Fertility is defined as the ability to conceive and produce offspring. According to the World Health Organisation (WHO), infertility is a disease of the male and female reproductive system defined by the failure to achieve a pregnancy after 12 months or more of regular unprotected sexual intercourse (3 – 4 times a week). The latest report shows that 1 in 6 people worldwide experience infertility.

Since the fertility potential of the female partner decreases after 35 years of age, it is recommended to consult after 6 months of trying to conceive in women between the ages of 35 to 40 years and 3 months in women over 40 years of age. Women with known causes of infertility such as amenorrhea (not having periods for more than 3 months), should immediately consult a gynaecologist to assess the cause and plan the treatment.

Both male and female factors contribute to infertility. It is important to evaluate both partners regardless of whether one partner has children from a previous relationship. At times it is impossible to find the cause of infertility and this is referred as idiopathic infertility.

Male causes of infertility:

• Testicular failure
• Hormonal disorders/ imbalance
• Obstruction of the reproductive tract
• Abnormal sperm function and quality

Female causes of infertility:

• Disorders of the ovaries such as polycystic ovarian syndrome
• Blocked fallopian tubes (due to previous STI’s or abdominal/ pelvic surgery)
• Uterine disorders such as fibroids, endometriosis, congenital uterine abnormalities
• Endocrine disorders (hormonal causes)

Dr Noma Mbungu will take a detailed medical history and physical examination on both partners including lifestyle factors such as excessive alcohol intake, smoking, etc. Depending on the likely cause, the following investigations will be done on the female partner:

• Routine urinary pregnancy test
• Routine Syphilis (RPR) & HIV test
• Hormonal profile – depending on the presenting complaint
• Transvaginal ultrasound (2D/3D/4D)
• Assessment of tubal patency (chlamydia IgG test in low risk patients and hysterosalpingogram in high risk patients)

Evaluation of the male partner includes :

• Routine Syphilis (RPR) & HIV test
• Semen analysis
• Hormonal profile – will depend of the semen analysis results

The management plan will be tailored according to the cause of infertility. Dr Noma Mbungu will counsel and advise the couple, using a holistic approach based on the best available evidence, which will allow the couple to choose the best management option.