Infertility

Infertility means that you have tried to have a child for more than a year, without success. Involuntary childlessness is common and there may be various causes for this. Childlessness can also be due to the fact that you may be single, live in a same-sex relationship or live in a relationship where the other partner does not want children.



When should you seek help?


Seek help when you have been trying to get pregnant for at least a year.

Seek help earlier if you know that a pregnancy may be difficult to achieve without help.

This could be, for example, if one or more of the following statements are true:

  • You who is trying to get pregnant are over 35 years old.

  • You who is trying to get pregnant have menstruation rarely or not at all.

  • You who is trying to get pregnant have had abdominal surgery, such as for appendicitis, and had complications.

  • One of you have had a malignancy and been treated with chemotherapy.



Causes of infertility


About one third of infertility cases are due to issues with the sperm.

  • The sperm may not work properly. There may be too few or there is no sperm in the semen but most of the time the cause is unknown.

  • Infection in the testicle, such as chlamydia or gonorrhoea.

  • Testicles that have not descended into the scrotum.

  • Testis are affected by chemotherapy or radiation at treatment for cancer or other diseases.

  • Testicular function may have been affected by anabolic steroid use.

One third of infertility cases are due to problems in the uterus or the ovaries.

  • Failure to ovulate, for example with PCOS.

  • The fallopian tubes work worse after an infection such as chlamydia or gonorrhea.

  • You may have endometriosis.

  • You may have been affected by, for example, radiation or chemotherapy during previous treatment for cancer or other previous diseases.

  • You may have polyps or muscle knots in the uterus or cervix.

  • You may be underweight or severely overweight. Ovulation can be affected by how much you weigh.

  • It may be due to a congenital condition such as Turner syndrome.


One third of infertility cases are due to a combination of issues on the male and female side, or no explanation can be found. Examinations and samples cannot show where the problem might be. It is called unexplained infertility. An investigation includes several different samples and tests. A semen sample is included to investigate whether there is sperm, how much there is and how they move. An examination can also show whether the ovaries, ovulation, fallopian tubes and uterus are working properly. There are several tests that can be done to show this:

  • Test ovulation by using so-called LH sticks. You do the test yourself at home.

  • Take your body temperature every morning to test for ovulation. When you ovulate, you get a slightly higher temperature. You do the test yourself at home.

  • Blood test that shows if you ovulated. The sample is given one week before the period, if it is regular.

  • Vaginal ultrasound where the ovaries and uterus are examined. An examination to see if the fallopian tubes are open or closed. To be able to see it, contrast fluid is flushed into the uterus and fallopian tubes.

  • FSH and LH samples show levels of hormones that reflect the function of the ovaries. You leave these samples in the first three or four days after your period, if your period is regular. You who do not have regular periods can submit a test at any time.

  • AMH test can be taken whenever during the cycle and indicates size of ovarian eggreserve.

  • Progesterone test can show if you have ovulated and is taken a week before you are due for your period.


When the investigation is complete


When all the tests have been done and the investigation is complete, you and the doctor can discuss which treatment would be best. Sometimes the doctor assesses that the chance of having a child is good and that you do not need any treatment, but must try a little more yourself. Sometimes the doctor can assess that the chance of having a child needs help with IVF and in this case issues a referral. Sometimes the doctor can determine that there is a failure of ovarian function or that sperm are missing. Then donation treatment may be relevant. Here, too, a referral will be issued.



HSSG


HSSG stands for hysterosalpingosonography and involves examination of the uterine cavity and passage in the fallopian tubes. During the examination, a catheter is inserted into the uterus and then, under vaginal ultrasound, an injection of saline and contrast-saline is made to see if there are indentations in the uterine cavity (polyp, myoma, malformation) and passage through fallopian tubes. The latter is a prerequisite for the passage of sperm and embryo, which is needed for pregnancy through natural fertilization.



HSG


HSG stands for hysterosonography and means that by injecting saline into the uterine cavity, the wall of the uterine cavity can be examined for the presence of e.g. polyp, malformation or fibroid. HSG is included as part of the larger HSSG examination.


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