Category: Infertility
How to support employees going through fertility treatment in the workplace?
Understanding the Causes of Infertility
For many, the journey to parenthood can be a challenging process, both physically and emotionally. We’re here to help you understand the different causes of infertility, and the options available for those who need support. Quick facts: What is infertility? Infertility is defined as not being able to conceive after one year (or longer) of trying. This could be despite having regular unprotected sex with a partner, or trying using methods like artificial insemination (IUI). There are 2 types of infertility: In the UK, as many as 1 in 7 heterosexual couples experience infertility, yet the causes are sometimes preventative, or treatable. Causes of infertility There can be many different reasons why you might struggle to conceive. This can include structural fertility issues, ovulation problems, underlying health conditions and hormonal imbalances. Let’s take a look at each. Ovulation issues Anovulation, also known as the inability to ovulate, is the most common cause of infertility. Ovulation is when a mature egg is released from one of your ovaries, each month, during your menstrual cycle. The egg travels into the Fallopian tube, where it prepares to be fertilised by a sperm, before then travelling down the tube to the uterus. When trying to conceive, ovulation is a crucial event, with the 5 days before ovulation and ovulation day itself often referred to as your ‘fertile window’.This is the time of the month when you’ll be most likely to get pregnant. Research suggests that as many as 25% of infertility cases are caused by anovulation. Anovulation can be caused by: Another possible explanation is a problem with the egg maturation process. This means that an “immature” egg may be released from your ovaries when it is not quite ready and unable to fertilise. Underlying health conditions Polycystic ovary syndrome (PCOS) PCOS is the most common underlying condition affecting fertility. PCOS affects as many as 1 in 10 people with ovaries. People with PCOS produce higher levels of androgen hormones, like testosterone. This can disrupt your menstrual cycle, ovulation, and balance of cycling hormones—like oestrogen, follicle-stimulating hormone and luteinising hormone (LH). As PCOS is still under-researched and misunderstood, many people are left undiagnosed and are unaware they have it until they are actively trying to conceive. This is why it’s a good idea to check in on your hormones before you start your conception journey. Primary ovarian insufficiency (POI) POI is when the ovaries stop working properly before the age of 40. POI is far less common than PCOS, affecting only 1 in 100 women younger than 40. Your ovaries produce oestrogen and progesterone—two cycling hormones responsible for the regulation of your menstrual cycle. When their function is disrupted, ovulation can also become disrupted or stop completely. People with POI also have a lower ovarian reserve, meaning fewer eggs for their age. Without a sufficient amount of eggs and the correct level of hormones needed to regulate your cycle, the possibility of conceiving is reduced considerably. According to the National Infertility Association, POI can be caused by genetics, autoimmune factors, induced by chemo or radiotherapy, or it can have an unknown cause. Uterine fibroids Uterine fibroids are noncancerous tumours that affect as many as 25% of people with a uterus. They can cause symptoms such as heavy periods, intermenstrual bleeding, and pelvic pain. In some cases, depending on the location in which they grow, and whether they affect the shape of the uterus or cervix, fibroids can also cause infertility. This is because they can block the fallopian tubes, stopping eggs from meeting sperm, or reaching the uterus for implantation. They can also get in the way of implantation if they are near the inner lining of the womb. Despite being less common than other causes of infertility, around 5-10% of infertile women and those assigned female-at-birth are found to have uterine fibroids, with their instance being much more common in Black women. Endometriosis Endometriosis is a common reproductive health condition that affects around 1 in 10 women and people assigned female-at-birth. With endometriosis, tissue similar to the tissue that makes up the lining of the womb starts to grow in other places, such as the ovaries and the fallopian tubes, causing lesions and scarring. This can cause several life-altering symptoms, such as painful and heavy periods, pain during or after intercourse and pelvic pain. It is also another common cause of infertility, with research suggesting it is present in around 20-50% of infertility cases. The exact link between endometriosis and infertility is unknown. However, some theories suggest that lesions and scarring can cause structural problems with the reproductive organs and chemical changes in the lining of the uterus. Structural infertility Structural infertility is a problem with the anatomical structure of the reproductive organs. This can include blockages, structural damage or abnormal growth in the fallopian tubes, uterus or ovaries. Structural issues with the ovaries or fallopian tubes can prevent eggs from being released from the ovaries or stop them from moving through the fallopian tubes to reach a sperm for fertilisation. Additionally, if the structure of your uterus is abnormal or damaged, it may prevent eggs from implanting into the endometrium (uterus lining). This is needed to create a healthy embryo and pregnancy. Structural infertility problems can also be caused by scarring from surgery, infections, injuries, or endometriosis. Also, the growth of noncancerous tissues such as uterine polyps on the lining of the uterus, can cause blockages. Polyps occur when additional tissue grows on your uterus. However, sometimes tissue grows elsewhere in your reproductive system potentially blocking your fallopian tubes and preventing pregnancy. Implantation failure Other possible explanations of implantation failure are: Infections and auto-immune disorders Untreated sexually transmitted infections (STIs) may have serious consequences for your fertility. STIs like chlamydia or gonorrhoea can cause scarring and blocking of your Fallopian tubes. Additionally, if syphilis is left to develop, it can cause stillbirth. There are also other forms of infections of the cervix with human papillomavirus (HPV) that could cause infertility. It’s […]
Secondary Infertility: Causes and Coping Strategies
Is it harder to conceive with your second child? It can be but it’s different for everyone. Unfortunately, infertility affects 1 in 6 people, so if you are struggling, you’re not alone. This article will share everything you need to know about what secondary fertility is, what causes it, and the treatment options available to you. Quick facts: What is secondary infertility? Secondary infertility is when you are having difficulty conceiving after previously conceiving and giving birth. To be defined as secondary infertility, the previous birth must have occurred without help from fertility treatments or medications like IVF (in-vitro fertilisation). The definition of primary infertility, in comparison, is when someone who’s never conceived a child has difficulty conceiving. So, how common is secondary infertility? Struggling to conceive might come as a shock if you’ve already had a baby. Secondary infertility, however, is a challenge faced by lots of individuals and couples who are trying for more children. A World Health Organization (WHO) report suggests that around 1 in 6 (17.5%) people are affected by infertility (primary and secondary infertility) worldwide. Secondary infertility: definition and signs You can be diagnosed with secondary infertility by a healthcare professional when: The main sign of secondary infertility is being unable to get pregnant when you’re having regular, unprotected sex for up to six months or a year depending on your age. It could also include several failed artificial insemination (IUI) attempts. If you’re worried about your fertility, discuss it with your GP or a healthcare professional. Common causes of secondary infertility The causes of secondary infertility are the same as the causes of primary infertility. For women and those assigned female-at-birth (AFAB), these include age-related fertility decline, hormonal imbalances, blockages in your reproductive environment (uterus, fallopian tubes or ovaries) and lifestyle choices such as your weight, nutrition, sleep, stress, and smoking and alcohol. For males and those assigned male-at-birth (AMAB), the causes of secondary infertility are similar. These include age-related fertility decline, lifestyle choices, and hormone imbalances. However, specific concerns for males and those AMAB are testicular damage, genital infections, or problems with ejaculation or sperm. Age-related causes of secondary infertility Age-related fertility decline could be a cause of secondary fertility. For women and those AFAB, it’s natural for the quantity (ovarian reserve) and quality of eggs to diminish, leading to a decline in fertility. In your 20s, your fertility peaks. Then, fertility gradually declines in your 30s, particularly after age 35.he chances of getting pregnant each month during your 30s are about 20%. That means that for every 100 fertile 30-year-old women trying to get pregnant in one cycle, 20 will be successful and the other 80 will have to try again. By age 40, the chance is less than 5% per cycle, so fewer than five out of every 100 women are expected to be successful each month. Advanced maternal age is associated with increased risks of infertility and complications during pregnancy. Factors like decreased ovarian reserve and higher rates of chromosomal abnormalities can contribute to challenges in conception. Hormonal imbalances affecting secondary infertility Hormonal imbalances are a leading cause of primary and secondary infertility. Hormones regulate your menstrual cycle—consider them the orchestrators of your fertility. Hormonal imbalances can indicate conditions like polycystic ovary syndrome (PCOS) or thyroid issues and can affect ovulation, meaning you might not release an egg every month or the release may be delayed. If an egg isn’t released, pregnancy can’t occur. Hormonal changes can also negatively affect male fertility, reducing sperm production, mobility and motility. Infections and STIs affecting secondary infertility Infections, both viral and bacterial, can affect your fertility. Some infections, particularly Sexually transmitted infections (STIs), can have lasting negative effects on your fertility if left untreated so it’s important to get regular checkups. Other viral and bacterial infections might temporarily affect fertility. For male secondary infertility, the testis are particularly susceptible to viral infection. Evidence is also emerging that Covid-19 might impact the testis. A common cause of secondary infertility in males or those AMAB, is poor semen quality, including a low sperm count, and low motility. This means sperm that isn’t moving properly or abnormally-shaped sperm which makes it harder for them to move and fertilise an egg. There’s a male fertility misconception that the type of underwear someone wears can affect fertility. Although there seems to be a link between increased temperature of the scrotum and reduced semen quality, there’s no evidence to suggest that the type of underwear worn by men and those AMAB can affect infertility. If you’ve had any infections, surgeries or medical diagnoses in the last 12 months, it might be worth mentioning to your GP if you’re having trouble conceiving or with secondary infertility. Medical diagnoses and treatments affecting secondary infertility Unfortunately, cancer treatments like radiation and chemotherapy, surgery, or a medical diagnosis can affect secondary infertility. If you’ve recently undergone cancer treatment or are about to, you might want to check your fertility with a hormone and fertility test and consider fertility preservation treatments like egg freezing, IVF (in-vitro fertilisation), and donor eggs or embryos. Lifestyle considerations for secondary infertility Lifestyle choices can affect secondary infertility. Things like being underweight or overweight, smoking, using drugs and drinking alcohol. These can all increase the risk of secondary infertility by disrupting your hormone balance and impacting your overall health and well-being. Poor nutrition can negatively impact fertility Poor nutrition like eating lots of trans fats and saturated fats found in ultra-processed foods, and having a high-sugar diet have been shown to negatively impact fertility. Regular exercise to support fertility Although regular physical exercise is considered healthy and will support weight management and optimise fertility, excessive exercise can negatively affect ovulation and fertility in women and those AFAB. Getting enough sleep to support fertility Studies suggest that sleep disturbances correlate with adverse reproductive health outcomes like menstrual irregularities, increased time to and reduced rates of conception, and increased miscarriages. Women with diminished ovarian reserve were found to be 30 […]
IVF Treatment: What to Expect
IVF can be a highly effective fertility treatment for some people, but it doesn’t guarantee a successful pregnancy. Here we cover what the IVF process entails, who could benefit from it and things to consider if you’re thinking about undergoing a cycle. Quick facts: What is IVF? In-vitro fertilisation (IVF) is a fertility treatment for those who can’t or don’t wish to conceive naturally. It’s one of the most common fertility treatments in the UK, with as many as 50,000 people undergoing IVF in the UK each year. IVF involves removing eggs from the ovaries, attempting to fertilise them with sperm in a lab and then transplanting any successfully fertilised eggs (embryos) into the uterus. This is called an IVF cycle. It’s an invasive procedure and doesn’t guarantee a successful pregnancy. Whether or not it’s right for you will depend on a range of personal and medical factors, as well as carefully considering the IVF cycle process. Fresh cycle vs frozen cycle IVF cycles can be fresh or frozen. Once an egg has been successfully fertilised by a sperm in the lab, it creates an embryo. This embryo is then typically incubated in the lab for 3-5 days. In a fresh cycle, it will then be transferred to the uterus. In a frozen cycle, the embryo will be frozen at this point and transferred to the uterus at another time. This might be done if your uterus isn’t prepared to receive an embryo, or if you had several embryos that were successfully fertilised, they will be frozen, rather than transferring more than 1 at time, which is associated with multiple pregnancies (expecting two or more babies from a pregnancy). Who is IVF for? IVF can benefit lots of different types of people. Some instances where IVF may be explored could be: What happens in an IVF cycle? There are four key stages involved in an IVF cycle—ovulation stimulation, egg retrieval, egg fertilisation and embryo transfer. The entire process may take between 4 to 6 weeks but will vary and depend on you. Ovulation stimulation Firstly, you’ll take a course of fertility medication to stimulate your ovaries to mature multiple eggs. Usually in one menstrual cycle, you’ll only release one egg for ovulation. But this medication stimulates many eggs to mature. During this time you’ll need to go to the clinic regularly for ultrasounds and blood tests to analyse your progress. The simulation period generally lasts for around 10 days. Egg retrieval and sperm collection Once your eggs are mature, you’ll undergo a retrieval procedure. Egg retrieval is carried out under ultrasound guidance, where a small transvaginal needle is used to suck follicular fluid that contains your mature eggs, out of your ovaries. You’ll have the option to have the procedure done under general anaesthetic or mild sedation. Whilst your eggs are being retrieved, your partner or sperm donor will be required to go into the clinic and produce sperm cells which will be used to fertilise your eggs, unless your partner or donor sperm has previously been frozen. Egg fertilisation During the fertilisation step, your eggs and the sperm will be combined in a lab. The goal is for the sperm cells to break into and enter your egg cells where an embryo will be formed. There are multiple techniques in which your eggs can be fertilised. One technique is called conventional IVF which involves placing the mature eggs in a petri dish full of sperm. Another technique is called intracytoplasmic sperm injection (ICSI), where one sperm cell is selected based on morphology and injected directly into your egg cell. The technique used depends on the sperm, clinic and whether or not you have attempted conventional IVF successfully or not before. Embryo transfer If you undergo a fresh cycle, any successful embryos will be transferred 2-5 days later. If you have a frozen cycle, you will be given medication to prepare the uterus lining and depending on your progress, your doctor will determine a transfer date. However, this doesn’t guarantee a pregnancy. The embryo will still need to successfully implant to your uterus. You will be given a pregnancy test roughly 2 weeks later, which can confirm whether or not the IVF process has been successful. The process for an embryo to grow into a healthy baby and undergo live birth is a very complicated and precise journey. A certain number of chromosomes, which is our genetic information in the form of our DNA, is required for an embryo to develop into a baby. The test that is used to understand and analyse the number of chromosomes in the embryo before implantation is called Pre-implantation Genetic Screening. However, many other screening techniques can be used too depending on your clinic. Is only one embryo transferred? If more than one egg is fertilised, your doctor will choose one to transfer, based on trying to assure the maximum possibility of a pregnancy. There are multiple criteria that the clinics use to determine this, including: Sometimes you will be given the option to transfer more than one embryo. This may increase your chances of developing multiple pregnancies but again, doesn’t guarantee a pregnancy. Can you get IVF on the NHS? The NHS provides full funding for IVF for those who: Whether or not you are eligible for IVF under the NHS also depends on where you live as different trusts have different requirements and funding availability. You must discuss thoroughly with your gynaecologist or GP and if you are not eligible, there are many private clinics available for IVF treatments. The cost for 1 cycle of treatment is roughly £5,000. This depends on the clinic you choose and the treatment protocol you follow. How effective is IVF? Yes, IVF can be an effective fertility treatment and many women can successfully become pregnant and give birth to healthy babies via IVF. The success rate depends on a range of factors, including age, medical history, sperm quality and success rates of your clinic. As younger women […]