Infertility in men and women: Key insight from an expert

In this detailed and informative article, revered consultant gynaecologist Mr Laxmikant Chaudhari sheds light on common causes of fertility problems in men and women and the most important factors affecting a couple’s ability to conceive. The highly respected specialist in fertility investigations also shares his expertise on the key lifestyle changes women can make to increase the likelihood of conception and the various treatment modalities available.

What are the common causes of infertility in men and women?

As laymen, people tend to feel that fertility is a problem pertaining to women, but that is not really true. Generally, we see that most cases of infertility may be related to men. In the United Kingdom, thirty per cent of cases for fertility referral are for male infertility.

In fact, male infertility is the most common reason for a fertility referral as opposed to common misconception that these issues are usually woman centric. The distribution in the causes of infertility is:

• thirty per cent: male factor, relating to sperm problems
• twenty per cent: anovulation, relating to problems with ovulation egg production
• twenty per cent: tubal factors, including damage to fallopian tubes due to sexually transmitted infections or pelvic inflammatory disease (PID)
• twenty per cent: unexplained

Unexplained causes of infertility relate to both partners and include cases where the couple undergoes all types of investigations, but the results are found to be normal although the couple has not been able to conceive. There are other rare causes of infertility, which account for a further five to ten per cent of the overall distribution, such as endometriosis and genetic reasons, but these are few and far between.

How does age affect female fertility?

Age is the single most important determinant for a woman’s fertility. Ageing is a process which affects the quality of the eggs and this becomes an issue over time and there is a steep decline in the quality of the eggs for any woman after the age of thirty-five years.

By the time a woman reaches the age of forty, she will have lost ninety per cent of the eggs she was born with. Eggs are like a finite pool which every woman is born with and throughout her reproductive lifetime, these are gradually lost. Therefore, age plays the single most important role in fertility status for any woman.

What are the different assisted reproductive technologies available for couples struggling with infertility?

There are certainly many options available but we start with the basics. This involves advising couples about doing simple things like folic acid and vitamin D supplementation to optimise the chance of conceiving.

We also counsel patients about a healthy lifestyle, including stopping smoking and recreational drug use, as well as limiting caffeine intake and reducing alcohol consumption to only two to three units a week. Maintaining a healthy body weight is also important and we recommend adhering to NICE guidelines and a BMI of between 18 and 30 in order to optimise a woman’s chance of fertility. Following standard fertility advice, we would expect that the majority of couples would conceive without intervention.

For couples who struggle to conceive in spite of all these efforts, there are certainly options available. In cases where anovulation is a problem (where a woman is not ovulating), we can certainly help the woman by giving fertility medication in the form of Letrozole or Clomiphine, which can induce ovulation and the chance of conception, which may not be happening naturally because of erratic cycles.

If there is a sperm problem, the couple will require IVF because this will bypass the problem of the inability of the sperm to fertilise the eggs. This treatment involves a process called ICSI, or intracytoplasmic sperm injection, where we harvest eggs and inject the sperm into the egg. Other problems, which may be age related or relate to a tubal factor, are also generally treated using IVF.

To summarise, the options according to hierarchy are:

• lifestyle changes
• optimising the likelihood of conception with medication like folic acid and vitamin D
• treatment with Letrozole in cases where there is a ovulation problem
• treatment with IVF if the problem is unexplained tubal factors
• treatment with ICSI if there is a sperm problem

Which lifestyle change can help increase chances of conception?

Lifestyle changes recommended for increasing the chances of conception include maintaining a healthy body mass index (BMI), which is between 18 and 30. It has been noted that having a low BMI (less than 18) can affect fertility adversely. Similarly, being overweight will also affect the fertility hormones and can stop you from conceiving.

Intense exercise of any form is harmful from a fertility viewpoint because it suppresses fertility hormones, there we advise against any more than three hours of intense exercise in a week. Additionally, giving up caffeine and recreational drugs, as well as limiting your alcohol consumption to two to three units a week go a long way towards optimising your success with natural conception as well as any fertility intervention.

What is the success rate of in vitro fertilization (IVF)?

In the best possible cases, the success of IVF would be somewhere around forty per cent and even up to fifty per cent in a perfect scenario. However, the success of IVF depends on a woman's age and her egg reserve, and these factors will play the single most important role in the chances of conceiving.

It’s important to note that IVF never has a hundred per cent chance of success, so it would be wrong to consider that treatment of this type is always going to work. We need to be realistic that even in a perfect situation, the embryos which are produced from IVF or even naturally may not be a hundred percent viable.

We tend to quote the best possible success rate at around forty per cent but it will be less if there are issues with age or egg reserve, as these are the most important determinants in terms of the treatment working. It’s only when we investigate a couple thoroughly and we have all the parameters in front of us, that we will be able to advise them on the chance of the treatment working in their individual case.

Mr Laxmikant Chaudhari is a highly respected consultant gynaecologist who specialises in fertility investigations with over twenty five years of experience. To schedule a consultation with Mr Chaudhari, visit his Top Doctors profile today.