Conception and Infertility – What You Need to Know
Navigating the complexities of conception and infertility can be challenging. In this insightful blog, Dr Simon Nothman sheds light on these important topics, helping you understand the process and the potential hurdles.
Conception is an amazing process that marks the beginning of pregnancy. It involves several biological factors working together, primarily the release of an egg from the ovary, its fertilisation by sperm, and the implantation of the resulting embryo in the uterus.
Navigating the complexities of conception and infertility can be challenging. In this insightful blog, Dr Simon Nothman sheds light on these important topics, helping you understand the process and the potential hurdles. This information aims to empower you with a clearer perspective on your reproductive health.
The Biology of Conception
- Ovulation: Ovulation is when a mature egg is released from one of the ovaries. This usually happens around day 14 of a 28-day menstrual cycle. As discussed in this blog article, it’s more complex than just this timing.
- Fertilisation: Conception happens when sperm travels through the cervix and uterus into the fallopian tube to meet the egg. This union forms a single cell called a zygote (also known as a fertilised egg or embryo), containing all the genetic information needed for a new human.
- Implantation: After fertilisation, the zygote divides and forms a blastocyst as it travels towards the uterus. Once it reaches the uterus, the blastocyst implants into the uterine lining, where it will grow and develop throughout pregnancy.
Understanding fertility
Fertility is the natural capability to produce offspring. On average, a fertile couple has about a 25% chance of achieving pregnancy in any given month, which rises to 85-90% over a year.
At its core, conception requires regular ovulation, healthy sperm, clear fallopian tubes to allow egg-sperm union, and a receptive uterine environment. Of course, having regular intercourse during the fertile window is key.
Additionally, for a healthy child, the embryo must have the correct number of chromosomes and be free of genetic diseases. (In in-vitro fertilisation (IVF), genetic testing can be done on embryos before implantation.)
Main causes of infertility
Infertility is defined as the inability to conceive after 12 months of regular, unprotected intercourse. About 15% of couples fall into this category. Among these couples, approximately one quarter of infertility cases can be attributed to the male partner, slightly more than a quarter to the female partner, another quarter to both partners, and the remaining cases remain unexplained even after a thorough evaluation by a fertility doctor.
- Ovulatory Disorders: Conditions like polycystic ovary syndrome (PCOS) can disrupt regular ovulation, making predicting fertile periods difficult.
- Tubal Factors: Blockages or damage to the fallopian tubes, (e.g. following past chlamydia, pelvic operations, endometriosis etc) can prevent sperm from reaching the egg or the fertilised egg from reaching the uterus.
- Male Infertility: Issues such as low sperm count, poor sperm motility, or abnormal sperm morphology can hinder the fertilisation process. These are discussed further in our post on semen analysis and male infertility. This category encompasses various causes, from mild sperm issues to complete absence of sperm in ejaculate.
- Uterine or Cervical Abnormalities: Structural issues like fibroids, polyps, or cervical problems can affect implantation and sperm movement. While these generally don't impair natural fertility significantly, they may increase miscarriage risk and lower success rates in fertility treatments.
- Unexplained Infertility: Sometimes, no specific cause is found despite thorough evaluation. This can be particularly frustrating for couples (and doctors!).
Diagnostic Testing for Infertility
Testing to assess causes of infertility varies based on medical history and specialist assessment. For heterosexual couples, typical tests include:
- AMH or Anti-Müllerian Hormone blood tests: Assessing hormone levels and ovarian reserve in the female partner.
- Pelvic ultrasound: Examining the health of the ovaries and uterus.
- Fallopian Tube Tests: HyCoSy or HSG tests to check for fallopian tube blockage.
- Semen analysis: Evaluating sperm count, motility, and morphology.
- Genetic Tests: Many fertility doctors will request a special blood test called karyotype for both partners.
- Genetic Carrier Screening: While not part of infertility testing, it's recommended alongside other tests.
Key takeaways
A couple of important take-away messages deserve repeating here:
- Fertility depends on both partners functioning well, and achieving it isn't always straightforward—many factors can affect natural conception, most of which aren't controllable.
- Causes of infertility can relate to issues in one or both partners' necessary functions, or sometimes no clear cause is identified.
- Infertility is common; you're not alone. With support, many couples navigate and succeed in this journey.
Understanding these fundamental aspects of conception and fertility can help couples make informed decisions and seek appropriate medical assistance when necessary. If you think you could benefit from a discussion of your fertility, please make a free appointment with one of our fertility GPs for a bulk-billed fertility assessment.
If you have been trying to conceive for more than 12 months and are under 35 years old, or for over 6 months and are over 35 years old, it might be time to book an appointment with a fertility doctor. Taking this step early can provide you with the insights and support you need on your journey to parenthood.
Don't wait—schedule your consultation today and take the first step toward understanding your fertility.
There is a lot of information available on infertility, we understand it might be overwhelming. To set your mind at ease and find out clear next steps, connect with our Fertility Concierge today.
Disclaimer: Please note that this is a Genea Group blog and as such information may not be relevant for all clinics. We advise that you consult clinics directly for further information.
Questions about your fertility challenges?
Please feel free to contact us at any time and one of our Fertility Concierge would be happy to answer your questions.
