• Basic male and female infertility investigations.

• Laparoscopy and Dye studies to confirm tubal patency are performed when necessary.

• Indivisualised treatment options

Investigating suspected infertility requires tests for both the woman and her partner. Tests for the woman may include:

• Physical examination – including medical history

• Blood tests – to check for the presence of ovulation hormones

• Laparoscopy – a ‘keyhole’ surgical procedure

• Ultrasound scans – to check for the presence of fibroids.

Male partner may also be asked to do a semen analysis test.

Female infertility can be caused by:

• Ovulation problems

• Polycystic ovary syndrome

• Problems with the fallopian tubes

• Problems with the uterus

• Endometriosis

Ovulation problems causing female infertility

For ovulation to occur, a part of the brain called the hypothalamus prompts the nearby pituitary gland to secrete hormones that trigger the ovaries to ripen eggs. Irregular or absent periods indicate that ovulation may be irregular or absent too.

Polycystic ovary syndrome causing female infertility
At ovulation, the ovaries produce small cysts or blisters called follicles. Typically, one follicle ripens to release an egg. In polycystic ovary syndrome, the follicles fail to ripen, forming little cysts on the outer edge of the ovary and often releasing male sex hormones.

Problems with the fallopian tubes causing female infertility

The sperm fertilises the egg on its journey down the fallopian tube. A blocked or scarred fallopian tube may impede the egg’s progress, preventing it from meeting up with sperm.

Problems with the uterus causing female infertility

The fertilised egg implants in the lining of the uterus. Some uterine problems that can hamper implantation include:

• Fibroids

• Polyps

Problems with the cervix causing female infertility

At the top of the vagina is the entrance to the uterus, called the cervix. Sperm must travel through the cervix to reach the uterus and fallopian tubes.

Cervical mucus around the time of ovulation is normally thin and watery so that sperm can swim through it. However, thick or poor quality cervical mucus can hinder the sperm.

Endometriosis causing female infertility

Endometriosis is a condition in which cells from the lining of the uterus migrate to other parts of the pelvis. It can damage the fallopian tubes and the ovaries, and alter the movement of the egg and sperm.

Even if the fallopian tubes and ovaries are not damaged, endometriosis can affect the movement of sperm, egg pick-up by the tube, egg fertilisation, embryo growth and implantation.

Treatment options for female infertility depend on the cause, but may include:

• Surgery

• Ovulation induction (using hormone therapy)

Surgery for female infertility

Female infertility can be caused by obstructions within the reproductive organs. Some of the problems that can be addressed by surgery include:

• Fibroids

• Polyps

• Endometriosis

• Abnormalities of the uterus

• Ovarian cysts

These days, most reproductive surgery is performed using an operative laparoscope (through the abdomen) or an operative hysteroscope (through the cervix and into the uterus).

‍https://www.healthdirect.gov.au/infertility

https://www.pregnancybirthbaby.org.au/about-infertility

‍RANZCOG Patient Information Resources