Infertility: How long should we try before seeking medical advice?

In his latest online article, renwoned consultant obstetrician an dgynaecologist Mr Ibrahim Bolaji offers his expert insight into infertility. He explains how long couples should try for before seeking medical advice, as well as the possibler cause of infertility in both men and women.

How long should couples try to conceive before seeking medical help for infertility?

The National Institute of Clinical Excellence (NICE) guidelines for the assessment and treatment of people with fertility problems define infertility as ‘‘failure to conceive after regular unprotected sexual intercourse for two years in the absence of known reproductive pathology’’.

Infertility is classified as primary, secondary, or voluntary.

• Primary infertility: includes those who have never conceived in the past after regular unprotected intercourse for one year.
• Secondary infertility: includes those who have conceived in the past (irrespective of the outcome of the pregnancy be it miscarriage, termination, ectopic or normal delivery), but fail to do so again after regular unprotected intercourse for one year.
• Voluntary infertility: includes those who have never tried for a pregnancy and/or have taken contraception.

It is generally recommended for couples to try to conceive for at least one year before seeking medical help for infertility. This timeframe is based on the understanding that for healthy couples having regular sexual intercourse, about 80-90% will conceive within the first year of trying. However, it's important to note that this is a general guideline, and individual circumstances may warrant seeking medical help earlier.

There are certain situations where it may be advisable to seek medical evaluation and assistance sooner than one year:

• Age: The single most important determinant of a couple’s fertility is the age of the female partner.  As women age, the fertility potential decreases, and the chances of conceiving naturally decrease. If a woman is over the age of 35, it is generally recommended to seek medical help after six months of unsuccessful attempts.
• Known issues: If either partner has a known medical condition that may affect fertility, such as low sperm count, ejaculatory problems, polycystic ovary syndrome (PCOS), endometriosis, irregular menstrual cycles, or a history of pelvic infections or surgeries, it may be appropriate to seek medical evaluation earlier.
• Lifestyle factors: If one or both partners have lifestyle factors that may affect fertility, such as a history of cancer treatment, chemotherapy, radiation therapy, or exposure to environmental toxins, it may be advisable to seek medical evaluation earlier.

Ultimately, the decision to seek medical help for infertility is a personal one. If a couple has concerns about their fertility or if they have been trying to conceive for an extended period without success, it is always appropriate to consult with a healthcare professional or a fertility specialist. They can provide guidance, conduct necessary tests, and offer appropriate treatment options based on the individual circumstances.

What are the common causes of infertility in men and women, and how is it diagnosed?

Infertility can have various causes in both men and women. Here are some common causes for each:

Causes of infertility in men

The commonest causes in men are sperm-related issues: Problems with sperm production, sperm quality (such as low sperm count, poor motility, or abnormal morphology), or blockages in the reproductive tract or varicocele can contribute to male infertility.

A varicocele is a swelling of the veins that drain the testicle. It can interfere with sperm production and quality.

Certain medical conditions can impact male fertility, including:  

• Infections
• Genetic disorders
• Testicular disorders
• Hormonal disorders
• Lifestyle factors (obesity, excessive alcohol consumption, smoking, drug use, exposure to environmental toxins)

Causes of infertility in women

There are several possible causes of female infertility, with the most common being ovulation disorders including:

• Irregular or absent ovulation, which can be caused by hormonal imbalances
• Polycystic ovary syndrome (PCOS)
• Thyroid disorders
• Premature ovarian insufficiency

Anatomical problems such as fallopian tube or uterine issues: Blocked or damaged fallopian tubes due to conditions like pelvic inflammatory disease, endometriosis, or previous surgeries can prevent the egg from reaching the sperm or the embryo from reaching the uterus.

Structural abnormalities of the uterus, such as fibroids, polyps, or intrauterine adhesions (Asherman's syndrome), can interfere with implantation and fertility.

Endometriosis is a condition where the tissue that normally lines the uterus grows outside of it. It can cause inflammation, scarring, and fertility problems.

Several other factors can also impact female fertility, including conditions such as:

• Hormonal imbalances
• Autoimmune disorders
• Certain medical conditions
• Obesity
• Excessive exercise
• Stress
• Lifestyle factors