Struggling to get pregnant

12:0AM, Apr 26th 2012

Why aren't we pregnant yet? Here are some common reasons why

Waiting for a positive test result can be a stressful time (AAP)

What should be a happy time for couples can become incredibly stressful as they fail to fall pregnant

One in six Australian couples experience infertility – defined as taking longer than 12 months to conceive for those under 35 and six months for over 35s.

The age of peak fertility for both genders is from their late teens to early 30s. The following chart of the fertility-age link is an average estimate of the likelihood of conception where both partners in a couple are the same age, after one year of unprotected intercourse:

Age 20: 90 percent
Age 30: 70 percent
Age 35: 55 percent
Age 40: 45 percent
Age 45: 6 percent

Causes of infertility are many and varied and involve both the male and female or a combination of factors.



Low sperm count
A low count can be caused by blocked tubes, exposure to toxins, chronic disease or over-heating of the testes. But a poor count doesn't necessarily mean infertility – it may just mean that it takes longer than average to conceive.

Abnormal sperm
A healthy sperm has a long, whipping tail that helps it swim through the female reproductive system. Sperm with poor motility may swim poorly or not move at all. Abnormally shaped sperm may also have problems penetrating the surface of the egg.

Hormonal problems
Healthy sperm creation relies on the pituitary gland producing testes- and follicle-stimulating hormones. If the pituitary gland isn't releasing enough of these hormones, the production of sperm will be impaired. Underactive or overactive functioning of the thyroid and adrenal glands can also have a negative impact on sperm. Blood tests will show if this is an issue.

Defective genetic material
Research has shown men who have fertility problems have a high number of sperm with broken or damaged DNA, the molecular chain that makes up a gene. DNA damage makes it harder to conceive. Lifestyle changes, such as an improvement in diet, reducing exposure to toxins and taking a vitamin supplement aimed at improving sperm quality, such as Menevit, can help.

Functional problems
The most significant functional problem that can contribute to male infertility is impotence, the inability to achieve or maintain an erection. There are many treatments out there for impotence — some good, some terrible – so it's best to shelve the embarrassment and consult a GP if this is a problem.



Ovulation issues
This generally refers to problems with releasing a mature egg from the ovaries once a month. Erratic or no ovulation can be due to hormonal problems, a disturbance in the pituitary gland, chronic illness, or being either excessively underweight or overweight. If a woman's menstrual cycle is all over the place, this may be a sign that ovulation is a problem. Treatment to stimulate ovulation usually involves fertility drugs.

Polycystic ovarian syndrome 
When a woman ovulates, her ovaries produce small follicles which ripen to release an egg. But for a sufferer of polycystic ovarian syndrome (PCOS), the follicles fail to ripen, forming little ovarian cysts. This results in unpredictable ovulation patterns and irregular periods, making pregnancy more difficult. PCOS affects about 10 percent of women with fertility problems. Fertility drugs or IVF may be options for PCOS sufferers.

Blocked tubes
Blocked or damaged fallopian tubes could either prevent sperm reaching the egg or stop the fertilised egg making its way to the uterus. Tube damage can be the result of pelvic inflammatory disease, previous surgery or an ectopic pregnancy. Treatment may involve surgery to open the tubes and IVF if surgery is unsuccessful or the tubes are too badly damaged to repair.

Poor quality eggs
In some cases, ovulation occurs, but the eggs may be damaged or have chromosomal abnormalities, so a pregnancy can't be sustained. While there are no outward signs to look for in terms of egg quality, age is a significant factor. A woman is born with her entire egg supply of around two million immature eggs, and only around 400 will ever mature. As she ages, the quality of her eggs diminishes.

This is a condition where cells from the lining of the uterus (the endometrium) grow in other parts of the pelvic area, such as the fallopian tubes, ovaries and abdomen, which can in turn lead to fertility problems. Endometriosis is often treated with surgery to remove the abnormal tissue or unblock tubes. Fertility drugs or IVF may also be options.


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