The Facts About Infertility – Q & A

When should you start asking questions about fertility? 

• A woman younger than 35 should ask for a fertility evaluation if she and her partner have not been able to conceive after one year of trying (unprotected intercourse). 
• If the woman is older than 35, she and her partner should seek evaluation if they have not been able to conceive after six months. 

What is the prevalence of infertility? 

• Infertility has been recognised as a public health issue worldwide by the World Health Organisation (WHO). 
• One in every four couples in developing countries is affected by infertility. A WHO study, published at the end of 2012, has shown that the overall burden of infertility in women from 190 countries has remained similar in estimated levels and trends from 1990 to 2010. 
• One in six couples worldwide experience some form of infertility problem at least once during their reproductive lifetime. 
• The current prevalence of infertility lasting for at least 12 months is estimated to affect between 8–12 % worldwide of women aged 20–44 
• 20–30 % of infertility cases are explained by physiological causes in men, 20–35% by physiological causes in women, and 25–40 % of cases are because of a problem in both partners. In 10–20 % no cause is found. 
• Infertility is also associated with lifestyle factors such as smoking, body weight and stress. 
• Increasing age in the female partner is one of the most common reasons for infertility today. 

How does age affect a woman’s fertility? 

A woman’s age is one of the most important factors affecting whether she is able to conceive and give birth to a healthy child. This is due to several changes that are a natural part of ageing: 

• The number and quality of eggs (ovarian reserve) decreases naturally and progressively from the time a woman is born until the time she reaches menopause. This decline is gradual until her early 30s but accelerates quickly after her mid-30s. 
• It is not only more difficult to get pregnant, but miscarriage and chromosomal abnormalities in the child (such as Down syndrome) are more common in older mothers. 
• Fibroids, endometriosis, and tubal disease are more common and can affect fertility. 
• Women who become pregnant at an older age have a higher risk of complications during the pregnancy, such as gestational diabetes and preeclampsia (high blood pressure). 

How does age affect a man’s fertility? 

• The decrease in a man’s fertility appears to occur later in life than in a woman’s fertility. In their mid-to-late 40s, men experience changes in their sperm that can cause issues with fertility and chromosomal/developmental problems with offspring. 

What other factors can cause a decline in fertility? 

If you have any of the following risk factors, you may consider seeking advice early: 

• Family history (mother or sister) of early menopause (before age 51) 
• History of cigarette smoking in either partner 
• Previous ovarian surgery 
• Exposure to chemotherapy or radiation to treat cancer in either partner 
• Shortening in the time between periods 
• Skipped or missed periods 
• History of injury to the testicles 
• Exposure to toxic chemicals (certain pesticides or solvents) 
• If a couple has an obvious medical problem affecting their ability to conceive, such as absence of periods (amenorrhea) or irregular periods, sexual dysfunction, a history of pelvic disease, or prior surgery, they should begin the infertility evaluation immediately. 

How is the quality of eggs and sperm tested? 

• The number and quality of your eggs (ovarian reserve) can be estimated using blood tests for follicle stimulating hormone (FSH) or antimüllerian hormone (AMH) levels. 
• An ultrasound is sometimes used to count the number of follicles (antral follicle count [AFC]). 
• There is no single test that measures ovarian reserve perfectly. 
• During semen analysis, a man’s ejaculate is examined to measure the number, shape, and movement of sperm. 

Is it possible to slow down or undo reproductive ageing? 

• No. However, eating well, exercising regularly, getting enough sleep, avoiding smoking, and adopting a lifestyle that reduces stress can improve your overall health. 
• Studies suggest that smoking, diet, and stress may have an impact on the quality of eggs/sperm and may accelerate menopause. 
• However, improved health does not offset the natural age-related decline in female fertility, which can take place much sooner than most women expect. 
• Sperm is being made continuously and takes about 3 months to mature. 
• Changes in lifestyle and exposure can show in the quality of sperm within a few months. 
• Unlike men, a woman is born with all her eggs, so there are no methods/treatments to grow more or new eggs or preserve the quality of those eggs that remain. 
• That is why it’s important to talk about family planning with a healthcare provider even if you are not thinking about getting pregnant right away. This might decrease the chance of having difficulties later. 

What medical options are there for improving fertility? 

• There are medical strategies that can improve the chance of conceiving, focusing on getting the egg and sperm together at the best time for conception to occur. 
• These strategies can include “washing” sperm, intrauterine insemination (IUI), in vitro fertilisation (IVF), or taking fertility medications. 
• These approaches may be helpful, but they cannot reverse the natural ageing process of the egg or sperm. 

What is in vitro fertilisation? 

• In infertile couples where women have blocked or absent fallopian tubes, or where men have low sperm counts, in vitro fertilisation (IVF) offers a chance at parenthood to couples who until recently would have had no hope of having a “biologically related” child. 
• In IVF, eggs are surgically removed from the ovary and mixed with sperm outside the body in a Petri dish. After about 40 hours, the eggs are examined to see if they have become fertilised by the sperm and are dividing into cells. These fertilised eggs (embryos) are then placed in the woman’s uterus, thus bypassing the fallopian tubes. 
• IVF currently accounts for more than 99 % of Assisted Reproductive Technology (ART) procedures. 

What other fertility treatment options are available? 

• Men and women who want to delay having a child until their late 30s or early 40s may consider methods to preserve their fertility. One way is to freeze sperm, eggs, or embryos. 
• In men, sperm collection is usually a quick, non-invasive, simple process and cryopreservation of sperm is well established. 
• A woman must undergo egg retrieval like in IVF. Embryo freezing is well established and generally more successful than freezing unfertilised eggs, but it requires that the woman have a male partner or use donor sperm. 
• The only other option for men and women who are already infertile is to use sperm, eggs, or embryos donated by another man, woman, or couple. Using donated gametes or embryos makes the chance of successful pregnancy the same as for the person who donated the gametes. 

For more information about fertility, it’s important to speak to your healthcare provider or a fertility specialist early to plan for your future reproductive health. Visit: www.merckfertilityjourney.co.za for further detailed information or to find a fertility clinic near to you. 

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