More in this section

Fertility | Our guide to Fertility Treatments

Fertility

The average pregnancy rate in a 25 year old couple with no pre-existing medical conditions is approximately 25% per month, at age 36 this drops to 15% and at age 40 this drops to 7%. 

In under 35’s after 1 year of trying (having regular unprotected sex every 2-3 days throughout your cycle), 85% of couples will conceive naturally; this rises to 95% within 3 years of trying. In couples over 35, 75% of couples will be pregnant within 3 years.

Types of fertility problems

In Ireland 1 in 6 heterosexual couples will experience problems with fertility. It is also worth mentioning that some couples can develop secondary infertility, where they have had one or more previous pregnancies and are now having difficulties getting pregnant.

Fertility can be affected by a multitude of factors such as age, weight, sexually transmitted infections, smoking, alcohol, stress and exposure to chemicals or drugs. Medical conditions such as thyroid disease, diabetes, mumps and chemotherapy can also affect fertility.

Causes of infertility

Male factors account for 40% of infertility, female factors account for another 40% and in 20% of cases no cause is found. This is important to state as in many cases people assume it is a female only issue when in fact it may be a male or female issue or a combination of both. For this reason in a heterosexual relationship both the man and woman should go for testing together. A good point of contact would be your local GP. This is obviously not relevant if you are single or in a same sex relationship, then you should go straight to a fertility clinic to see what options you have regarding egg or sperm donation and surrogacy.

Heterosexual couples under 35 years of age should see their GP or fertility clinic if they have been trying for one year without getting pregnant. Couples over 35 years should see their GP or fertility clinic after 6 months of trying.  The GP can do a physical exam, order blood tests, STI screens and semen analysis. One blood test the GP can order for women looks at AMH (Anti-Mullerian Hormone) - this hormone is produced by cells in follicles within the ovaries. The AMH level can give an indication of remaining egg reserve for women, but again it is important to state this is only an indication and women with low AMH can still get pregnant.

Men can have problems with libido, erectile issues or ejaculation disorders. Hormonal factors such as tumours, hypogonadism and chromosomal conditions can also impact fertility, along with previous infection with mumps or STI’s. Most commonly, male factor infertility is caused by a problem with sperm quality. Sperm concentration may be low (oligozoospermia) or absent (azoospermia), they may not be mobile meaning they cannot reach the egg (asthenazoospermia) or they may be abnormal in shape where they cannot penetrate the egg (teratozoospermia).

Women can have issues with ovulation (PCOS, hypothalamic dysfunction, hyperprolactinaemia, early menopause), tubal problems (Pelvic inflammatory disease, previous ectopic pregnancy or pelvic surgery) or uterine problems (polyps, tumours, endometriosis, cervical stenosis or uterine abnormalities).

Fertility treatments

Lifestyle advice:  It is recommended that all women of child bearing age in Ireland should be taking Folic acid 400mcg, certain groups of women should be prescribed Folic acid 5mg dose by their Doctor (history of neural tube defects or epilepsy). Women and men trying to conceive should minimise consumption of alcohol, stop smoking and drug use. Women who are under weight or overweight (BMI’s over 29 or under 19) and men who are overweight (BMI over 29) are more likely to have reduced fertility.

Treatment options depend on investigations and the cause of infertility: patient age, physical examination and findings from such, blood results and semen analysis.

  • Drug therapy for hormonal imbalances- this varies depending on the issue involved.
  • Ovulation induction- This treatment option is used for women who have irregular ovulation or no ovulation. Medication used are oral drugs and include: Clomifene, Tamoxifen and Letrozole, among others such as injections, they stimulate the ovaries to produce follicles.
  • If ovulation induction fails or is not an option for the couple, they can move onto Intra-Uterine Insemination- this involves direct transfer of sperm into the uterus, placing sperm near the eggs for fertilisation. This may not be a suitable option for every couple and some couples will go directly to IVF.
  • IVF- In-vitro fertilisation involves collecting eggs from the ovaries (this can be from the person wanting to get pregnant or donor eggs) and a man’s sperm (which can also be from a donor). The eggs and sperm are combined in a Petri dish and hopefully fertilise. The sperm can also be injected directly into the egg (Intracytoplasmic sperm injection-ICSI). Embryos are graded by an embryologist and the highest quality embryos are implanted into the uterus. Embryos can be transferred immediately into the uterus (fresh transfer) or frozen, stored in the clinic and transferred at a later date.

When it comes to your fertility, seek treatment promptly. If you are over 35 or have known issues (such as endometriosis) seek help after 6 months, if under 35 then 1 year. Of course you can seek advise prior to these timelines, if you so wish. It is also important to know that fertility treatments are not guaranteed and only increase a patient’s chance of having a baby. Fertility treatments are also associated with risks including over-stimulation of the ovaries, miscarriage, ectopic pregnancy, infections in the pelvic region and multiple pregnancies.

In general both treatment and medicines used for infertility are very expensive- before undergoing treatment every person (any partners or dependent children under 23 and in full-time education) should apply for the Drugs Payment Scheme- on www.mydps.ie. This scheme is currently capped at €80 per calendar month for medicines prescribed by your doctor and covered under this scheme. Please check with your Pharmacist, if your medicines will be covered under this scheme.

Going through infertility can be very tough on your mental and emotional well being. It can feel like an isolating and lonely journey. There are many support groups on Facebook and Instagram to link in with people going through similar situations. Most fertility clinics will also provide counselling and support groups for couples and individuals. Your GP can also help you if you feel you are suffering with your mental health.

The National Infertility Support and Information Group provide zoom meeting for members; they also have a live chat feature and a phone line for help and advice. All available at:  www.nisig.com

Philip McGorisk

Supervising Pharmacy

Close

POP-IN HTML goes here

Close

Your Basket

Your basket is currently empty