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Female & Male Infertility

Definition of Infertility

The American Society for Reproductive Medicine (ASRM), 2023, defines ‘‘Infertility’’ as a disease, condition, or status characterised by any of the following:

  • The inability to achieve a successful pregnancy based on a patient’s medical, sexual, and reproductive history, age, physical findings, diagnostic testing, or any combination of those factors.
  • The need for medical intervention, including, but not limited to, the use of donor gametes or donor embryos in order to achieve a successful pregnancy either as an individual or with a partner.
  • In patients having regular, unprotected intercourse and without any known aetiology for either partner suggestive of impaired reproductive ability, evaluation should be initiated at 12-months when the female partner is under 35-years of age and at 6-months when the female partner is 35-years of age or older.

Understanding Infertility

This affects millions of people worldwide, as well as approximately 1-in-6 Australian couples, highlighting its significance as a health concern Nationwide. Infertility can be attributed to factors involving either partner or a combination of both, and it requires comprehensive medical evaluation and management.

The aim is to have a holistic approach to the treatment.

LGBTQ+ couples also face unique challenges around accessing fertility and surrogacy options, as well as themselves often needing infertility evaluation prior to embarking on their fertility pathway of choice.

Causes and Specific Factors:

  • Ovulatory Disorders: Conditions like Polycystic Ovary Syndrome (PCOS), which is particularly prevalent in Australia, significantly affect women’s ability to ovulate normally.
  • Tubal and Pelvic Causes: Blockages in the fallopian tubes or conditions such as endometriosis can prevent eggs from being fertilised or reaching the uterus.
  • Age-Related Factors: Fertility naturally declines as women age, with a more marked decrease after the age of 35. This is due to a lower number and quality of eggs.

Statistics:
Female factors account for approximately 40% of all infertility cases in Australia. Issues such as ovulatory dysfunction and tubal damage are among the most common.

Causes and Specific Factors:

  • Genetic Factors: Certain genetic conditions like Y chromosome microdeletions and other chromosomal abnormalities can affect sperm production and function.
  • Lifestyle Factors: Smoking, excessive alcohol consumption, and obesity are known to negatively impact sperm quality and quantity. Occupational exposures to toxins and heat (excessively hot baths, showers, saunas) can also play a role.
  • Medical Conditions: Issues such as diabetes, cystic fibrosis, and infections like mumps can impair sperm production. Treatments for cancer, including chemotherapy and radiation, are also significant factors.

Statistics:
Research indicates that male factors alone are responsible for about 30% of all infertility cases in Australia. Issues with sperm production or function are the most common reasons for male infertility.

  • Heterosexual couples are advised to seek a fertility evaluation if they have not conceived after 12-months of trying, or after 6-months if the woman is over 35 years of age.
  • Individuals with known risk factors such as irregular menstrual cycles, previous pelvic surgeries, or known genetic issues should also consider earlier evaluation.
  • Same sex couples should seek help when they are ready to start a family together.

Your first appointment with Dr Mane is extensive, lasting approximately 1-hour. A detailed history of both partners is important. Please bring any reports from previous treatments with you if possible.

Assessment typically includes:

  • Medical and Sexual History: This includes discussions about the duration of infertility, menstrual history, lifestyle factors, and previous pregnancies.
  • Diagnostic Testing:
    • For Women:
      Pathology Tests: blood and urine. This is baseline investigations, AMH and infection screening.
      Pelvic ultrasound / hysterosalpingography (HSG): These are important investigations as they tell us about your anatomy, the antral follicles on the ovaries, uterine cavity and any fallopian tube patency.
    • For Men:
      Semen analysis is crucial and may be followed by hormonal profiling, genetic testing, or testicular biopsies, ultrasound if needed.
  • Infection Screening: An important part of the initial workup testing. Both partners are screened for infections like HIV, Hepatitis B &C, Syphilis, Rubella, Cytomegalovirus (CMV), Chlamydia, Gonorrhoea. This is to protect you and your baby, and to keep our IVF laboratory staff safe, as well as to screen for infections, given we handle gametes and embryos in the lab.
  • Reproductive Carrier Screening: In any pregnancy, there is a chance the baby will be born with a serious genetic condition, such as Cystic Fibrosis, Muscular dystrophies and Fragile X- Syndrome. The chance of this happening is low (typically 1.5% of babies).

    A reproductive carrier screen is a blood test of the parents. It looks to see if they carry genetic changes (mutations) that could cause certain genetic conditions in their child. The test is Medicare rebatable from November 2023.

    The extended genetic carrier screening test, test > 600 conditions is mandatory for couples using donor sperm or eggs. The test is done through Eugene. The results can take up to 4-6 weeks. This includes a genetic counselling consult, and a report to match your carrier result with the result of your chosen donor.
  • Counselling: Counselling is an important part of fertility treatment. It is strongly recommended that every patient should have at least one session of counselling. For patients using donor sperm or eggs, two counselling sessions are Mandatory. The counsellors are accredited counsellors who can see you on Zoom. For more details: https://www.cityfertility.com.au/fertility-services/support-services/counselling-services/

Dr Shree Mane provides a wide array of fertility medicine services, from initial assessments to advanced reproductive technologies (ART):

  • Ovulation Induction (OI): This is recommended for young women with only ovulation problem like PCOS. This can be the first line of treatment in some patients. Usually, your GP can initiate this treatment and monitor it. Usually, 3-4 cycles of OI can be attempted.
  • Intrauterine Insemination (IUI): Suitable for some types of infertility, this procedure involves placing thawed frozen donor sperm into the uterus around the time of ovulation. This is also offered to same sex couples (lesbians) using Donor sperm. The success rate of IUI is limited.
  • In Vitro Fertilisation (IVF): This involves multiple steps like stimulating the ovaries with injections to produce multiple eggs, at the same time downregulating to avoid premature ovulation. Once ready, the eggs are retrieved from the ovaries by a small procedure (trans-vaginally). The Embryologist then mixes eggs with sperm in the lab (IVF or ICSI). The best embryo on Day-5 is called a Blastocyst and is transferred into the uterus gently.
  • PGT-A: Pre-implantation genetic testing is available to select genetically normal balanced embryo for transfer in cases of recurrent implantation failure or to check the embryo for any known genetic condition. We will discuss this procedure in detail.
  • Egg freezing: This is a method of freezing your unfertilised eggs for future use. Many women may want to postpone childbearing for different reasons. Some women who unfortunately suffer from cancer or other genetic condition may want to freeze their eggs to be used later in life. Egg freezing involves a woman’s mature eggs being developed and removed using standard IVF treatment techniques. This process typically involves three stages of treatment: pituitary suppression, ovarian stimulation and egg retrieval
  • Complementary therapies: Yoga, Acupuncture, Meditation,Aromatherapy, massage are some of the complementary therapies. This should be discussed with us to know about pros and cons.

Conclusion

Infertility is a complex issue that affects many couples across the world. Understanding the causes and available treatments is the first step toward addressing this challenge.

With specialist support and advanced treatments, many couples can achieve their dream of parenthood. Whether you’re just starting to explore your options or have been trying to conceive for a while, professional guidance and care are key components of a successful fertility journey.

Dr Shree Mane is a Sydney Obstetrician and Gynaecologist, and Fertility Medicine sub-specialist with 30+ years of experience. She has achieved specialist registration in India, the United Kingdom and Australia.

She consults and operates across Western Sydney and offers Saturday appointments, as well as telehealth bookings.

If you have a question about a condition or treatment, or would like to book an appointment, please contact us and one of our friendly staff members will happily assist you.

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