Are You Having Difficulty Conceiving?

What is infertility?

Primary infertility is defined as an inability to conceive after one year of trying, or an inability to carry a pregnancy to a live birth. Secondary infertility is difficulty conceiving after already having conceived (and either carried the pregnancy to term or had a miscarriage).

The problem is common. Approximately 1 in 4 people in New Zealand will experience infertility during their lifetime. A number of these people will require some form of medical assistance to achieve a pregnancy. If you have been trying to conceive and have been unsuccessful, and you are concerned, then it is worth seeking medical advice

People that should seek help early are:

• Women who have irregular periods, which is a sign that ovulation may not be occurring;
• Women who have had pelvic surgery (to ovaries, tubes or appendix) or pelvic infection which may have damaged fallopian tubes;
• Women over 35 years of age;
• Women with known reproductive pathology, e.g. endometriosis, fibroids, PCOS;
• Men who have had genital surgery, infection or significant trauma.

If none of these factors exists, 80% of people can expect to get pregnant in the first year of trying. A normally fertile couple in their 20’s have on average a 25% chance of conceiving each month.

Infertility is often experienced as an on-going grief, a grief in which many people feel alone and isolated. People experiencing secondary infertility after one or more children may also experience similar grief.

Help is available

Over the past 20 years, there have been significant advances in treatment for those with fertility problems. However, these treatments can take quite some time to complete and do involve tests for both males and females. This period of waiting, investigation and treatment can prove quite stressful.

After initial tests with your local GP, you may be referred to a Fertility Clinic. These clinics are located in Auckland (3 individual clinics), Hamilton, Wellington, Christchurch and Dunedin. Many clinics hold satellite clinics in other regions for initial or review consultations. You also have the opportunity to be placed on a public waiting list for fertility treatment if you meet the criteria.

Some people may choose to undertake a Preconception Health Programme to improve their general and reproductive health. This could increase their chances of a natural conception and will certainly support any future medical treatments.

Public treatment

Those who are eligible for public funding receive one fully funded cycle of treatment.

If you do not have a baby from the initial round of treatment then you could be eligible for a second cycle of publicly funding. Your specialist will discuss with you which is the most appropriate treatment option for you.

If you are eligible for public treatment, our recommendation is to get on the waiting list as quickly as possible. This will give you options, even if you decide to have privately funded treatment in the interim.

Private treatment

In both the North and South Islands, you have the choice of private clinics for treatment and consultations. You will need to pay for private treatment, but in general there is no waiting period. For more information, ask your GP or local support group for a list of accredited Fertility Clinics near you.

Common causes of infertility

MEN (approx. 40%)

Male fertility problems can be caused by abnormalities in sperm numbers, movement or shape. However, the causes of many sperm problems remain unknown.

Causes could be:

• Failed vasectomy reversal
• Retrograde ejaculation
• Blocked ducts
• Varicocele
• Absence of vas deferens
• Undescended testes in childhood
• Autoimmune (antibody) disorders
• Lifestyle factors including testicular heat, nutrition, exposure to chemicals, smoking and alcohol

WOMEN (approx. 40%)

Female fertility problems commonly include:

• Tubal problems
• Endometriosis
• Disorders of ovulation
• Polycystic ovarian disease
• Frequent miscarriage
• Hormonal problems
• Autoimmune (antibody) disorders
• Recurrent genito-urinary infections
• Lifestyle factors including smoking, weight, nutrition and environmental factors

Unexplained infertility

Up to 20% of couples (including those experiencing secondary infertility) will have no diagnosed cause for their infertility. There is rarely a quick or simple answer to infertility problems. Infertility is not something you catch and in most cases, is not preventable.

Have a plan and stay in control

If you are concerned about trying to start a family, or if you have a child and are having difficulty conceiving a second time, below are some suggestions that may help you during the ‘getting answers’ process.

Take a list of questions with you to your health professional, and write down the answers. (Sometimes your anxiety about the cause of your infertility can cause you to forget what you wanted to ask, or what the answers were.)

Ensure you are referred to a Reproductive Health Specialist or Clinic when necessary; they have specific experience in fertility treatment

Ask for copies of all your test results, and keep them in a folder at home, as there may come a time when you may need a copy of the information

Ask your doctor to explain what the tests and the results mean

Ask your specialist to keep your GP filled in on what is happening

Try to be assertive, and let your GP or Specialist know honestly how concerned you are

Seek out information for yourself – join FertilityNZ!  Self-knowledge assists you to help yourself and understand more fully what is happening

Ask your GP to organise blood tests and sperm tests for you and your partner, BEFORE you are referred to the specialist. These need to be no more than 6 months old, and current results will save you time

Consider undertaking a Preconception Care Programme to improve general and reproductive health and also improve your chances of conceiving, having a healthy pregnancy and a healthy baby.

Talking about fertility problems can help

One of the greatest ways to deal with infertility is to talk about it. This is not always easy or comfortable. At some point during infertility treatment, or investigation, you may experience a state of crisis.

This crisis in turn, may lead to feelings of isolation and despair. This can place a strain on your relationship. You may also feel alone and not have people to talk to who understand the experience of infertility.

Due to the personal nature of infertility, it is difficult to know who to contact. All New Zealand fertility clinics have trained counsellors, and you do not need to be a patient of the clinic to make an appointment with a counsellor there.

FertilityNZ has an informative website with a chat room facility and a free number you can call for information and support. It can also put you in touch with your nearest local group.

Please note that the information presented on this page is intended only as a brief summary. For specific advice on your particular medical situation, you should always consult your professional healthcare provider.