Female Infertility

Dr Crawford is a highly respected fertility specialist based in Sydney, known for her unique combination of expertise as a surgeon, obstetrician and gynaecologist. Her extensive knowledge in reproductive endocrinology allows her to provide a holistic approach to her patients and deliver the best possible care. Her patients benefit from her vast experience and ability to offer a wide range of treatments and services in one location.

If you have been trying to get pregnant and have not yet succeeded, Dr Crawford can help you achieve your dream of starting a family. She can work closely with you to create personalised treatment plans and support. She partners with Monash IVF, utilising state-of-the-art technology and equipment to ensure the best possible outcomes.

What is Female Infertility?

Fertility is the capability of women to achieve pregnancy.

Infertility is usually defined as not being able to get pregnant despite trying for one year. A broader view of infertility includes the inability to carry a pregnancy to term and have a baby.

Pregnancy is the result of a chain of events. A woman's fertility often depends on her body’s ability to release an egg from her ovaries (ovulation). The egg must travel through a fallopian tube toward her uterus (womb). A man’s sperm must join with (fertilise) the egg along the way. The fertilised egg must then become attached (implant) to the inside of the uterus.

While these steps may seem simple, many things can happen to prevent pregnancy from occurring. To know more about the comprehensive range of fertility investigations and treatments suitable for you, make an appointment with Dr Crawford.

Who Are Affected By Infertility?

It is a myth that infertility is always a “woman’s problem.” Infertility affects both men and women, and a variety of factors can cause it.

In about 30-40% of cases, infertility is caused by problems with the male reproductive system, such as low sperm count or poor sperm motility. In another 30-40% of cases, infertility is caused by problems with the female reproductive system, such as ovulation disorders or structural problems in the reproductive system. In the remaining 20-30% of cases, infertility is caused by a combination of male and female factors or is of unknown cause.

It is recommended that you seek medical advice if you are a woman aged below 35 years and fail to conceive after 12 months of contraceptive-free intercourse or if you are aged 35 years and above and fail to conceive after six months, to improve your chances of conceiving.

What are the Causes of Female Infertility?

Some of the most common causes of female infertility include:

Ovulation disorders: include conditions such as polycystic ovary syndrome (PCOS) and primary ovarian insufficiency (POI), which can cause absent, irregular or infrequent ovulation, making it difficult for a woman to become pregnant.
Structural problems: These include conditions such as blocked or damaged fallopian tubes, uterine fibroids, or endometriosis, which can make it difficult for the egg to reach the uterus or for the fertilised egg to implant in the uterus.
Hormonal imbalances: These can be caused by conditions such as thyroid disorders or pituitary gland tumours and can affect ovulation and the menstrual cycle.
Medical conditions: Certain medical conditions, such as diabetes, lupus, or rheumatoid arthritis, can also contribute to infertility.
Lifestyle factors: Certain lifestyle factors, such as smoking, alcohol consumption, and being overweight or underweight, can also contribute to infertility.
Age: A woman's fertility declines with age, and the chance of becoming pregnant decreases as a woman gets older.

In some cases, the cause of infertility may not be clear. A comprehensive evaluation by a specialist like Dr Crawford is necessary to identify the root cause of infertility and provide appropriate treatment options.

Infertility and Age

Ageing is an essential factor in female infertility. The ability of a woman’s ovaries to produce eggs of good quality declines with age, especially after age 35. About one-third of couples where the woman is over 35 will have problems with fertility.

How is Female Infertility Tested?

If you have been trying to have a baby without success, you may want to seek medical help. If you are over 35, or if you have reason to believe that there may be a fertility problem, you should not wait for one year of trying before seeing a doctor. A medical evaluation may determine the reasons for a couple’s infertility.

Ovulation testing: This is most commonly performed with a progesterone blood test 1 week before the expected menstrual period. At times ovulation may be assessed with cycle-tracking, which involves measuring levels of oestrogen, progesterone, luteinising hormone (LH) follicle-stimulating hormone (FSH) in the blood, at various time points during the menstrual cycle, which can indicate whether ovulation is occurring.
Hormone testing: This includes measuring levels of estrogen, progesterone, and testosterone in the blood, which can indicate whether any hormonal imbalances may be affecting fertility.
Imaging tests: include ultrasound, Sonohysterogram and Hysterosalpingo-contrast-sonography (HyCoSy). These can be used to check for structural problems in the reproductive system, such as blocked or damaged fallopian tubes or uterine fibroids.
Laparoscopy: This is a surgical procedure that can be used to check for endometriosis or other conditions that may be affecting fertility.
Hysteroscopy: This procedure is used to look inside the uterus to check for any issues, such as fibroids, polyps, or adhesions.
Genetic testing: This can be used to check for genetic disorders or chromosomal abnormalities affecting fertility.
Ovarian Reserve Testing: This includes measuring the levels of Anti-Mullerian Hormone (AMH) and Follicle-stimulating hormone (FSH), which can indicate the number of eggs a woman has remaining, also known as ovarian reserve. The antral follicle count (AFC) can also be checked via ultrasound.

How is Infertility Treated?

Infertility can be treated using various methods, depending on the underlying cause of infertility. Some common treatments include:

Medications: Medications such as Letrozole, clomiphene citrate, gonadotropins, or metformin can stimulate ovulation or regulate the menstrual cycle in women. Occasionally for men, medications such as hCG may be used to increase sperm count and testosterone levels. These medications should only be used after careful assessment and on prescription.
Assisted Reproductive Technologies (ART): These include in vitro fertilisation (IVF) and intracytoplasmic sperm injection (ICSI), , which can help fertilise an egg outside of the body. These methods can be used for both female and male infertility.
Surgery: Surgery may be used for structural problems in the reproductive system, such as blocked or damaged fallopian tubes, or remove uterine fibroids or endometriosis in women. In men, surgery can be performed to extract sperm directly from the testes, in certain circumstances (such as after vasectomy) or correct varicocele, a varicose vein in the testicle that can affect sperm production.
Lifestyle changes: Making lifestyle changes such as losing weight, quitting smoking, and reducing alcohol consumption can help improve fertility.
Egg/Sperm Donation: This may be used when a person has exhausted their own egg/sperm reserve or when the eggs/sperm are of poor quality. It involves using eggs/sperm from a healthy donor to achieve pregnancy. It is also commonly used for intended solo parents or same-sex couples.
Surrogacy: This involves having another person carry the pregnancy to term. It is typically considered when a woman has a medical condition that makes it unsafe for her to carry a pregnancy or if she does not have a uterus in which to carry a pregnancy. Not all treatments will be suitable for every individual or couple, and the specific treatments recommended will depend on the person's circumstances and the suspected cause of infertility. A specialist like Dr Crawford can provide a comprehensive evaluation and discuss the options available, including the potential success rate, risks, and costs associated with each treatment.

Why Consider Taking Action for Infertility?

Considering taking action for infertility is essential for several reasons. Firstly, age plays a significant role in a woman's fertility, and the earlier an individual or couple seeks help, the better their chances of success will be. Secondly, infertility can be emotionally challenging and stressful for couples, and seeking treatment can help alleviate some of these feelings and provide hope. Additionally, infertility is a time-sensitive issue; the longer an individual or couple waits to seek treatment, the more difficult it may be to achieve pregnancy.

With the advancement of technology and medical treatments, the chances of success have increased, so seeking early medical help can improve the likelihood of success and reduce the time and cost of treatment.

For some couples or individuals, starting a family may be a personal goal; without the help of infertility treatment, it may not be possible. Infertility treatment can provide an opportunity to fulfil this desire. A specialist like Dr Crawford can provide comprehensive evaluation, guidance, and support throughout the process, increasing the chances of a successful outcome.