Infertility is something which happens to other people, isn't it? Actually, it's a surprisingly common problem, affecting at least 15 percent of couples.

Among these couples, 40 percent will have a combination of male and female infertility factors, while in only 20 percent will the man be the only partner responsible for infertility. About 40 to 50 percent of all infertility is due to problems experienced by the woman.

What causes infertility?

There are many reasons why a couple may be infertile. These range from disease, to drugs and lifestyle.

Some of the more common problems are:

  • Endometriosis:. This is a condition in which tissue from the endometrium (innermost lining of the womb), grows outside the womb, generally in the pelvis. These fragments of tissue, growing and behaving in the same way as they would if they were still in the womb, are one of the causes of painful periods and infertility. Scarring can occur on the ovaries or fallopian tubes, resulting in bands of tissue which prevent the eggs from traveling into the tubes where they are fertilised. This can be dealt with either by surgery, or by drugs.

  • Pelvic infections:. A leading cause of infertility in men and women is sexually transmitted diseases (STDs). Gonorrhoea and chlamydia are the most common infections which will lead to infertility. Many women who are infected with either disease have no symptoms, so do not seek treatment. If these diseases remain untreated, they can lead to scarring and damage of the fallopian tubes in women, and damage to reproductive structures such as the ejaculatory ducts in men.

  • Pelvic inflammatory disease:. This is an infection of the woman's upper reproductive system which can involve the fallopian tubes, womb and ovaries. It is sometimes caused by STDs, but can also happen after an abortion, or a D and C (dilatation and curettage). Infection after childbirth, and as a result of using an IUD can also cause this.

  • Female hormonal imbalances:. Some women have problems with their fertility hormones which can cause irregular ovulation and periods, or complete lack of ovulation. This is the major cause of female infertility, and can sometimes be successfully treated with infertility drugs.

  • Varicocele. This is the name of a common cause of infertility in men, describing varicose veins in one or both testicles. This is found in between 20 and 40 percent of infertile men. The condition raises the temperature of the testicles, which damages the sperm, but it is easily recognised and can be corrected surgically.

  • Prostatitis:. Prostatitis is an infection of the prostate gland, and a frequent cause of infertility in men. It often has no symptoms, but can be cured with antibiotics.

  • Caffeine:. Some research has shown that women who drink more than five cups of coffee daily take longer to fall pregnant. Caffeine may also cause defects in men's sperm.

  • Alcohol:. Alcohol increases the risk of miscarriage, and can also cause damage to the eggs before conception.

  • Smoking:. Chemicals in cigarette smoke kill sperm, so reducing a man's sperm count. Women who smoke also take longer to conceive, and have a higher chance of miscarriage.

  • Social drugs. Marijuana and cocaine may seriously reduce sperm count, and the ability of the sperm to swim (motility). They also increase the number of defective sperm.

  • Heat:. There is evidence that prolonged exposure to extreme heat, such as in a sauna or jacuzzi, produces high temperatures in the testicles, which negatively affects the sperm.

  • Extremes of weight:. Women who are very thin, or very overweight, often have problems ovulating.

Simple measures

Some of the possible causes of infertility listed above can be controlled. So, stop smoking, abstain from alcohol, and avoid saunas if you are a man.

There are studies which have shown that increased amounts of vitamin C can reverse some of the possible problems causing male infertility. Men who take more than 1000 milligrams a day were found to have increased sperm count, motility and longevity.

Men can try switching to underwear which doesn't hold the testicles quite as close to the body, since this warms the testicles.

Commercial lubricants can interfere with sperm motility, so try not using them for a while if you are having trouble conceiving.

What sort of doctor do you need?

Generally, people are told not to seek help until they have been trying to conceive for at least a year. However, there may be clues that ovulation is not happening, such as irregular or absent periods. A history of sexually transmitted diseases or cancer treatment, or being over the age of 35, may suggest that advice should be sought earlier than one year.

Start with your family practitioner or gynaecologist. They will often carry out some baseline tests which will suggest where you should go next. Both partners need to be evaluated.

If you do not have medical aid, and money is a problem, your nearest medical school will usually help, although they may advise a longer period without conceiving before seeking help, than a private specialist.

What tests to expect

Try and time your first visit to a fertility specialist to coincide with the first few days of your monthly cycle, so that you can start trying to get pregnant immediately.

Take all your medical records, and make a list of questions which you want to ask. Take along any charts you have been keeping of body temperature or frequency of periods.

Discuss the cost of the tests and possible treatment if you are going privately. Do this at the first consultation so that you have some idea what you are in for.

Your fertility specialist may want to carry out a number of tests. The most common are:

  • A sperm count and examination of the sperm for abnormalities.
  • Blood screening for blood type, full blood count, lipid levels, HIV and hepatits, as well as immunity to German measles (rubella), and thyroid function tests.
  • Bacterial cultures of your cervix (neck of the womb) to check for gonorrhoea and chlamydia, and other infections.
  • Ultrasound of your womb and ovaries. This may be done at different stages of your cycle.
  • Cervical mucous tests, which are done on the day you are most likely to have "fertile mucous". This includes a test done soon after you and your partner have had sex, to see if the sperm are alive and can pass through the mucous.
  • Hormone screening tests to see if you are producing normal levels of the various hormones necessary for fertility, and producing them at the correct time. Men will also be tested for hormones required for male fertility.
  • X-ray studies of your tubes and womb to see if there is any blockage, or other problem, which will prevent conception.

Possible treatment

There are many treatments which can allow a couple to conceive in many cases. However, there are people who will not ever conceive, whatever type of treatment is tried. Discuss all possibilities with your specialist.

Some of the more common treatments include:

  • Fertility drugs:. There are several drugs which can stimulate ovulation in women. Clomiphene citrate has been used since the 1960s, with a 75 percent success rate in stimulating ovulation, and a 35 percent success rate in promoting conception. It can be combined with other drugs. Human menopausal gonadotropin has a 90 percent ovulation-stimulation rate, and a 60 percent pregnancy rate. However, some 20 percent of women who fall pregnant using these drugs, have multiple births. Another treatment is with synthetic gonadotropin-releasing hormone, which is infused into the veins every 90 minutes for six to eight days each month. Different doses of some of the same medication can be used for men.

  • Microsurgery:. Surgeons can sometimes repair obstructed fallopian tubes, blocked male reproductive ducts or varicose veins in the testicles. Adhesions caused by endometriosis can also be removed.

  • Intrauterine insemination:. In this technique, infertility drugs are used to stimulate the release of several eggs at once, and then concentrated, motile sperm are placed directly into the womb. This treatment is particularly useful for couples with unexplained infertility, or for those in which the woman produces antibodies which attack her partner's sperm in the vagina.

  • Donor sperm banks. Donor sperm can be used if the man produces no, or only defective sperm.

  • Assisted reproductive technologies. There are many variations of high-tech methods by which sperm and eggs are combined to maximise the chances of pregnancy. All of the variations involve two steps, starting with the woman taking infertility drugs and producing multiple eggs which are then harvested under anaesthesia. The best known of these methods is in-vitro fertilisation (IVF), responsible for the so-called "test-tube babies". The eggs are harvested through the vagina, under ultrasound guidance, and are then fertilised outside the body in a culture dish. A few days later, the fertilised eggs, called zygotes, are placed in the womb. The success rate is about 17 percent. Variations of this technique are gamete intra-fallopian transfer (GIFT), and zygote intra-fallopian transfer (ZIFT). In GIFT the harvested eggs are mixed with the sperm and inserted directly into the the fallopian tubes, allowing fertilisation to occur naturally. The success rate is 27 percent. In ZIFT harvested eggs are fertilised in a culture dish, and then surgically placed in the fallopian tubes. The success rate is 23 percent. These techniques are only used in women who have functional fallopian tubes.