Sometimes, "giving it time" and letting nature take its course is sufficient to achieve a pregnancy.
Often however, the problem is medical in nature and there are effective treatments available.
About 1 in 6 couples worldwide have a fertility problem and millions of babies are born as a result of assisted reproduction techniques.
At least 1 in 2 couples who seek fertility treatment will have a child.
Most couples should consult a doctor after a year of trying to get pregnant.
If the woman is over the age of 35 and has not conceived after 6 months of trying or has an irregular cycle, it is recommended that she visit the Gynaecologist sooner.
In some cases (eg age > 40 years old, history of gynaecological problems, etc), a constultation with the Gynaecologist is suggested as soon as the couple decides to have a baby.
The male partner’s fertility should also be evaluated, seeing as male infertility occurs just as frequently as female infertility.
In about 40% of infertile couples, the cause can be attributed to the male partner.
In another 40% of infertility cases, the woman may have one of the following problems:
• Irregular ovulation, eg polycystic ovaries
• Blocked fallopian tubes
• Abnormalities in the cervix or the uterus
In the remaining 20%, the cause cannot be found with the usual screening tests (unexplained or idiopathic infertility).
In some cases, bad timing is the primary obstacle when it comes to conceiving.
To find out when you ovulate (and to determine the best time for sexual intercourse), you may use an ovulation kit, which detects the increase of LH which occurs 12-36 hours before ovulation. If the test never yields a positive result, consult your doctor.
You may also use the Gynaecology & Fertility Centre's ovulation calculator.
Irregular ovulation occurs in about 1/3 of all infertility cases.
If you are diagnosed with an ovulation problem, fertility drugs may help.
The most common choice is Clomiphene Citrate, a relatively cheap and effective drug.
Approximately 50% of all women taking Clomiphene become pregnant, usually within 3 cycles. It should not be administered for more than 6 months. Clomiphine increases the chances of a multiple pregnancy because it causes the release of many oocytes.
If no pregnancy occurs within 6 months of taking clomiphene, your Gynaecologist may recommend fertility hormone injections.
A wide range of fertility drugs is available, which is particularly effective in stimulating ovulation.
About 1 in 2 women who ovulate become pregnant. As in the case of Clomiphene, injectable hormones increase the likelihood of multiple pregnancy.
Very often the cause of infertility can be traced to the fallopian tubes because scar tissue (adhesions) prevents the egg from descending to the uterus.
This scar may be due to endometriosis, pelvic infections or previous surgical procedures. In some cases, there is no clear cause.
Laparoscopy may, under certain circumstances, remove the scar tissue in the reproductive tract and increase the chances of getting pregnant naturally. It should be mentioned that women with tubal factor infertility bear an increased risk of ectopic pregnancy.
Blocked fallopian tubes
Ιntra-Uterine Ιnsemination (IUI) is a popular solution for a wide range of fertility problems.
Sperm is placed directly into the uterus during the time of ovulation.
IUI is often carried out in combination with fertility drugs to stimulate multiple, but controlled, ovulation.
It is considered a simple procedure which, in certain cases, has a success rate of 20 – 25% per cycle.
Intra-Uterine insemination (IUI)
IUI may be carried out with donor sperm, should the male partner be completely sterile.
It has very high success rates in fertile woman with the overall pregnancy rate reaching 80%.
IUI with donor sperm
IVF is recommended when other treatments are unsuccessful and, in certain cases, is the first treatment option (eg tubal factor, severe oligozoospermia, advanced age of woman, etc).
The steps included are: fertility drugs for ovarian stimulation, egg retrieval, fertilization in the lab and embryo transfer to the patient's uterus.
Two weeks after egg retrieval, a pregnancy test measures the hormone β-HCG in the blood.
IVF is a complex, time consuming and expensive procedure that requires a team of well qualified Reproduction Specialists and state-of-the-art equipment.
The success rates range between 35-40%.
The chances of success depend on many factors, one of the most important of which is the woman's age.
In Vitro Fertilization (IVF)
When the sperm count or motility is significantly low, fertilization of an oocyte is not possible, even with conventional IVF.
ICSI achieves fertilization by placing a spermatozoon directly into the interior of the oocyte.
Today, in the majority of IVF cycles, ICSI is preferred as it increases fertilization rates and, in addition to severe male factor, is the technique of choice in cases of poor ovarian response, women >40 years old, previous fertilization failure, etc.
Intra-Cytoplasmic Sperm Injection (ICSI)
Women above 40 years old, women with poor quality oocytes or multiple IVF failures may choose to use donor eggs.
If the process is successful, the patient will carry a baby that is biologically related to her partner and will be able to experience pregnancy, childbirth, breastfeeding, etc.
In Greece there is clear legislation regarding IVF using donor eggs, aiming to protect the stakeholders from a medical and ethical perspective.
IVF with donor eggs
To maximize the chances of IVF success, 2-3 embryos are usually transferred to the uterus in Greece.
Therefore, a woman may become pregnant with twins or, in rare cases, triplets.
A multiple pregnancy increases the risk of miscarriage, anemia, hypertension and other complications during pregnancy.
It also increses the risk of preterm labour.
Couples undergoing IVF should discuss these issues with their doctor.
IVF and multiple pregnancy
Embryos are usually transferred into the uterus when they reach the stage of 2-8 cells (2-3 days after egg retrieval).
When transferred at the blastocyst stage, the embryos are cultured in the laboratory for 5 days.
One or two blastocysts are then selected for transfer, thus eliminating the possibility of triplets while maintaining a high success rate.
IVF and blastocyst transfer
Couples who haven''t been able to conceive with IVF treatment recommended to them so far, may choose to use donor embryos.
In this case, other couples have given written consent to donate their surplus embryos to infertilte couples.
If successful, this procedure allows the couple to expeirence pregnancy, labour, breastfeeding, etc. but the baby will not be biologically related to either parent.
Surrogacy is an option for women who, for various reasons, are not able to conceive and/or carry a pregnancy to term.
In conventional surrogacy, the surrogate is inseminated with the partner's sperm. Today, however, most couples choose gestational surrogacy, in which the surrogate becomes pregnant by transfering an embryo created via IVF treatment (using the eggs and sperm from the infertile couple) and she is therefore not the biological mother.
If the procedure is successful, the baby will be biologically related to the subfertile couple.
You can boost your fertility with some simple lifestyle changes.
If you smoke, quit. Smoking reduces both male and female fertility and has a documented impact on pregnancy rates after IVF treatments. Smoking also increases the irsk of miscarriage and complications during pregnancy.
A healthy diet is important and, in some cases, supplements and vitamins are recommended. There is evidence that certain vitamins, minerals and anti-oxidants may boost fertility in men and women.
Women are encouraged to take Folic Acid, while trying to conceive naturally or with the aid of assisted reproduction techniques.
Natural methods of boosting fertility
Holistic therapies, when applied in combination with conventional medical techniques, are often effective in the treatment of many diseases, ranging from asthma to headaches.
Many subfertile couples use such methods during their fertility treatment.
Scientific reports demonstrate that acupuncture improves sperm quality, the flow of blood to the uterus, ovulation and, in general, increases the success rates of IVF.
Holistic therapies (acupunture, yoga, etc)
Should fertility treatment be repeatedly unsuccessful it may become an unbearable burden – physically, emotionally and financially - therefore, it may be time to consider other alternatives.
A Fertility Therapist can help you and your partner explore other options.
Many couples find satisfaction in life without children. Others choose to adopt.
An integrated Assisted Reproduction Unit can guide you in all the options available.