Endocrinology Treatment of Infertility The problem 57% healthy young women conceive within 3 months, which is considered normal, as it is hard to fall pregnant. You need to plan it right, so you have sex during the ovulation period e.g. the day are few remaining days after ovulation. After 1 year, 80-90% of normal couples conceive. This doesn't show much of a problem; it might be normal considering that the couples may have been having sex outside the ovulation window. After 2 years this figure rises to 95%. Subfertility: a failure to conceive after 2 years without contraception. Infertility: a complete inability to conceive; there is a total lack of ability. It could be caused by blocked fallopian tubes or the male doesn't produce sperm. - No explanation, which happens in 30% of couples - The male factor, which is 19% - Ovulatory failure in woman, 27%. The corpus leutem only appears when there is ovulation; looking for rising level of progesterone will show if the woman has ovulated. - There is tubal damage 14% - physical barrier to the egg getting down the tube - Endometriosis or other factors, 5%. This is where the lining of the uterus grows outside the uterus - and this tissue responds to the natural rise of the hormones and will bleed on period into the abdominal cavity. A lot of us are choosing to have babies later on in life, even though the ovaries are on the decline Not as easily to fall pregnant as the egg has to be fertilized within a few days of ovulation - small window for the production of the baby The treatments target ovulatory failure In vitro treatments for conception need eggs; the treatment for ovulation is common so the woman can produce the eggs for the remaining treatment. Investigation of infertile couple 1. Performed by the GP. - Full medical history of BOTH partners. - hormonal diseases might be the problem - Semen analysis. - detect problem in man, won't need to be invasive with the woman
Endocrinology General medical advice: - Timing of intercourse. - Avoid hot baths & tight underpants in the male. - spermatogenesis happens at a lower temperature - Stopping smoking and drinking in BOTH. If "technique" OK, and semen levels normal THEN ovulatory performance investigated. Initial therapy: anovulation? Hormonal: mid-luteal phase progesterone levels confirms luteinisation of follicle; NOT ovulation. Ultrasound: direct visualisation of ovaries, measurement of number and size of follicles. - see the developing follicles and corpus leuteum. If anovulation confirmed, we use treatments to promote ovulation: - anti-oestrogen: follicular phase is inhibition, if it is given at this time, it blocks receptors on the hypothalamus and pituitary gland and extends the follicular phase. There is more chance of developing eggs. Hopefully there will be a natural surge of LH to release the egg, or the LH can be prescribed by GP. If anti-oestrogen therapy fails after 2-3 cycles: GP refers to specialist clinic Specialist clinic - Full endocrine screen