infertility reasons

 

Ovulation Disorders (See Ovulation Induction)

 

Tubal Blockage

Tubal blockage can occur as a result of previous sterilisation, previous abdominal or pelvic surgery or from a pelvic infection. Before IVF was a successful treatment tubal surgery was the only option available for women with this cause of infertility. Tubal damage increases the risk of an ectopic tubal pregnancy, (ie where the embryo implants in the fallopian tube instead of in the uterus). For this reason, unless the assessment of the tubes is favourable most specialists recommend IVF and embryo transfer instead.

Uterine causes

Forgotten IUDs, adhesions following multiple curettes, polyps, fibroids in the cavity of the uterus and tissue from a previous pregnancy loss or termination can all cause failure of an embryo to implant. These conditions are diagnosed and treated by performing a surgical procedure called a hysteroscopy. The success rate will depend on the cause of the uterine problem.

Male Factor Infertility

The causes of this are not always known. It is assessed by a semen analysis which measures sperm count, motility, shape and presence of antibodies. In general, the more abnormalities found, the less fertile is the semen sample. However there are naturally fertile men with abnormal semen samples and infertile men with apparently normal samples. Sperm quality varies from sample to sample and often deteriorates following acute illness so impairment of male fertility should not be diagnosed on examination of a single sample. Men who have had a vasectomy may have their fertility restored by microsurgery. Sperm reappear in about 70% of cases, but half of these have high levels of sperm antibodies which vastly reduces the capability of the sperm to fertilise an egg. Since 1993 in Australia and Albury, a method of sperm micro-injection has been used which involves the injection of a single sperm into the egg. This method is called Intra Cytoplasmic Sperm Injection (ICSI) and has proven to be very successful. It is appropriate for couples where there has been difficulty in achieving fertilisation with routine IVF methods or where semen tests show that routine IVF would not give satisfactory results. Couples where the male partner has very low sperm numbers and who would not be offered treatment with other IVF methods can now achieve good results with ICSI. Men who have had vasectomies (even if reversal has been attempted) and men with absent or blocked vas deferens (the tube that carries sperm from the testes) can now have sperm retrieved that may be used for sperm micro-injection. For men who cannot produce sperm, a surgical procedure called microsurgical sperm aspiration or testicular needle biopsy will need to be undertaken and this is routine at RMA.

Endometriosis (See Endometriosis)

 

Unexplained infertility

As the name implies, this is an inability to conceive when, after full investigations, no medical cause has been readily found. However, this does not mean that the cause is psychological or that the couple is trying too hard. Although psychological issues may play a role in infertility, we feel that in most cases unexplained or poorly explained infertility probably means that our tests are insufficiently sensitive to diagnose the problem.
 

Zika Virus & Pregnancy

Data involving Zika, its transmission and infectivity, and its adverse effects on fetuses and adults is changing daily. Guidance based on current knowledge is iterative as our understanding of this virus rapidly changes. Any guidance published today may not be accurate for counseling and treatment of individuals tomorrow. Refer to the CDC Zika website for the most updated information: https://www.cdc.gov/zika/
 
SUMMARY TABLE. CDC recommendations for preconception counseling and prevention of sexual transmission of Zika virus among persons with possible Zika virus exposure – United States, August 2018
 

Exposure Scenario Recommendations (update status)
Only the male partner travels to an area with risk for Zika virus transmission and couple planning to conceive The couple should use condoms or abstain from sex for at least 3 months after the male partner’s symptom onset (if symptomatic) or last possible Zika virus exposure (if asymptomatic).
(Updated recommendation)
Only the female partner travels to an area with risk for Zika virus transmission and couple planning to conceive The couple should use condoms or abstain from sex for at least 2 months (8 weeks) after the female partner’s symptom onset (if symptomatic) or last possible Zika virus exposure (if asymptomatic).
(No change in recommendation)
Both partners travel to an area with risk for Zika virus transmission and couple planning to conceive The couple should use condoms or abstain from sex for at least 3 months from the male partner’s symptom onset (if symptomatic) or last possible Zika virus exposure (if asymptomatic).
(Updated recommendation)
One or both partners have ongoing exposure (i.e., live in or frequently travel to an area with risk for Zika virus transmission) and couple planning to conceive The couple should talk with their health care provider about their plans for pregnancy, their risk for Zika virus infection, the possible health effects of Zika virus infection on a baby, and ways to protect themselves from Zika. If either partner develops symptoms of Zika virus infection or test positive for Zika virus infection, the couple should follow the suggested timeframes listed above before trying to conceive.
(No change in recommendation)
Men with possible Zika virus exposure whose partner is pregnant The couple should use condoms or abstain from sex for the duration of pregnancy.
(No change in recommendation)

Source: Polen, KD, Gilboa SM, Hills S, Oduyebo T, Kohl KS, Brooks JT, et al. Update: Interim Guidance for Preconception Counseling and Prevention of Sexual Transmission of Zika Virus for Men with Possible Zika Virus Exposure – United States, August 2018. MMWR Morb Mortal Wkly Rep 67:868-71