After a year of regular, unprotected sexual contact, a couple is having trouble becoming pregnant. One in seven couples may be affected, and male factors may be the cause in 20% of the instances. Within a year of trying, over 85% of couples become pregnant.

We often explore if there isn’t a pregnancy after six months of trying for older women (>35 years) or couples with recognised risk factors for infertility.

The most common reason for subfertility is stress or anxiety, and the least common is a hormonal deficiency, which can be corrected by therapy. Sometimes the cause cannot be identified with certainty.

How do we assess male fertility?

It’s crucial to have a thorough understanding of a man’s medical and health history :

– Development throughout childhood

– Sexual maturation throughout adolescence

– Sexual background

– Personal and family medical history

– History of STIs

– Infections

– Surgeries

– Exposure to contaminants such as alcohol, radiation, hormones, chemotherapy, hazardous chemicals, or results of any past fertility tests

Examination of the male partner, mainly :

– Dimensions and weight

– Penis (size and shape)

– Testes (morphology, consistency and risk of torsion)

Semen analysis :

– This is the most important part of the infertility investigation.

– This is performed after one to two days of abstinence.

– After collection, the semen is examined for its volume, motility and morphology (shape).

The process of oocyte retrieval is:

– Oocytes are obtained by a minor surgical procedure called egg harvesting or follicular aspiration.

– This can be done on an outpatient basis and does not require an overnight stay in the hospital.

How do we evaluate fertility in women?

A detailed history of the women’s medical health, including :

– Past treatments

– Pregnancy history

– Previous pregnancies, including number and length of menstrual cycles

– Sexually transmitted diseases

– A detailed history of sexual activity and previous attempts to conceive with her partner.

Menstrual history of the woman is very important :

– Absent menstrual periods are one of the most common causes of infertility.

– Menopause is another cause if it is sudden and without any evidence of disease.

– Many women have menstrual irregularities, like frequent or long periods with light to heavy bleeding.

Physical examination includes:

– Reproductive organ examination

– Examination of the uterus and adnexa

– Pelvic ultrasound

– A pelvic exam feels like a cat scan on the outside, but it is a much more sensitive evaluation of the uterus.

– The pelvis is carefully examined to look for any abnormalities, usually with ultrasound and sometimes x-rays.

– A Pap smear (colposcopy) may be requested during this examination to evaluate cervical cells as part of a previous abnormal Pap.

Tests to confirm ovulation or egg release. This can be done by:

– Serum hormone levels – when certain hormones are present, ovulation has occurred.

– A blood test to measure progesterone levels after ovulation.

– Ultrasound to see if an ovarian cyst is present (which contains a follicle ready to release an egg).

– Basal body temperature monitoring.

Fallopian tubes can be assessed by:

– Laparoscope (laparoscopy) – a thin telescope is passed through the vagina and the pelvis.

– Hysterosalpingogram (HSG) – dye is injected into the uterus, and then x-rays are taken to see if it flows out of the uterus and into the fallopian tubes.

– Pregnancy tests.

Women can be given artificial insemination to achieve pregnancy. In this procedure, sperm is obtained by a process called sperm retrieval. The sperm is then mixed with the woman’s egg and put into her uterus by inserting the needle into the vagina. Inseminated women should continue to receive prenatal care from their physicians throughout pregnancy and delivery.