What is Infertility?

Infertility is the medical term used to describe the condition of being unable to conceive a pregnancy, after a year of unprotected sexual intercourse. Other definitions include failure to contribute to conception or the woman being unable to carry the pregnancy through to full term.

There are two types of infertility:

• Primary
• Secondary

Primary infertility is the name given to the condition in which pregnancy has never occurred.

Secondary infertility refers to a couple who have had a successful pregnancy before but are unable to conceive again. Even after trying for a year or more.

Many people assume that infertility is a ‘woman’s problem’, but the reality is that a great many men experience problems to do with male fertility. In fact statistics show at least 20% of infertility cases are to with male infertility.

Research findings show that just over 50% of all infertility cases are a result of female infertility.

Around 20% of cases are to do with male infertility.

Around 30 to 40% of cases are to do with both male and female infertility.

Advances in medical technology and an increased understanding of the issues surrounding infertility have resulted in a greater awareness of the subject. Plus there is now a realisation that it affects men as well as women.

It is important to bear in mind that 85% of couples achieve a successful pregnancy, although this percentage starts to decrease with age. The older a woman is the less likely she is to conceive.

Pregnancy statistics

The Human Embryo Fertilisation Authority (HEFA) state that only 20% of all couples achieve pregnancy in the first month. This means that it can take quite a few ovulation cycles before a pregnancy is achieved. But, even after a year of trying, around 10% will still be unsuccessful.

And the chances of becoming pregnant vary for each cycle and with age. We have already mentioned that your chance of pregnancy decreases as you get older and this is even more noticeable after the age of 35. And, your risk of a miscarriage increases as well.

The best time to become pregnant is between the ages of 20 to 25. This drops slightly for women aged between 25 to 30 but then starts to drop quite rapidly after the age of 35.

So, you basically have a better chance of conception under the age of 35.

However, there is an increasing trend for women to delay pregnancy until they are older. Many women prefer to become established in their careers before thinking about starting a family. Or they prefer to wait until they have found the right partner.

Society has changed in its attitude to the woman’s role with the result that many women choose to ‘have it all’ but the question is does it come at a price?

The biological clock

There is evidence to show that in spite of all these cultural changes, nature has not changed in regard to a woman’s biological clock. The biological clock is used to refer to the monthly ovulation cycle in which a mature egg is released from the ovaries. If this egg is successfully fertilised by a sperm then pregnancy will occur. If not then this unfertilised egg and the lining of your womb is released in the process called menstruation (also known as a ‘period’).

Every woman is born with a lifetime’s supply of eggs within her ovaries but these are gradually used up over a period of time during the monthly ovulation cycle. And this is more noticeable the older a woman gets. This is why you often hear women talking about the ‘ticking of their biological clock’ especially as they approach their 40th birthday!

Men also have a biological clock and this can ‘tick’ in much the same way as a woman’s. The ability to conceive can drop once the man reaches his late thirties or forties which may be due to DNA damage in sperm. This can contribute to the increase in miscarriages after the age of 35 and reduce the chances of a successful pregnancy.

Basically, men are less fertile once they reach their 40th birthday.

Women have a chance of becoming pregnant right up until the menopause but the reality is that your chance of doing so decreases past the age of 35. In fact, your risk of infertility increases each year past your 35th birthday.

There are women who become pregnant in their forties or fifties but there are risks with doing so. To start with there is an increased risk of a miscarriage which can be as high as 1 in 2 for women over 40.
This does happen the older you get so it is something to bear in mind if you are looking to delay motherhood.

To give you more of an idea of this risk here are some statistics on age-related miscarriages (general guide only):

• Women in their 20’s have a 10% chance of miscarriage
• Women over 35 have an 18% chance of miscarriage
• Women aged 45 or more have a 50% chance of miscarriage

Other risks include birth defects, preeclampsia, premature birth, high blood pressure and diabetes.

The main reason for this is the ageing process: your ovaries age along with the rest of your body which means that your eggs become less fertile. And this can result in ‘chromosomal abnormalities’ in which a defective gene is passed down to the unborn child.

Examples of birth defects include Down’s Syndrome and Turner’s Syndrome.

However, none of this means that an older woman cannot conceive; it just means that it is more difficult to do so. There are a range of tests which can be performed to determine a woman’s reproductive capacity. These tests assess hormone levels and the function of the ovarian follicles (sacs which contain cells found in the ovaries) to determine the level of supply of eggs within the ovaries.

The higher the number of remaining eggs in your ovaries the greater your chance of conception.

These tests include the day 3 FSH (follicle stimulating hormone) test and the Oestriadol test.

These are discussed in more detail in our Fertility Tests section.

Apart from the issue of age there are many other factors which can contribute to this condition and sometimes it is difficult to separate fact from fiction! This is an emotionally distressing condition to start with so the last thing you want to hear is a load of old wives tales!

A few of the more common ‘infertility myths’ are discussed on the next page.