, even if after thorough assessment no cause is found, we have a lot of experience in managing such cases. There are a number of proven treatments that could increase the chances of pregnancy, ranging from fertility tablets to intra-uterine insemination and test-tube baby technique (IVF). Of course there are many tests and treatments that may be on offer but with no proof of benefit, and our consultants will be able to expertly advise you on all those points.
Finally, many couples with unexplained infertility have a good chance of getting pregnant naturally, and the chance depends on many factors such as age and duration of infertility. Our consultants will advise you on your chance of getting pregnant naturally and with treatment.
The chance of miscarrying any pregnancy is about 15%. Recurrent pregnancy loss is the term used after 3 miscarriages, though sometimes after 2. We can offer full investigations for this condition and provide not only treatment but also support during pregnancy. There are many causes including chromosomal (genetic), hormonal, immune, and abnormal blood clotting. The investigations include hormonal assessment, pelvic ultrasound scan to assess the cavity of the uterus and the ovaries, blood tests to detect any increased tendency for the blood to clot, and genetic chromosome analysis of both partners. Support (in the form of regular scans and reassurance) in early pregnancy in women with recurrent pregnancy loss has been shown in studies to increase the chance of a successful pregnancy.
TopIt is not unusual for many couples to go through repeated fertility treatment attempts unsuccessfully, and keep being advised to carry on doing the same treatment next time without further investigations. We offer detailed investigations of the causes of recurrent treatment failures, such as genetic tests, careful investigation of the womb, and immune causes. Treatment is then offered accordingly.
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