Infertility

Infertility is now affecting a growing number of couples throughout the world. It is defined as the inability to conceive after twelve months of unprotected sexual relations. Approximately 330,000 couples in Canada have a problem with infertility (10 to 15%). Fertility is diminished in 84% of couples, with 10% sterility in women (fallopian tubes blocked on both sides), and 6% sterility in men (absence of spermatozoa). In one-third of couples, the problem originates with the man (abnormal semen analysis). Endometriosis and/or an infection damaging the fallopian tubes cause infertility in a further third of couples. Ovulation problems are diagnosed in 15% of couples, and 10% will have a diagnosis of unexplained infertility despite all the tests carried out to find a cause. It should also be noted that in one-third of couples both the man and woman have a problem.

The number of infertile couples has increased over the past few years, mainly because a lot of couples defer pregnancy for professional or personal reasons. The older the woman, the greater the risk that she may be exposed to an infection that can damage her fallopian tubes or that she may develop endometriosis. In addition, fertility diminishes significantly in women as they grow older because of the lower number of ova in the ovaries, unlike men who remain fertile until an advanced age. Fertility in women starts to decline when they reach 30, and this is accentuated after age 35. The risk of miscarriage also increases with age. A woman over 40 has a 40% chance of having fertility problems and, if she becomes pregnant, the risk of miscarriage is also around 40%. While it is not a good idea to try to become pregnant if the circumstances are not right, the fact remains that earlier is better than later.

The percentage of couples who consult fertility clinics has also increased over the past few years. There is more information out there, couples are better informed, and the success rate of the various fertility treatments has improved.

WHAT HAPPENS WHEN A COUPLE COMES TO A FERTILITY CLINIC?

The first step is an interview and physical examination. The man is generally not examined unless the semen analysis is abnormal. The woman's history will be looked at for irregular periods, salpingitis, previous surgery, or any other indication that might suggest a reason. Samples are taken during a gynecological examination to test for chlamydia, and sometimes endometriosis might be suspected. Semen analysis, temperature curve, and an X-ray of the fallopian tubes (a hysterosalpingography) are usually ordered during a couple's initial assessment in a fertility clinic. Blood tests are required mainly if the woman's periods are irregular. Tests can be prescribed after only six months' infertility for women who are over age 35 or subject to very irregular periods. Any woman who tries to become pregnant should take a folic acid supplement (at least 0.4 mg per day), as this will lessen the possibility of certain types of brain and spinal malformation in the unborn child. Consultation with the fertility clinic's psychologist is encouraged. Infertility is a source of great stress for a couple and psychological support is generally much appreciated. The couple will then be seen again once initial test results are received.

WHAT TREATMENT IS AVAILABLE?

If the fallopian tubes are blocked or their X-ray is abnormal, a laparoscopy can both confirm the diagnosis and treat the condition. If the semen analysis is abnormal, it will always be repeated at least one month afterwards, since it is known that a man's sperm count can vary at certain times. If it is still abnormal, he will be referred to a urologist specializing in fertility, who will carry out a complete interview, physical examination, and take blood tests if necessary. The treatment varies depending on the cause, but insemination with the spouse's sperm or, in severe cases, in vitro fertilization with micro-injection, or the use of donor sperm are all possible approaches. If the woman ovulates little or rarely, ovulation can be induced using a specific kind of pill (clomiphene citrate), or sometimes injections.

AND WHAT HAPPENS IF ALL THE TESTS ARE NORMAL?

We have to remember, at this point, that any type of treatment is intended simply to speed up the occurrence of a pregnancy that would probably have happened at some point in the future, in any case. For example, after one year of infertility, more than 60% of couples (11% of pregnancies per cycle) will conceive without treatment during the following year. After more than three years of infertility, the chance of spontaneous pregnancy is far less (below 5% per cycle). It is important to note that normal monthly fertility is 20%. Our treatments are designed to increase the chances of pregnancy by stimulating ovulation, with or without insemination. In vitro fertilization is the final type of treatment with the best chance of success, but it is far more expensive.