Facts on Fertility

1 in 6 couples face fertility issues, which may be caused by a number of male or female factors.

Infertility is recognized by the World Health Organization as a disease of the reproductive system. It may be caused by a number of medical conditions, of which male & female factors can both contribute. However, it is sometimes not possible to explain the causes of infertility. Lifestyle factors may also contribute to subfertility, such as weight, smoking, caffeine consumption, alcohol consumption and exposure to environmental pollutants.

When do I need to consult?

Heterosexual couples whose female partner is below 35 years of age are recommended to consult after 12 months of unprotected sexual intercourse. When the female partner is older than 35 years, the couple is recommended to consult after 6 months of unprotected sexual intercourse.^1-5

Common Fertility Issues

There are two types of infertility: primary infertility (when someone has never conceived before and experience some difficulty getting pregnant), and secondary infertility (when someone has conceived in the past but experiences difficulty getting pregnant again). Male & female factors may both contribute to infertility, while for up to 25% of couples it remains unexplained.^6-9

Male factors

• Abnormal sperm or low sperm count
• Absence of sperm in the ejaculate
• Conditions affecting the delivery of sperm

Female factors

• Ovulatory dysfunction: problems with the monthly release of an egg
• Damaged or blocked fallopian tubes: preventing sperms from reaching the egg for fertilisation
• Endometriosis: disorder in which tissue similar to the lining of the inside of the uterus grows outside of the uterus
• Uterine, cervical or pelvic abnormalities

Fertility checklist

A complete fertility workup is key to identify the reason of infertility and then select the right treatment. Your doctor will first ask you some questions on your medical history and work to understand your sexual habits. You will then be prescribed a list of tests to understand if there are any underlying medical condition that may explain a subfertility.

Semen A semen analysis is a key test of the fertility workup. It measures the quantity and quality of sperm in the ejaculated fluid. For some men, more advanced procedures might be recommended: an ultrasound of the scrotum, genetic testing, testicular biopsy.

Ovaries & Ovulation Beyond your menstrual cycle history, an evaluation of your ovulatory function may include: a transvaginal ultrasound (imaging test during which a probe is inserted into the vagina to see your ovaries and the number of developing follicles*), a blood test to check your hormonal levels (Anti-Müllerian Hormone (AMH) showing your ovarian reserve, and the four hormones regulating your cycle: estrogen, progesterone, Follicle Stimulating Hormone (FSH), Luteinizing Hormone (LH)).

Fallopian Tubes An hysterosalpingography (HSG) is an effective solution to see if your fallopian tubes are open (patent). A clear fluid called a contrast medium is slowly infused into your uterus and your tubes, while x-rays images are taken. Depending on your medical history, alternative options might be proposed to you: a transvaginal ultrasound or a laparoscopy (a type of surgery during which small incisions are made in the abdominal wall to insert a small camera, allowing to see the inside of the pelvis).

Uterine Cavity An HSG is an effective solution for visualizing the uterine cavity. Depending on your medical history, alternative or complementary tests might be proposed to you: a transvaginal and/or pelvic ultrasound, an hysteroscopy (insertion of a small camera through the vagina into the uterus to view the inside of your womb) and/or a laparoscopy.

* Follicles are small bags in your ovaries that contain your eggs. Their count at the beginning of the cycle is an indication of your ovarian reserve.

Watch the webcast

The patient journey in fertility management

Embarking on your fertility journey: what are the considerations you should make? Dr. Edgar Mocanu (Ireland) & Kate Brian (Fertility Network UK)

Check your tubes: what is the place of HSG in fertility management? Prof. Anne Hemingway (UK) & Kate Brian (Fertility Network UK)

Your fertility testing is done, what are the next steps? Prof. Neil Johnson (New Zealand) & Mario Flos (Freya Netherlands)

Visit the HSG Benefits page for more about the procedure.

HSG Benefits

^{1. NHS (National Health Service). UK. 18/02/2020. www.nhs.uk/conditions/infertility}
^{2. Government of Canada. 28/05/2018. www.canada.ca/en/public-health/services/fertility/fertility}
^{3. CNGOF (Collège National des Gynécologues et Obstétriciens Français). France. 31/05/2016. www.cngof.fr/infertilite/322-la-consultation-le-bilan-les-causes}
^{4. Practice Committee of American Society for Reproductive Medicine in collaboration with Society for Reproductive Endocrinology and Infertility. Optimizing natural fertility: a committee opinion. Fertil Steril. 2017 Jan;107(1):52-58.}
^{5. Infertility Workup for the Women's Health Specialist: ACOG Committee Opinion, Number 781. Obstet Gynecol. 2019 Jun;133(6):e377-e384.}
^{6. NHS (National Health Service). UK. 18/02/2020. www.nhs.uk/conditions/infertility/causes}
^{7. ASRM (American Society of Reproductive Medecine). www.asrm.org/topics/topics-index/unexplained-infertility}
^{8. Practice Committee of the American Society for Reproductive Medicine. Evidence-based treatments for couples with unexplained infertility: a guideline. Fertil Steril. 2020 Feb;113(2):305-322.}
^{9. CNGOF (Collège National des Gynécologues et Obstétriciens Français). France. 31/05/2016. www.cngof.fr/communiques-de-presse/105-l-infertilite}