Infertility is a difficulty in becoming pregnant. Delays in getting pregnant (conceiving) are often quite normal but despite this it often causes a lot of distress to the couple. For couples having regular sex the chance of getting pregnant after one month of trying is approximately 30%, 75% after six months, 85% after one year and 90-95% after two years. About 1 in 7 couples will have an unwanted delay in getting pregnant.
Is it time for investigations?
Generally, investigations are offered to couples who having been trying to conceive for over one year. However, for some people, earlier investigations are appropriate. It is reassuring to know that even after one year of trying to conceive half of couples will conceive naturally in the following year without treatment.
Common causes of fertility problems
Problems with ovulation (egg production in the woman) account for 1 in 3 cases of subfertility. There are many causes:
- Hormonal problems
- Polycystic ovarian syndrome
- Being underweight or overweight
- Chronic illnesses e.g. diabetes
- Excessive exercise
Problems with the womb, cervix or fallopian tubes account for 1 in 5 cases. Causes include:
- Scarring e.g. previous surgery or pelvic infection
- Large fibroids
Problems with your partner's sperm account for 1 in 5 cases. Causes include:
- Anatomical problems
- Side effects of some drugs
UnknownIn approximately 1 in 3 couples no cause will be found.
Investigations and treatment
After a detailed consultation ideally with the couple together we will arrange appropriate investigations and where possible offer advice and initial treatment if required. As mentioned above, half of couples being investigated for difficulty conceiving will actually conceive in the year following referral. Early pregnancy scans can be arranged for reassurance following successful conception should the couple wish. For couples requiring assisted fertility techniques appropriate referral can be made to the centre of choice and all investigation results will be forwarded to ensure continuity of care.
Miscarriage is unfortunately common and occurs in up to 3 out of every 10 pregnancies. Most miscarriages (70-80%) occur in the first 12 weeks of pregnancy. The vast majority of women who miscarry go on to have a successful pregnancy the next time they conceive.
What are the symptoms?
The most common symptoms of miscarriage are bleeding and abdominal cramps in early pregnancy. The amount of bleeding can vary from spotting to heavier bleeding with the passage of clots. In some cases women do not have any symptoms and the miscarriage is diagnosed during an early pregnancy ultrasound scan.
Common causes of miscarriage
Most miscarriages are caused by a genetic problem with the developing pregnancy. The faults are usually a one-off problem rather than something that is likely to happen again. There are many other less frequent causes of miscarriage. It is important to realise should a miscarriage be diagnosed that lifting that heavy box, being stressed or having sex has not caused the miscarriage and it is very likely nothing could have prevented it happening.
Diagnosis of miscarriage
A miscarriage is usually confirmed following an
ultrasound scan, often an internal (trans vaginal) ultrasound scan is required. Occasionally a scan may need to be repeated approximately a week or so later to be 100% sure of the diagnosis. Occasionally, a blood test (Beta HCG) can be of use in confirming the outcome of the pregnancy.
Management of miscarriage
Some early pregnancy miscarriages will 'come away' without the need for any medical treatment; usually associated with increased bleeding and cramps for a short period of time and then a reduction in the bleeding after the miscarriage is complete. Medical treatment with tablets or surgery are sometimes offered following assessment.
I have had a miscarriage, do I need investigations?
Most women who miscarry will not miscarry again. Investigations are generally only carried out if a couple miscarry three times in a row.
The Miscarriage Association may be helpful either at the time or in the months that follow.