DEFINITION OF INFERTILITY

The inability of a couple to conceive a pregnancy after one year of unprotected sexual intercourse
PRIMARY VS. SECONDARY INFERTILITY
In primary infertility, pregnancy has never occurred. In secondary infertility, one or both members of the couple
have previously conceived, but are unable to conceive again after a full year of trying

HYPOFERTILE & STERILE INFERTILITY

Hypofertile couples have trouble conceiving quickly. Their fertility may be less than ideal or they may be
having problems with timing, but they can eventually conceive without special treatment. For example, the man
might have a low sperm count, or the woman might have endometriosisroadblocks, but not brick walls.
Sterile couples won't be able to conceive without medical or surgical treatment. For example, the man might
not create enough sperm to fertilize an egg, or the woman might have blocked fallopian tubes.
HOW IS INFERTILITY DIAGNOSED?
A complete medical history and a physical exam are the first steps in diagnosing a fertility problem. Both
partners need to be evaluated. The couple may also need blood tests, semen specimens from the man, and
ultrasound exams or exploratory surgery for the woman.
HOW IS INFERTILITY DIAGNOSED IN A WOMAN?
If a woman has an infertility problem, she will be referred to a doctor who specializes in reproductive
endocrinology. Her diagnostic tests may include:
Blood tests and urine tests to check hormone levels.
A Pap smear to study the health of the cervix.
Urine tests to evaluate LH surges.
A basal body temperature test, which checks whether the woman is releasing eggs from her ovaries. A
woman's temperature rises slightly during the days she ovulates. The woman will chart her basal body
temperature every day for a few months on a graph. She will take her temperature orally or may take
her temperature vaginally with a special ultra-sensitive thermometer available at most drugstores.
An endometrial biopsy, in which the doctor removes a piece of tissue in the uterine lining. Examining
this tissue will tell the physician whether eggs have been released and whether the corpeus luteum is
producing enough progesterone. This test is often done if the results from the woman's basal body
temperature chart are unclear.
An ultrasound to look for fibroids and cysts in the uterus and ovaries. This test uses sound waves to
picture the uterus and ovaries, causes little discomfort, and is very effective.
A postcoital test, in which the doctor takes a sample of mucous from the woman's vagina. She must have
the test during her fertile days and within 12 hours after she and her partner have sex. The test will tell
the doctor if the man's sperm can survive in the woman's cervical mucous.
More complex tests include:
A laparoscopy: If the doctor suspects ovarian or fallopian tube scarring or endometriosis, a woman
may undergo a laparoscopy. The doctor makes two small incisions at the pubic bone and navel, and
carbon dioxide gas is injected into the stomach to enlarge it.
Then the doctor inserts a laparoscope, a long tube with lenses and a fiberoptic light, into one incision
and a long probe through the other opening in the skin. With the probe, the doctor can view the ovaries,
fallopian tubes and uterus to check for scar tissue. In some cases, he may cut away scar tissue
discovered during this operation.
The woman usually has to undergo general anesthesia for the procedure, but the risks of bleeding,
infection and reaction to the anesthesia are slight.
A hysterosalpingogram: This test checks the condition of the woman's fallopian tubes.
The doctor clamps the cervix and injects a needle filled with dye into the woman's uterus. An X-ray is
taken to determine whether the dye passes through the open ends of the fallopian tubes. If the dye
emerges from the end of the tubes, they are not blocked.
The test may also reveal other fertility problems, such as fibroid tumors, structural abnormalities and
endometrial polyps. In some cases, the dye actually clears away blockages in the fallopian tubes, and
restores the woman's fertility.
The dye is harmless and is absorbed by the woman's body after going through her tubes. The test may
be uncomfortable, but is rarely painful. Unfortunately, it is noted for both false positive and false
negative diagnoses.
HOW IS INFERTILITY DIAGNOSED IN A MAN?
The tests for male infertility are fairly simple and easy. After a medical history and an examination, the man's
sperm are tested. He'll be asked to ejaculate into a cup and this specimen will be evaluated. The man should not
ejaculate for several days before he takes the test, because each ejaculation may reduce the sperm count.
Health workers will check the man's semen for several factors:
sperm count (20 to 100 million sperm is the normal number)
movement
maturity and shape of the sperm (which reveal its quality)
the amount of sperm produced (one teaspoon is sufficient)
acidity (the semen should be slightly acidic)
The man may be asked to undergo this test twice, because some illnesses such as infections or viruses can affect
the sperm. If a man has abnormal sperm, he'll be referred to a fertility specialist, where he'll experience more
tests, such as:
Hormonal blood tests.
Imaging tests that check for swollen veins or reproductive system blockages.
A testicular biopsy. This is a procedure done in the office. The doctor takes bits of tissue from the testes,
and this tissue is examined to see whether the cells that produce the sperm are working properly.
Anti-sperm antibody tests, which check whether the woman's mucous rejects the man's sperm. These
tests also show whether the man produces antibodies to reject his own sperm.
A hamster egg test, which studies the sperm's ability to penetrate a hamster egg. The outer covering of
the egg is removed to allow the sperm to more easily penetrate. This test cannot result in a living
embryo. It's expensive, however, and sometimes unreliable.
A human zona penetration test, which tests whether the man's sperm can fertilize dead human eggs.
Again, this test cannot result in a living embryo, and is thought to be more reliable than the hamster egg
test.
A bovine cervical mucous test, which checks whether the sperm can penetrate cervical mucous taken
from a cow.
TYPES OF INFERTILITY IN WOMEN
The most common causes of infertility seen in women are:
Illness - Certain diseases, such as diabetes, kidney disease or high blood pressure may cause infertility. Ectopic
pregnancy and some urinary tract infections may also elevate the risk of infertility.

Medications - Many medicines, such as hormones, antibiotics, antidepressants, and pain killers may bring on
temporary infertility. Commonly used medications such as aspirin and ibuprofen can also impair fertility if
taken mid-cycle. Acetaminophen (Tylenol) pills can reduce the amount of estrogen and luteinizing hormones in
the body, impairing fertility.
Premature Menopause - Some women may experience premature menopause, when their ovaries stop
producing eggs. Often the cause is excessive exercise or anorexia.
Surgical Complications - Scar tissue left after abdominal surgery can cause problems in the movement of the
ovaries, fallopian tubes, and uterus, resulting in infertility. Frequent abortions may also produce infertility by
weakening the cervix or by leaving scar tissue that obstructs the uterus.
Immune System Problems - Women may develop antibodies or immune cells that attack the man's sperm,
mistaking it for a toxic invader. Certain autoimmune diseases, in which the woman's immune cells attack
normal cells in her own body, may also contribute to ovarian problems.

Luteal Phase Defect - In a luteal phase defect, a woman's corpus luteum - the mound of yellow tissue produced
from the egg follicle - may fail to produce enough progesterone to thicken the uterine lining. Then the fertilized
egg may be unable to implant.
Fibroids - Fibroids, or benign growths, may form in the uterus near the fallopian tubes or cervix. As a result,
the sperm or fertilized egg cannot reach the uterus or implant there. Fibroids in the uterus are very common in
women over age 30.
Ovulation Disorders: A very fine balance of various hormones such as estrogen, progesterone, luteinizing
hormone, follicle-stimulating hormone is required to timely ovulate (release of egg from the ovary). The main
cause of ovulation disorders is hormone imbalance. Low levels of progesterone can cause interference in the
adhesion of the embryo to the uterine lining. It also increases the risk of a miscarriage. High levels of estrogen
are also associated with infertility in women.
Ovarian failure Ovarian failure can be a consequence of medical treatments (for ovarian tumours for instance),
or the complete failure of the ovaries to develop or contain eggs in the first place (for example, Turner's
Syndrome).The treatment for ovarian tumours may involve surgical removal of all or part of the ovary. Ovarian
failure can also occur as a result of treatments such as chemotherapy and pelvic radiotherapy for cancers in
other body areas. These therapies destroy eggs in the ovary.
Endometriosis: It refers to a condition where the uterine lining doesn't form normally. It grows outside the
reproductive tract causing fallopian tubes to become blocked. These blockages cause infertility in almost 10%
of infertile women. In advance cases of endometriosis, the forward movement of sperm are blocked due to
adhesion between fallopian tubes, ovaries and uterus. This results in infertility. Studies have indicated that the
eggs of women with endometriosis are more likely to have genetic abnormalities than those who do not have
the disease.
Uterine and Cervical Disorders: Benign growths such as fibroids on the uterine wall can interfere with the
attachment of embryo to the wall of the uterus and thereby cause problems in conception.
Abnormalities in cervix shape or change in the texture of cervical mucus can make the movement of sperm
from vagina to uterus extremely difficult.

Ageing :Age is a critical factor affecting a woman's fertility woman. In our society many women choose to delay
having children. Some of the common reasons for this include education and career demands, financial stability,
second marriages/relationships and waiting for a suitable partner.
Reproductive function declines as a woman ages, particularly after the age of 35. Women are born with a finite
number of eggs, unlike men who produce sperm most of their adult life. In the years approaching menopause,
there are fewer and fewer eggs left in the ovary. The quality of eggs also diminishes as a woman gets older.
When a woman is in her late thirties, there is an increase in chromosome abnormalities that can result in birth
defects like Down syndrome.
Ageing can also affect other reproductive organs and functions, such as the uterus, hormone production, and
ovulation. There is also a higher incidence of miscarriage in women in their late thirties.
Infertility treatments cannot reverse the ageing process and should not be thought of as a safeguard that will
ensure a pregnancy at some point in the future. The success rates of IVF for women over 35 are much lower
than for younger women.
Polycystic ovaries: Polycystic ovaries contain lots of small cysts, making the ovary larger than normal. The
condition, called polycystic ovarian disease (PSOD), is also associated with high levels of androgen and
estrogen. Women with PSOD have irregular periods and may not ovulate, resulting in infertility.
Immunological factors: The presence of antibodies to sperm in cervical mucus can cause infertility. In other
cases, the mother's immune system prevents the embryo from attaching to the wall of the uterus and so causes
a miscarriage.
Fallopian tube damage: It is in the fallopian tube that fertilization takes place, after the egg is released from
the ovary into the tube and is met by sperm. Full or partial blockage of the fallopian tubes will prevent
fertilization taking place.
Fallopian tubes can be damaged by inflammation that results from viral or bacterial infections, some types of
sexually transmitted diseases, or complications of surgery such as adhesions or scarring.
MALE INFERTILITY
Sperm defects
A low sperm count is the most common cause of male infertility. Abnormalities in sperm shape or their ability
to swim can also cause infertility problems. These can be due to hormonal imbalances, infection, or testicular
varicocele.
A total absence of sperm (known as ' azoospermia') in the ejaculate can be caused by testicular damage,
mumps, anatomical disorders, or lack of hormones.
Immunological factors
Some men produce antibodies to their own sperm, which prevent the sperm from penetrating the egg. The
exact cause is not known but may be due to infection or vasectomy.
Spermatic cord occlusion
The spermatic cord is the tube that transports the sperm from each testis to the penis and any blockages will
cause infertility. Common causes are vasectomy, infection and some sexually transmitted diseases.
Ejaculation disorders
Some ejaculation disorders such as retrograde ejaculation where the semen is ejaculated backwards into the
bladder can prevent proper transfer of sperm into the vagina without the man being aware of the problem.
Under-developed testes-usually arising after a mumps infection, a hernia surgery, an injury or birth defect.

Swollen veins in the scrotum.

Undescended testes-a problem often present from birth in which the testes remain in the body cavity.
Normally they descend into the scrotum before birth.

Infections, such as gonorrhea or tuberculosis, that block the ducts through which the sperm travel.

Injury to the testicles

Chronic prostate infections
Ageing
Until recently, ageing was considered a risk factor only for female fertility. However, recent research shows
ageing affects sperm function too. Sperm that swim in a straight line have a far better chance of making their
way through the female reproductive tract to reach the egg. But the swimming ability of a man's sperm declines
as the man ages. The older a man gets the greater the chance of genetic abnormalities in the sperm itself.
UNEXPLAINED INFERTILITY
In approximately ten per cent of couples, both partners may appear fine but are still unable to become
pregnant. While it is easier to treat couples where the cause of infertility is obvious, couples with unexplained
infertility can also be treated
HOW IS INFERTILITY IN A WOMAN TREATED?
After the physician has determined possible causes of the infertility, a course of treatment can then be planned.
Sometimes simple instructions, like knowing when having sex is most likely to produce a pregnancy, are all that
is needed. In many cases, medications are indicated, while in other cases, the woman may require surgery or
other forms of treatment.
If medications are unhelpful or surgery is not appropriate, other specialized techniques will be offered.
Medications can help solve hormonal problems and ease infections in women with fertility problems. Surgery
to repair reproductive organs may also resolve a woman's infertility.
WHAT MEDICINES TREAT FEMALE INFERTILITY?
If the woman isn't producing eggs, often she can be helped with fertility drugs. Fertility drugs are fairly safe,
although some researchers have voiced concern that they may increase the risk for ovarian cancer. Several of
the most recent studies, however, have found no increased risk of ovarian cancer and suggest that the drugs
may even protect against cervical cancer. Fertility drugs include:
Clomiphene: This drug triggers the release of FSH and LH, boosting egg growth and helping the ovaries release
a monthly egg. The drug is considered safe, is fairly inexpensive, and carries less risk of multiple births than
other drugs. Women who have polycystic ovary syndrome or menstruate irregularly apparently benefit most
from this drug. Sixty percent of women on clomiphene successfully ovulate, and about 30 percent of women
become pregnant in the first three months of being on the drug. Side effects may include nausea, insomnia,
breast tenderness and headaches.
Bromocriptine: This drug suppresses a hormone called prolactin, which, if released in excessive amounts, may
cause a woman to stop ovulating. Ninety percent of women on bromocriptine release eggs while on the drug.
It's considered fairly safe, but side effects may include nausea, dizziness, headaches and low blood pressure.
Human Menopausal Gonadotropins (HMG): If other drugs don't work, the doctor may prescribe HMG. This
drug is comprised of hormones extracted from the urine of postmenopausal women and contains large
amounts of LH or FSH. Women who have trouble ovulating, endometriosis, infertility caused by cervical
problems or unexplained infertility are good candidates for this drug. To monitor the woman's progress, the
doctor will order regular ultrasounds to check the quality and number of eggs being released.
Luteinizing Hormone-Releasing Hormones (LH-RH): LH-RH drugs are used when the pituitary or
hypothalamus gland is not producing hormones. They are also used to treat endometriosis. Most women must
administer these drugs themselves with a portable pump, and the equipment is unwieldy and expensive. Risks
include an increased chance of infections and clotting, and multiple births.
Human Chorionic Gonadoptropin (hCG). Chorionic gonadoptropins are often prescribed with HMGs, and
sometimes with clomipheme, to stimulate the release of the egg. They may also be used to treat endometriosis.
One of these drugs, Humegon, has resulted in pregnancy in more than 26 percent of cases in clinical trials.
Possible side effects are ovarian enlargement, ovarian cysts and multiple births.
Urofollitropin (FSH): This drug is made up of FSH taken from the urine of postmenopausal women. It can be
used with hCG to bring on the release of an egg. It's an effective drug for women with polycystic ovary
syndrome, for whom clomiphene has been ineffective.
Other medications that may cure fertility problems include:
Antibiotics - They may cure infections in the reproductive system, such as in the cervix or lining of the uterus,
and some sexually transmitted diseases.
The hormone progesterone - This hormone develops the lining of the uterus and helps a fertilized egg
implant.
Corticosteroids -These may be prescribed for the treatment of endometriosis.
Oral contraceptives, antiandrogens, and drugs to reduce insulin levels - These drugs are used in women
with polycystic ovary syndrome to restore regular periods and ovulation and to reduce symptoms stemming
from an oversupply of male hormones.
Drugs to treat thyroid disease, benign tumors or to improve poor quality cervical mucous.
WHAT SURGERIES TREAT FEMALE INFERTILITY?
If investigations suggest that surgery may cure infertility, then depending on the cause, surgery may be used to
deal with:
Fibroids or defects in the woman's uterus.
Endometriosis in the woman. In these surgeries, the doctor removes the uterine tissue that has grown
outside the uterus.
A scarred fallopian tube in the woman. In surgeries for this problem, the scarred tissue is removed or
the entire scarred section of the tube may be cut out. The tube is then rejoined and reattached to the
uterus.
HOW IS INFERTILITY IN A MAN TREATED?
WHAT MEDICINES TREAT MALE INFERTILITY?
A number of drugs can be prescribed to ease male fertility problems, but their effectiveness varies widely.
Here's a look at some of them:
Hormones - Though hormones can be quite successful in women, they are only occasionally effective in men.
Hormone drugs for men include testosterone, menotropins, GnRH medications, bromocriptine, clomiphene
citrate and human chorionic gonadotropin (hCG). Many of these drugs are quite expensive, however.
Antibiotics - These may help treat sexually transmitted diseases and other infections.
Corticosteroids - These drugs can aid men who make antibodies to reject their own sperm, but they may also
have serious side-effects after long use.
Viagra - This is a newly developed medicine for male impotence. The man takes Viagra an hour before having
sex. The medication improves blood flow to the penis, resulting in an erection. Studies have revealed that 70
percent of men who used Viagra improved their ability to maintain an erection. The drug can have severe side
effects for certain men, however, especially those with heart disease. Men with heart disease, who have had a
heart attack, or those with low blood pressure should not take the drug.
WHAT SURGERIES TREAT MALE INFERTILITY?
If investigations suggest that surgery may help with male infertility, then depending on the cause, surgery may
be used to deal with:
Varicose (or swollen) veins in the man's scrotum, helping to restore proper sperm movement.
An obstruction in the man's reproductive organs, including the epididymis, vas deferens and
ejaculatory duct. These blockages can halt the sperm's passage or prevent it from mixing with semen.
WHAT IS ARTIFICIAL (PARTNER) INSEMINATION?
If the man's semen is fertile but can't reach the cervix because of premature ejaculation or an inability to
maintain an erection, partner insemination may be considered. Men with low sperm count, women with poor
quality mucous, and couples with reproductive abnormalities may also benefit from this procedure.
Even if the man has erection problems, he may collect his sperm through a partial erection. The woman also
takes fertility drugs to increase her output of eggs. During a day when she is ovulating, she places the man's
semen in her cervical canal with a syringe. The doctor may also perform this simple procedure in his office.
If the man has low sperm count, his sperm can be "washed" to instill it with more energy beforehand. In this
procedure, the sperm is separated from semen and then placed in the woman's cervix. Adding calcium to the
sperm washing solution or storing it briefly in a liquid containing warm egg yolk may also enhance the sperm's
movement.
For women with cervical mucous that is too thick, or for partners with reproductive abnormalities or
unexplained infertility, the sperm may be placed in the uterus or fallopian tubes instead of the cervix.
Unfortunately, partner insemination is not always a guaranteed success. A couple may have to go through the
procedure six to 12 times before pregnancy occurs.
WHAT IS DONOR INSEMINATION?
Donor insemination uses sperm from a donor male that is placed in the woman's cervix, fallopian tubes or
uterus. This procedure may create pregnancy if the partner has few or no sperm, or an untreatable illness that
affects his reproductive system. Single women who wish to have a child without a partner often use this method
to achieve pregnancy.
Donors are screened for illnesses such as sexually transmitted diseases, for blood types, and for sperm that may
react to the woman's mucous. Routine use of frozen semen also may reduce the risk of sexually transmitted
diseases.
ASSISTED REPRODUCTION
Assisted reproduction refers to a number of advanced techniques that aid fertilization. These techniques are
often used for women who have irreversible damage to their fallopian tubes or cervical mucous problems. It
can also benefit couples with unexplained infertility.
IVF (In-Vitro Fertilization)
IVF is the most well known of assisted reproduction techniques. In this method, the woman takes fertility drugs
to stimulate her ovaries to produce more eggs. The physician then retrieves one or more of the eggs by
laparoscopy or by passing a needle through the vaginal wall. The partner's sperm is then mixed with the eggs in
a petri dish, and fertilization may take place.
If fertilization occurs, the embryo is allowed to develop outside the womb for a few days. Then it is implanted in
the lining of the woman's uterus with a small plastic tube. Most centers now place two to four embryos in the
womb in the hope that one will burrow into the lining and begin to develop normally. Any leftover embryos are
frozen to be used later, should the first IVF procedure fail to work. IVF increases the risk of multiple births.
In a variation of IVF called ovum transfer, a donor egg is fertilized with the partner's sperm and then placed in
the woman's uterus. This technique is often used when the woman has not been able to produce eggs, even with
fertility drugs.
The effectiveness of IVF has improved in the past few years but the chance of pregnancy is still only 20 to 40
percent. It costs as much as $12,000 and usually is not covered by insurance, although some states require
coverage of infertility treatment.
GIFT (Gammete Intrafallopian Tube Transfer)
In this method of assisted reproduction, the woman's eggs are retrieved but not fertilized. Instead, they are
mixed with the man's sperm and immediately placed into the woman's fallopian tubes. The woman must have
healthy tubes for GIFT to work.
ZIFT (Zygote Intrafallopian Transfer)
ZIFT involves placing the fertilized egg itself into the fallopian tubes. This procedure can be more successful
than GIFT because the doctor has a greater chance of ensuring that the egg is fertilized. Again, the woman must
have healthy tubes for ZIFT.
ICSI (Intracytoplasmic Sperm Insertion)
In this technique, a single sperm is injected into the egg, and the embryo is placed in the fallopian tubes or
uterus. This method is often recommended when the male partner has very few sperm or other fertilization
methods are not suitable for the couple.
FASIAR (Follicle Aspiration, Sperm Injection, and Assisted Follicular Rupture)
In a new method known as FASIAR, the physician punctures the follicle, and then removes the eggs with a
syringe that also holds the sperm. This mixture is then immediately injected back into the follicle. FASIAR may
reduce the risk of multiple births and is less expensive than other procedures.
PREVENTION
For having positive effects on fertility incorporating the following into lifestyle before and during the time males
& females are trying to conceive could be beneficial:
Quit smoking. Smoking has been linked to low sperm counts and sluggish sperm motility in men and an
increase in miscarriage in women.
Reduce your alcohol intake. Alcohol (especially binge drinking or chronic abuse), affects the fertility of both
men and women trying to conceive either naturally or through infertility treatments. Alcohol is toxic to sperm,
reduces sperm counts, can interfere with sexual performance, disrupt hormone balances and increases the risk
of miscarriage.
For women, no more than one to two standard drinks a day is recommended. For men, the limit is slightly
higher three to four standard drinks a day.
Eat a balanced diet. A well-balanced diet includes carbohydrates, protein and fibre. All women should increase
folic acid intake (found in green leafy vegetables, fruit, cereals, but also available as supplements) prior to and
during the first three months of pregnancy.
Exercise moderately. Excessive exercise can lead to menstrual disorders in women and affect sperm
production in men due to the heat build-up around the testicles.
Avoid environmental poisons and hazards such as pesticides, lead, heavy metals, toxic chemicals, and ionizing
radiation.
Check with your doctor that any medication or herbal remedies (prescribed or over-the-counter) that you
may be taking do not affect fertility.
Give up recreational drugs such as marijuana and cocaine as these have been linked to low sperm counts in
men and infertility in women.
Women in particular should:
Lose weight if you are overweight. Being overweight can decrease your chances of becoming pregnant. This
can be achieved through moderate exercise and a balanced diet, both of which have positive effects on fertility.
Men in particular should:
Wear loose-fitting underwear such as cotton boxer shorts. Tight-fitting underwear can lower sperm
production.
Prevent overheating. Stay clear of saunas, spas and hot baths, as heat around the testicles impairs sperm
production.
COST AND LEGAL ISSUES
HOW MUCH DOES IT COST?
The cost of a stimulated IVF cycle where hormones are used to boost egg numbers varies between clinics
but is approximately $3000. There are additional costs for services such as donor programs, ICSI, PGD, artificial
insemination, freezing of sperm and embryos.
Medical appointments and most infertility treatments are covered by Medicare.
If one have private medical insurance then hospital day surgery fees are covered (providing IVF is included in
the level of private health insurance that one have).
The "Medicare Plus Safety Net" provides a rebate of approximately 80 per cent of "out of pocket " fees paid for
out-patient services that are provided outside a hospital . It is not applicable for procedures such as oocyte
retrieval or ICSI.
LEGAL REQUIREMENTS
The laws regarding infertility treatments differ in each state.
Victoria has the most stringent legislation regulating the use of IVF in clinics and for research purposes. In 1995
the Victoria Parliament passed the Infertility Treatment Act 1995. It also set up a regulatory body called the
Victorian Infertility Treatment Authority (ITA) to oversee the use of infertility treatments in clinics and research
into infertility within Victoria. Doctors, scientists and counselors involved in infertility treatments in Victoria
must obtain approval from ITA.
In Western Australia, the Human Reproductive Technology Act 1991 governs the use of infertility treatments.
Likewise in South Australia there is the Reproductive Technology Act, 1988. The remaining states do not have
specific legislation but clinics adhere to strict guidelines set out by the National Health and Medical Research
Council.
All infertility centres are inspected and accredited by a body of professionals and consumers (patients)
established under the auspices of The Fertility Society of Australia. This body is called Reproductive Technology
Accreditation Committee and is responsible for the setting of best practice guidelines and standards for
infertility treatment in Australia and New Zealand. Failure to achieve accreditation status from this body means
that treatment offered by the infertility centre is not covered by the Medicare rebate.
Storage of eggs, embryos and sperm
There are laws that govern how long gametes (eggs and sperm) and embryos can be frozen. These laws are
enforced to ensure the decision-making process regarding the use or disposal of gametes and embryos is kept
with the couples who produced them.
In Victoria, eggs and sperm can be stored for a maximum of ten years, and embryos for a maximum of five years
(although the ITA can grant an extension).
If one has stored eggs or embryos she has the following options:
use them yourself
donate them to another couple
dispose of them
Donate them to research.
Donor eggs, embryos and sperm
Where legislation exists, donor gametes (eggs and sperm) can only be used if defects in the gametes will not
allow fertilization to occur or if there is the possibility that a gamete carries a genetic abnormality that can be
passed onto the child.
In Australia, it is against the law to buy eggs from donors. Some clinics offer an egg donation service where
women may donate their eggs to infertile couples. However, due to lengthy waiting lists and very few donors,
clinics will encourage you to find your own donor.
With regard to parental rights, the law recognizes that the woman who gives birth to the child is the mother,
regardless of the child's genetic origins.
There is different legislation for freezing sperm depending on the intended use. If sperm is to be used to fertilize
your partner's eggs to produce a child, then you will have legal and social obligations to care and support that
child. If the sperm is to be donated, the only obligations you have are to undergo counseling and testing for
transmissible diseases prior to donating.
Laws governing information access vary in each state. In Victoria, legislation dictates that a compulsory register
must be kept detailing identifying information of donors and their offspring. Donors can find out how many
children have been born from their donations. And children born from donated gametes or embryos can apply
for their birth origin information once they reach the age of 18.
In NSW, there are no laws regarding identification issues for gamete and embryo donors or children. However,
IVF clinics recommend that the donor be someone you know in order for the child to maintain some level of
contact with their genetic 'parent'.
PSYCHOLOGICAL & EMOTIONAL ASPECTS OF INFERTILITY
Most people simply take it for granted that they will be able to have children. In fact, one in six couples trying to
have a baby will experience problems in doing so. Infertility is often described as a life crisis, creating upheavals
similar to those associated with a death in the family or divorce. People are often shocked when they discover
that they are infertile and commonly go through a period of disbelief. Others rush into treatment without first
coming to terms with the diagnosis. The overall impact of infertility on individuals differs greatly, and is
influenced by factors such as cultural background and the importance a person places on having children in
their life.
INFERTILITY AND WOMEN
Individual women have different experiences of infertility but there are several feelings that are common.
Women may feel a sense of anger at not being able to have children and resentment towards other pregnant
women. They may also have feelings of guilt, regarding their infertility as punishment for putting their career
first, using contraception, or for a previous termination.
Some women may feel uncomfortable around children and consequently start to isolate themselves from family
and friends who have children. Increasing isolation leaves the women without social support networks to help
them overcome the feelings of depression and frustration commonly associated with infertility. Christmas,
Easter, Mothers and Fathers Day become painful reminders of their infertility instead of celebratory occasions.
A woman may develop feelings of hatred or disgust towards her body, perceiving it as inadequate, dysfunctional
and diseased. Similarly, a womans sense of femaleness is often closely associated with pregnancy and
motherhood. Infertility, therefore, may have a serious impact on a womans sexual identity, leaving her feeling
less sexually attractive or asexual.
Infertility and attempts to overcome it can lead to a loss in perspective. Women may put everything else in their
lives on hold, putting all their energy and time into getting pregnant. They may delay making changes in
everything from their careers to their current housing situation, deciding to wait until after they have 'had the
baby'.
Infertility and, in particular, medical treatment programs can place women on an emotional rollercoaster of
hope and then despair. Women may often go through a cycle of hopefulness leading to disappointment at the
arrival of their period.
INFERTILITY AND MEN
Many of the medical treatments for infertility focus on the womans body which can leave men feeling helpless
and left out of the process. If the couples infertility is due to a sperm dysfunction, the man may feel that he is
impotent or lacking in masculinity. The strong societal link between fertility and virility causes many men to
keep their infertility a secret, in turn increasing their feeling of isolation. While women may find some support
from female friends, it is not uncommon for mens male friends to show little understanding.
INFERTILITY AND RELATIONSHIPS
Infertility can also place a great strain on a relationship, particularly in cases in which the problem lies with one
partner. The infertile partner may constantly fear being left for another (fertile) person, while the fertile partner
may blame or feel anger towards their partner. Frequently there are differences in couples expectations
concerning children, with women more likely to express a greater need for a child. Differing levels of
enthusiasm are often apparent in couples where one partner has children from a previous relationship. Coming
to an agreement on what fertility tests to perform, what treatment options to pursue and when to stop
treatment can all cause conflict in the relationship. If one partner does not want to begin or continue with
treatment, the other partner may feel as though they are being denied the chance to have a child and become
resentful.
Treatment for infertility also frequently interferes with a couples normal sex life. The initial discussions to
identify possible fertility problems involve disclosing many personal details regarding ones sex life. Similarly,
the loss of privacy associated with tests such as sperm counts and the post-coital test can destroy feelings of
intimacy. Timing sex around ovulation can make it feel like a chore than something pleasurable. The lack of
spontaneous sex and sex for enjoyment rather than procreative purposes can lead to sexual dysfunction such as
erectile problems in men and vaginal dryness in women.
Although infertility is potentially the source of much strain on a relationship, many couples also report that
going through the experience has made their relationship stronger. Couples that have shared the physical and
emotional stresses of infertility may feel that it has brought them closer together and has cemented their
relationship. Successfully coping with infertility can result in couples feeling confident that they can tackle any
future problems.
INFERTILITY AND FAMILY/FRIENDS/EMPLOYERS
Infertility can also place a strain on relationships with family and friends. Families, in particular prospective
grandparents, may place added pressure on people by publicizing their expectations for grandchildren.
Enquiries from in-laws can be especially stressful and the daughter or son-in-law may feel that the comments
are intrusive. Friends who are unaware of the full implications of infertility may appear unsympathetic and
offer unhelpful suggestions such as "go on a holiday". Friends and family with children may assume that people
with infertility do not wish to be reminded about children and so will avoid announcing their own pregnancies
or issuing invites to social events like childrens birthday parties and baby showers.
Employers may not fully understand the issue of infertility and are, therefore, unsupportive. An employee may
find it difficult to arrange time off work to undergo diagnostic tests and treatment. Similarly, they may not feel
comfortable revealing why they require the time.
POSITIVE STRATEGIES
For some couples and individuals, becoming informed, consulting a counsellor or therapist and joining a
support group can help in coming to terms with infertility and coping with the stresses of treatment programs.
Different coping strategies will suit different people and be appropriate for particular stages of the infertility
experience.
Becoming informed
Obtaining information about infertility and the various treatment options available helps people to feel that
they are more in control of the situation. Reading material on the topic also allows people to make informed
choices about tests and treatments and to confidently ask their health practitioner any questions they may
have.
Counseling:
Visiting a counselor who is experienced in infertility issues will enable people to openly discuss their feelings
about being infertile. They can also voice their fears and concerns about approaches to treatment, as well as the
possibility of remaining childless. Counseling may be particularly beneficial to couples whose relationship has
suffered as a result of infertility. For couples experiencing disruptions to their normal sex life, advice from a sex
therapist may be useful.
Support groups:
Many people confronted by infertility find that consulting or participating in a support group can be very
helpful. A support group can provide information on infertility and infertility treatments as well as contact with
other people with similar problems. Being able to talk to people who have been through the same ordeal
reduces feelings of isolation. Support groups offer strategies for coping with particular problems associated
with infertility and can also offer a sense of hope through sharing other peoples success stories.
PREVALENCE
Generally, worldwide it is estimated that one in seven couples have problems conceiving, with the
incidence similar in most countries independent of the level of the country's development.
Fertility problems affect one in seven couples in the UK. Most couples (about 84 out of every 100) who
have regular sexual intercourse (that is, every 2 to 3 days) and who do not use contraception will get
pregnant within a year. About 92 out of 100 couples who are trying to get pregnant do so within 2 years.
Women become less fertile as they get older. For women aged 35, about 94 out of every 100 who have
regular unprotected sexual intercourse will get pregnant after 3 years of trying. For women aged 38,
however, only 77 out of every 100 will do so. The effect of age upon mens fertility is less clear.
In people going forward for IVF in the UK, roughly half of fertility problems with a diagnosed cause are
due to problems with the man, and about half due to problems with the woman. However, about one in
five cases of infertility have no clear diagnosed cause
In Britain, male factor infertility accounts for 25% of infertile couples, while 25% remain unexplained.
50% are female causes with 25% being due to an ovulation and 25% tubal problems/other
In Sweden, approximately 10% of couples are infertile. In approximately one third of these cases the
man is the factor, in one third the woman is the factor and in the remaining third the infertility is a
product of factors on both parts.
INFERTILITY: PROGNOSIS
It is very hard to obtain statistics regarding the prognosis of infertility because many different problems may
exist within an individual or couple trying to conceive. In general, it is believed that of all couples who undergo
a complete evaluation of infertility followed by treatment, about half will ultimately have a successful
pregnancy. Of those couples who do not choose to undergo evaluation or treatment, about 5% will go on to
conceive after a year or more of infertility.