Fertility

As with most areas of health, the way we live our lives can impact on how well our body functions. The most common lifestyle factors associated with reduced fertility are as follows:

Increased Female Age

The chances of achieving a pregnancy fall sharply after the age of 35 and 40 even though women may still be menstruating normally, the quality of her remaining eggs is reduced and the chances of conception are low. This is a limiting factor not only for normal conception but also in IVF.

A variety of test may be employed to give a better prediction of ovarian reserve than age alone.

Diet and BMI

Diet and BMI play an important role in the proper functioning of the male and female reproductive systems. Women who are overweight or underweight are less likely to conceive compared to those who have a BMI of 19- 30.

Smoking

Stopping smoking is advised for both partners. The carcinogens in cigarettes are harmful to sperm and egg and they reduce the overall chances of pregnancy

Alcohol

Alcohol intake can affect fertility. Whilst trying to convince, consumptions should be limited to no more than a few drinks a week for each partner.

Stress

Stress is believed to have a negative impact on the chances of conception. Doing whatever you can to be calm and relaxed during this difficult time is recommended.

Infertility is when a couple cannot get pregnant (conceive), despite having regular unprotected sex. Around one in seven couples may have difficulty conceiving. This is approximately 3.5 million people in the UK. About 84% of couples will conceive naturally within one year if they have regular unprotected sex.

A problem in any one of a number of key processes can result in infertility. Male and female factors can exist in isolation or combination fertility investigations, diagnoses and treatments should always be considered in the context of the couples.

Sperm problems will contribute to about 40% of infertility cases.  The normal working of the male reproductive system involves first the production of healthy spermatozoa and its delivery to be ejaculated. Key to the diagnosis of male infertility is a semen analysis, which assesses primarily sperm numbers, sperm movement and sperm form.

Dsyfunction of the female reproductive organs is also apparent in around 40% of infertile couples. The most common identifiable causes of female fertility problems are outlined below:

• Ovulatory dysfunction,(or anovulation) where an egg is not released from the ovary every month, is the single most common cause of female infertility. Predominantly anovulation is caused by hormonal imbalances such as polycystic ovarian syndrome (PCOS) but ovarian scaring and premature menopause can also result in failure to ovulate.
• Tubal disease, comprising anything from mild adhesions to complete blockage of the fallopian tubes, prevents fertilised eggs from travelling from the site of fertilisation to the uterus. It may also prevent the sperm from reaching the egg. Normal uterine implantation can therefore not occur. The main causes of tubal infertility are pelvic infections caused by bacteria such as Chlamydia, previous abdominal diseases or surgery and ectopic pregnancy.
• Endometriosis is characterised by excessive growth of the lining of the uterus. These endometrial cells can extend as far as the outside of the fallopian tubes, the ovaries and the bladder. As they respond to hormones the same way as they would do in the uterus.  Endometriosis can cause both fallopian tube and ovarian scarring.

The services offered at DVH are: 

• Female Test
• Male Assessment
• Follicular Tracking
• Uterine Cavity Check 
• Hyscosy

When ovulation (release of an egg by the ovary) is not occurring regularly, ovarian stimulation can be used to increase the chance of an egg being produced in a cycle. Your stimulated cycle is monitored by ultrasound and blood test. Couples will be advised when is the best time to have intercourse.

Tracking ovulation is the best way to identify the appropriate time to get pregnant.  Ovulation can be irregular or it can be affected by diet, stress or illness. Ovulation is triggered by a surge of Luteinising Hormone (LH) from the pituitary gland. LH also stimulates the ovary to begin producing the hormone Progesterone. This surge normally occurs 24-48 hours before ovulation and can be tracked more accurately with ultrasound and blood test.

A service to help couples with fertility problems is now available at Darent Valley Hospital.  HyCoSy or hysterosalpingo - contrast Sonography, is a simple and safe test used to look at the condition of the fallopian tubes in women with fertility problems.

The procedure is performed by inserting a ballooned catheter (small tube) into the uterus (womb) and slowly injecting contrast foam into the cavity. An ultrasound scanner is then used to see if the flow of the foam in the tubes is normal. The contrast foam makes the tubes stand out on an ultrasound examination.  Above all, other pelvic organs (uterus and ovaries) can be seen at the same time by this dynamic ultrasound examination, reducing the number of tests necessary to investigate infertility.

HyCoSy is the initial investigation to assess the status of the tubes, especially in women who do not suffer from pelvic pain or have a history of pelvic infection or repeated surgical operations. Before HyCoSy there were other procedures to assess the tubes. These procedures were expensive, involving radiation, dye, surgery/anaesthesia and hospitalisation. HyCoSy is less expensive, 30% cheaper, and relatively non-invasive in comparison.

Mr El-Sayed,  lead  consultant for fertility at the hospital said: “Straight after the procedure, I am able to discuss the results with the couple. This is very important as we can start further infertility management at the end of the test. This one-stop-shop approach helps to avoid undue delay or stress to the couple concerned.”

• British Fertility Society: http://www.britishfertilitysociety.org.uk/
• Human Fertilisation Embryology Authority: http://www.hfea.gov.uk/
• NICE Guidelines 2014: https://www.nice.org.uk/guidance
• Funding applications: http://www.infertilitynetworkuk.com/nhs_funding_2/nhs_funding_in_england