What is infertility counselling?

From the moment we hit adolescence we begin to learn about reproduction, and not just the how, but also the why. We are taught about the worth and sense of fulfillment that can come hand in hand with having a family, so naturally we grow up believing that when the time comes for us to create are own descendants (if of course we wish to), we will be able to do so.

But what if the time comes and we are unable to conceive?

Infertility has been a source of sadness and despair since the earliest times, with stories of the emotional and social struggles of being unable to reproduce even appearing in the Old Testament.

Feeling that your body is suddenly working against you can be a very painful realisation, and on top of this you may then also be expected to make extremely difficult decisions regarding your future. Should you try again? Or is it time to start thinking of other ways to start a family?

So what is infertility? Infertility by definition, is a difficulty in conceiving despite having regular unprotected sex. There is no definitive cut off period after which a medical professional is able to say a couple is ‘infertile’, though statistics do suggest that the probability of a couple who have been trying to fall pregnant naturally for more than three years with no success is 25% or less.

Infertility statistics

According to NHS statistics, about one in six or seven couples may experience difficulties when trying to concieve, which means that around 3,500,000 are affected by the condition in UK.

However, whilst the number of individuals who experience problems is high, only 5% of the above figure are actually infertile. Statistics show that for every 100 couples attempting to fall pregnant naturally by having regular unprotected sex:

• 20 will fall pregnant within one month
• 70 will fall pregnant within six months
• 85 will fall pregnant within one year
• 90 will fall pregnant within 18 months
• 95 will fall pregnant within two years.

^{*These values are cumulative}

Although the statistics are encouraging, and increasingly better investigations and treatment mean that many individuals are able to overcome their fertility issues, for others, infertility often leads to isolation, loneliness and unfortunately a breakdown in relationships.

Infertility causes

There is no one definitive factor which causes infertility. According to the NHS, approximately one third of fertility problems are due to issues with the female, one third are down to problems with the male, and in up to 23% of circumstances doctors are unable to pinpoint a cause.

Infertility in women

Ovulation is vital to pregnancy, and without the monthly release of an egg there will be nothing for the male sperm to combine with. Failure to ovulate for whatever reason, is one of the most common causes of infertility and can occur as a result of a number of conditions:

• Polycystic ovary syndrome (PCOS)
  This is a condition that often inhibits the ovaries from producing an egg.
• Early menopause (POI)
  A women’s ovaries stop working before she reaches the age of 40.
• Thyroid problems
  An underactive or overactive thyroid gland can prevent the occurrence of ovulation.
• Chronic long term illness
  Some women who suffer from long term chronic illnesses such as diabetes, cancer or kidney failure may not ovulate.
• Cushings syndrome
  A hormonal disease that can stop the ovaries from releasing an egg.

Other possible causes of infertility in women include those listed below:

• Problems with the womb or fallopian tubes
  The fallopian tubes are essentially the pathway from the ovary to the womb, along which the egg travels whilst being fertilised along the way. When the egg reaches the end of its journey down the fallopian tubes, it is then implanted into the lining of the womb where it then grows and matures into a baby.However, if either the fallopian tubes or the womb are damaged, or indeed if they stop working, it may then become very difficult to conceive.

  Damage to the fallopian tubes or the womb can be caused by a number of factors. For example, pelvic surgery can sometimes scar the fallopian tubes, whilst cervical surgery can result in a shortening a the cervix (neck of the womb).

• Pelvic inflammatory disease (PID)
  This is an infection which occurs in areas including the fallopian tubes, womb and ovaries and is usually caused by a sexually transmitted infection (STI). The disease can damage and scar the fallopian tubes, thus meaning the egg is unable to travel into the womb.
• Endometriosis
  Endometriosis is a condition in which minute pieces of the womb lining begin to grow in other places, such as in the ovaries for example.The growth of this sticky tissue or cysts can lead to blockages and mishaping of the pelvis and can also distort the way in which the follicle releases the egg.

Male infertility

For men, the most common cause of infertility is abnormal semen, accounting for 75% of all male infertility cases.

There are a number of explanations for abnormal male semen, some of which can be found listed below:

• Low sperm count
  Some men have a very low number of sperm, or in some cases they have none at all.
• Low sperm mobility
  This is where the sperm has difficulty making its way to the egg.
• Abnormal sperm
  In some cases, sperm may be an abnormal shape which makes it difficult for them to swim to the egg and fertilise it.

Other causes of male infertility include:

• Testicles
  The primary role of the testicles is to produce and store sperm, meaning that if they are damaged this can heavily impact the quality of semen. Damage can occur through infection, congenital defect, testicular cancer, injury, surgery, a lump in the testicles.

• Ejaculation disorders
  When a man ejaculates or ‘comes’ during sex, the sperm then travels up the cervix to gain access to the main part of the uterus and into the fallopian tubes. However, problems with ejaculation often means that the sperm is unable to do this.

– Retrograde ejaculation is where the semen is ejaculated into the bladder, preventing it from taking the path it needs to in order to fertilise the egg.

– Premature ejaculation is when ejaculation happens too fast. This is a relatively common condition which in many cases may not be so premature as to prevent conception. However, in cases where a man ejaculates before enough semen is deposited into the vagina, the migration of sperm to the fallopian tubes may be difficult.

Factors affecting both sexes

Age

Unfortunately age works against us if we are looking to conceive, and as we age our fertility begins to reduce.

According to statistics, the biggest drop in fertility levels occurs during our mid thirties. For women who are aged 35, 95% will fall pregnant within three years of having regular unprotected sex. For women who are 38 however, this figure falls to 75%. Whilst fewer statistics exist with regards to male age and fertility, it is thought that men over the age of 35 are half as likely to achieve conception in comparison to men younger than 25.

Stress

Stress is a multi faceted aspect of conception. There is a growing body of evidence suggesting that stress does in fact have a direct impact upon fertility – limiting the production of sperm in men, whilst also affecting ovulation within females.

In addition, many experts are also warning couples attempting to conceive about the indirect impact of stress. Work stress for example, may have an effect upon partner relations, which can in turn lead to a reduction in libido which then leads to a reduced frequency of intercourse.

In addition, for couples who are desperately willing themselves to conceive, there is certainly a temptation to become an expert in the menstrual cycle, working out exactly when ovulation is occurring, keeping pregnancy tests stock piled in the bathroom and having sex like it is a military operation. To either one partner, or both, making love may begin to simply feel like a routine, and subsequently resentment and stress may set in.

Weight

Being outside of a healthy weight range can seriously impact fertility. Women who are overweight or severely underweight for example, will often find that their ovulation is effected, or in some cases it may stop entirely.