With most fertile couples it is possible to conceive within 12 months of regular unprotected sex. Of course, you may still become pregnant naturally, but it would be wise to seek advice.
To achieve pregnancy you must ovulate, have at least one functioning patent fallopian tube, produce watery mucus by the cervix near the time of ovulation that permits the ejaculated sperm to pass into the uterus from the vagina, and have a healthy womb with good lining (endometrium) that permits implantation of the embryo.
At the beginning of the menstrual cycle the pituitary gland in the brain releases a follicle-stimulating hormone (FSH) which stimulates the ovary to produce follicles. One of these follicles grows faster to become the “dominant follicle”. It is from this follicle that the egg will be released.
The follicles produce oestrogen which promotes development of the endometrium and progesterone, released after ovulation, which prepares the endometrium for pregnancy.
When the egg is released, it is picked by the fallopian tube and then fertilised in the outer third of the tube. The fertilised egg continues to the uterus to implant in the lining (endometruim) resulting in a pregnancy. If pregnancy does not take place, the endometium is shed as a menstrual period approximately 14 days after ovulation.
Ovulatory disorders occur as a result of hormonal imbalance either within the hypothalamus, the pituitary or in the ovaries. Common causes include stress, excessive changes in body weight and polycystic ovaries. Polycystic ovaries (POC) can affect up to 30% of women with infertility problems. The ovaries contain many tiny cysts, and women with PCO may experience menstrual irregularities, fertility problems, excessive body hair, acne and obesity. Treatment usually involves ovulation induction ± intra-uterine insemination (IUI). Laparoscopic ovarian drilling using diathermy or laser is an alternative treatment option.
Fallopian Tube Blockage may occur as a result of a previous infection or abdominal surgery complicated by adhesions. Accumulation of fluid in the tube (hydrosalpinx) may also become a source of chronic infection and inhibit fertility. Although some blockages may be treated surgically, IVF is often the best option.
Endometriosis is a condition where the tissue, which normally lines the uterus, is found at other sites in the pelvis. Bleeding occurs from these tissues at the time of menstruation causing pelvic pain and painful periods. Blood filled cysts may develop within the ovaries, causing pelvic scarring that affects the fallopian tubes and leads to infertility.
Treatment of endometriosis for infertility is surgical often key hole but recurrence of is common. IVF is a more appropriate treatment for most of the patients with endometriosis-induced infertility.
Unexplained infertility affects up to 25% of infertile couples. It is not always possible to determine if the eggs are actually released from the follicles, if the fallopian tubes are functioning or if the sperm is capable of fertilising the egg. Intrauterine insemination (IUI) offers a simple relatively non-invasive procedure. If pregnancy does not occur within three IUI cycles, alternative methods such as IVF ± ICSI should be considered.