Subfertility-the extent of the problem
Infertility is an absolute term and should be avoided if possible. Subfertility is a better term and is defined as the failure to conceive within one year of regular unprotected intercourse.Fifteeen per cent of couples or one in six couples who want a baby experience an unwanted delay in conception and subfertility. Approximately 50% will conceive after receiving advice and simple treatment, and the remaining half require more complex assisted conception techniques, but nearly 5% will remain involuntarily childless.

Conception is most likely to occur in the first month of trying with a 30% conception rate. The chance of spontaneous conception or natural conception over the first 6 months of regular unprotected intercourse is approximately 75% and this rises to 90% after 1 year and 95% after 2 years of trying to conceive. In other words, at the end of 1 year, 90 % of couples will have conceived provided both partners are normal and have no obvious problems.


Factors affecting conception
The likelihood of spontaneous conception is affected by the age of the female partner, previous pregnancy, duration of subfertility, frequency of sexual intercourse, timing of intercourse during the natural cycle, extremes of body mass index or weight, smoking and if there is any pathology present. The single most important factor in determining fertility is the age of the female partner, with fertility reducing rapidly in women over the age of 35 years of age.


Normal conditions for pregnancy
In order for a normal pregnancy to occur, an egg must be produced from the female ovary, adequate sperm must be released from the male testes, the sperm must reach the egg, fertilisation must occur and the fertilised egg must implant in the womb. If there is a problem in any of these steps, subfertility occurs.Problems contributing to subfertility can broadly be due to defective egg release(ovulationproblems),including Polycystic Ovarian Syndrome, defective sperm(male problems), tubal problems(sperm cannot meet egg), unexplained, implantation problems, endometriosis, fibroids, cervical and coital problems. The proportion of each type of subfertility varies in different populations. In 40% of couples, a problem will be found in both partners.


Subfertility investigations and treatments
If you and your partner are experiencing some difficulty, you may wish to have an infertility assessment to uncover the cause of the problem. The basic evaluation can be completed within a few menstrual cycles in most cases and includes:

  • Medical history and physical examination
  • Ultrasound and hysterosalpingography
  • Semen analysis
  • Ovulation assessment
  • Laparoscopy may be used to diagnose and treat endometriosis, pelvic adhesions or ovarian cysts. The patency of the fallopian tubes can also be assessed.

Based on the results of these tests, treatments like ovulation induction, surgery to remove growths (polyps or fibroids) or adhesions, intra-uterine insemination (IUI) or in vitro fertilization (IVF Pregnancy) can be recommended.