6A couple may have problems with infertility if they have not been able to conceive after 12 months of regular sex without contraception. It is a common problem, affecting at least 1 in 8 couples at some time in their lives. While infertility can often be treated, it is important to seek medical attention as quickly as possible as the fertility rate of the woman decreases with age, regardless of the treatment. The reasons for infertility could be due to either the male factor, the female factor or a combination of both. Thus, it is important to evaluate as a couple and not just the woman as commonly, albeit erroneously, believed.
A thorough medical history from the couple is vital. For the man, usually a semen analysis to assess the sperm count, morphology (shape and structure) and motility (ability to swim) is required. For the woman, hormonal tests will be needed to check for ovulation. A gynaecological ultrasound can exclude major abnormalities of the uterus and ovaries like fibroids and ovarian cysts respectively. The patency of the fallopian tubes is another important test in the work-up for infertility. Depending on the clinical situation, this can be done either via hysterosalpingography (diagnostic imaging with dye) or laparoscopy (key-hole surgery).
Depending on the cause of infertility, the treatment can range from simple advice on timing of intercourse, use of fertility drugs with timed intercourse to surgery to unblock the fallopian tubes or to remove fibroids and cysts. Assisted conception like intra-uterine insemination (IUI), in-vitro fertilisation (IVF) or intracytoplasmic sperm injection (ICSI) may be recommended when deemed necessary.