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.