Infertility: The Basics

Infertility affects millions of couples across the world. The World Health Organisation (WHO) states that 1:6 couples are estimated to suffer from this disease. However, infertility remains very much a condition that carries a lot of stigma and shame in many communities. Lack of education and awareness are some of the contributing factors that have been identified as making it difficult to shift these attitudes in society.

It has been found that most couples who suffer infertility don't always know or acknowledge what they are going through until its sometimes too late for any medical intervention. Here I discuss the basics of infertility and what couples should do next.

The signs and causes

The WHO definition of infertility states that this is when couples have failed to conceive after one year of active unprotected sexual intercourse. Most people are not aware of this and will keep trying for years without seeking medical attention. In low income countries, facilities and resources may even be a hindering factor to seeking help. Other factors are traditional, cultural, faith & religious beliefs.

In women infertility is commonly caused by problems of ovulation which can come as a result of polycystic ovarian syndrome (PCOS), thyroid problems, or premature ovarian failure. Other issues mentioned are scarring from surgery, cervical mucus problems, fibroids, endometriosis, pelvis inflammatory disease, some medicines such as chemotherapy ("Overview: Infertility").

In men the common causes of infertility are "problem in the ejection of semen, absence or low levels of sperm, or abnormal shape (morphology) and movement (motility) of the sperm" ("Infertility"). There are other factors that can contribute to male infertility like, lifestyle habits, chronic health conditions or injuries. In some cases infertility in both men and women is unexplained.

What to do

The first thing that couples should do if they suspect infertility is to visit a doctor and explain their position. In the UK the National Institute for Health and Care Excellence advises that:

"A woman of reproductive age who has not conceived after one year of unprotected vaginal sexual intercourse, in the absence of any known cause of infertility, should be offered further clinical assessment and investigation along with her partner" (NICE Clinical Guideline 156).

It is important that investigations are conducted for both parties. Some cultural barriers have in the past prevented men from having investigations done. It is important for society to recognise that male infertility is a real issue.

Once investigations have been conducted, the doctors will proceed to treat the cause of the infertility or refer the couple to specialist fertility services for fertility treatment. There are various levels of treatment that a couple can be offered. My next Blog will discuss in detail the type of investigations that couples can expect to be conducted as well as treatment pathways.

This Blog is aimed at giving the most basic knowledge about infertility. Please follow the links provided to read more.

Works Cited

"Overview: Infertility." National Health Service, 9 August 2023, https://www.nhs.uk/conditions/infertility/

Accessed 19 October 2024.

"Infertility." World Health Organisation, 22 May 2024, https://www.who.int/news-room/fact-sheets/detail/infertility

Accessed 19 October 2024.

"Overview: Polycystic Ovarian Syndrome." National Health Service, 11 October 2022, https://www.nhs.uk/conditions/polycystic-ovary-syndrome-pcos/

Accessed 19 October 2024.

"Endometriosis." National Health Service, 27 August 2024, https://www.nhs.uk/conditions/endometriosis/

Accessed 19 October 2024.

"Overview: Fibroids." National Health Service, 9 September 2022, https://www.nhs.uk/conditions/fibroids/

Accessed 19 October 2024.

"Fertility problems: Assessment and treatment -[ Clinical Guideline- CGI56]." National Institute for Health and Care Excellence, 20 February 2013,

https://www.nice.org.uk/guidance/CG15

Accessed 19 October 2024.