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When should we consult a doctor about fertility?

The odds of having a baby

Pregnancy is a result of a complex combination of factors and events. Even when everything works perfectly, conception can take time – and luck.

A healthy 30-year-old woman has about a 20% chance in a given month to get pregnant.¹ Theoretically, about 90% of couples can expect to conceive during the first year of attempting to become pregnant.²

However fertility declines with age. After the age of 35, women experience physiological changes, which contribute to a significant decline in fertility.³

Infertility is defined as the failure to achieve a successful pregnancy after twelve months or more of regular unprotected intercourse.⁴
After the age of 35 medical evaluation may be warranted after six months.⁴

If you have concerns, a good way to start is by talking to your doctor. You may also consider seeing an obstetrician/gynaecologist, a urologist, or a fertility specialist such as a reproductive endocrinologist or an andrologist.

Your medical history

In certain circumstances, you should also seek specialist advice if you think your medical history could stand in the way of achieving pregnancy.

Find out more about the kinds of medical conditions that affect fertility.

About one in ten couples experience difficulties conceiving.² The majority of couples who see the treatment through eventually succeed.⁵ Read more about treatment pathways.

Setting out in unison

Deciding to seek medical advice may seem like a big deal – an admission that something’s not quite right. But it’s actually a step towards realising your dream to have a baby. That has to be a positive step!

Before making a medical appointment it’s important you discuss your fertility plan as a couple. Agree on what action to take. Conception difficulties are just as likely to affect men as they are women. Male infertility is the primary diagnosis in approximately 25% of cases and contributes to a further 15–25% of the remaining cases.⁶

Scientific advances over the past three decades have helped millions of men and women overcome problems with fertility. Treatments are achieving unprecedented results. Depending on the underlying cause, many relatively simple procedures are available.

^{1. Age and Fertility. A Guide for Patients. ASRM 2003;www.asrm.org/Patients/patientbooklets/agefertility.pdf 2. Boivin J et al, International estimates of infertility prevalence and treatment seeking: potential need and demand for infertility medical care. Hum Reprod. 2007;22: 1506-1512. 3. Age and Fertility. A Guide for Patients. ASRM 2003; www.asrm.org/Patients/patientbooklets/agefertility.pdf 4. Definitions of fertility and recurrent pregnancy loss. Fertil Steril 2008;90:S60. 5. Pinbourg A et al, Prospective longitudinal cohort study on cumulative 5-year delivery and adoption rates among 1338 couples initiating infertility treatment. Hum Reprod.2009;24: 991-999. 6. Collins J.A. Evidence-based infertility: evaluation of the female partner. International Congress Series 2004;1266: 57–62.}

Urologist

A medical specialist dealing with the treatment of the urinary tract and urogenital system.

Uterus

A pear-shaped organ also known as the womb that supports the developing foetus throughout pregnancy. The uterus consists of: the cervical opening, the cervix and the uterine cavity. The two fallopian tubes open into the uterus.

Ultrasound

A medical imaging technique used instead of X-rays to view the reproductive organs and monitor the development of follicles.

Obstetrician/Gynaecologist

A doctor who delivers babies and specialises in the treatment of female reproductive organs.

Oestrogen

A hormone that stimulates secondary female sexual characteristics and controls the course of the menstrual cycle. Oestrogen is also produced in low quantities in males.

Oligospermia

A condition when a sperm sample contains less than 20 million spermatozoa per ejaculate. Many medical conditions reduce sperm concentration. The effects may be temporary or permanent. See also Azoospermia.

Outpatient

A Person undergoing a clinical procedure that does not require admission to hospital.

Ovarian failure

The failure of the ovary to respond to hormonal stimulation from the pituitary gland because of damage to or malformation of the ovary, or a chronic disease such as autoimmune disease or ageing process.

Ovarian follicle

The structure in which eggs are nurtured to maturation. Although in general only one egg is released at a time, somewhere between 10 and 20 follicles begin the process of maturation monthly. The excess ovarian follicles are reabsorbed before ovulation occurs.

Ovulation

The release of the matured egg or ovum from the ovarian follicle.

Ovum

A matured egg.

Ovulation Induction (OI)

Medical treatment carried out to initiate ovulation.

Ovarian Hyper Stimulation Syndrome

A condition characterised by enlargement of the ovaries, fluid-retention and weight gain. May occur when the ovaries are over-stimulated during assisted reproduction.

Ovaries, Ovary

Almond-sized organ(s) located on either side of the uterus, which produce and release mature egg cells and the hormones oestrogen and progesterone.

Ectopic pregnancy

A pregnancy in which the embryo implants outside the uterus and cannot be sustained.

Ejaculate

The seminal fluid discharged upon male orgasm, which helps transport sperm.

Egg retrieval

A procedure used to obtain eggs from ovarian follicles for use in In Vitro Fertilization. Retrieval may be performed during a laparoscopy procedure or via the vagina using a blunt syringe and with the aid of an ultrasound to locate the follicle in the ovary.

Embryo

The early stages of foetal growth from conception to the eighth week of pregnancy.

Embryo transfer

The process whereby an embryo is transferred into the uterus after the egg has been fertilized outside the body during a laboratory procedure.

Embryologist

A specialist involved in the various aspects of assisted reproduction laboratory procedures related to sperm, oocytes and embryos.

Endocrinologist

A medical specialist concerned with the study of hormones and infertility, having first trained as an obstetrician/gynaecologist.

Endometrial biopsy

The removal of a sample of the lining of the uterus for examination.

Endometriosis

A condition whereby cells that normally line the uterine cavity grow outside the womb, for example in the fallopian tubes, ovaries, or even the bladder or intestines. The cause is largely unknown. Scarring from endometriosis may cause conception difficulties.

Endometrium

The lining of the uterus, which is shed during the menstrual cycle. If conception takes place, the embryo implants itself into the rich vascular membrane, which nourishes the developing foetus.

Epididymis

A tightly coiled tube located above the testicles or testes, where sperm mature for fertilization.

Cervical mucus

A natural lubricant produced by the female body that aids the transportation of sperm and helps protect against infection.

Cervix

The cervix or neck of the uterus is the lower, narrow portion of the uterus where it joins with the top end of the vagina.

Chlamydia

A sexually-transmitted infection, which may be asymptomatic or cause genital inflammation and discharge, pelvic pain and fever. Untreated, chlamydia can lead to Pelvic Inflammatory Disease (PID) and fertility problems.

Chromosomes

Structures found in the nucleus of cells that contain genes and carry heredity information, such as eye colour, blood type and vulnerability to disease. Humans have 23 pairs of chromosomes. One set of 23 chromosomes is inherited from the biological mother via her egg and the other from the biological father, via his sperm. Each sperm cell contains either male or female sex chromosomes. As such, it determines the gender of the foetus. Genetic abnormalities occur when an individual is born missing a chromosome or has more copies of a chromosomal pair.

Clomiphene citrate

A prescription drug used to bring on ovulation. It comes as a tablet and is often used as an initial treatment for women with ovulation problems. Clomiphene citrate induces ovulation in 80% of women who have trouble ovulating on their own.

Conception

The moment of fertilization when the sperm meets and penetrates the egg.

Congenital abnormalities

Physical abnormalities present at birth.

Corpus luteum

A hormone-secreting mass within the ovary that forms from the remains of a follicle each time an egg is released. The hormones it produces prepare the uterus for embryo implantation. If pregnancy does not occur, the mass is shed during menstruation.

Cryopreservation

A technique used to store human tissue at very low temperatures. Embryos that are not used in an ART cycle may be preserved in this way for future use. Also known as “Freezing”.

Cryptorchidism

A condition usually detected at birth or childhood whereby the testicles fail to descend. When a male foetus develops in the uterus, his testicles normally form inside his abdomen and descend into the scrotum shortly before birth. Undescended testicles usually descend themselves by the sixth month of life, but are unlikely to descend after this period of their own accord.

Amenorrhoea

The absence of a menstrual period in a woman of reproductive age. Physiological states of amenorrhoea are seen during pregnancy and breastfeeding. Outside the reproductive years, there is an absence of menses during childhood and after menopause. See also premature menopause.

Andrologist

A medical specialist who deals with male health, particularly relating to the problems of the male reproductive system and urological problems unique to men.

Artificial Insemination (AI)

Procedure whereby sperm are deposited via the vagina into the cervix or uterus using a catheter. The technique is used to transfer donor sperm or to overcome problems with sexual performance, the interaction between sperm and mucus, or the quality of sperm.

Assisted hatching

A procedure whereby a small hole is drilled in the protective membrane of the embryo using a laser device or a dilute acidic solution to assist hatching and aid implantation.

Assisted Reproductive Technologies (ART)

A variety of procedures used to bring about conception without sexual intercourse, including In Vitro Fertilisation (IVF), Gamete Intra-Fallopian Transfer (GIFT) or Zygote Intra-Fallopian Transfer (ZIFT), Intracyto-plasmic Sperm Injection (ICSI), Microsurgical Epididymal Sperm Aspiration (MESA) and Testicular Sperm Extraction (TESE).

Autoimmune disease

A disease where the body attacks its own cells due to an overactive immune response.

Azoospermia

A complete absence of sperm in the semen. See also Oligospermia.