Fertility

Infertility is the inability to conceive after a year of trying and this affects 1 in 7 couples. At least 50% of people affected by PCD can get pregnant without difficulty the remainder may need some sort of assistance. There are several reasons for not conceiving and they can be divided, for simplicity, into four groups:

Male Factor

This is when the sperm is poor quality. This affects 25% of couples. Either the count, the percentage swimming well (motility) or the number that look normal (morphology) are low. Sometimes all three are low. Occasionally a man may have no sperm in the ejaculate, this is called azoospermia.

In men with PCD, the sperm may have poor motility, and this reduces the chances of conceiving naturally. This can be overcome with in-vitro fertilization (IVF) and intra-cytoplasmic sperm injection (ICSI). The female partner is given drugs to make her produce lots of eggs. These are collected by a simple surgical procedure. A single good quality moving sperm is injected into each egg (ICSI) to fertilise it. The resulting embryos are then placed in the womb.

In azoospermia a surgical procedure can be performed, and sperm can be successfully extracted from the testis in over 50% of men. Alternatively, donor sperm may be used.

Tubal Disease

The sperm and egg meet in the fallopian tube and fertilization occurs then the fertilized egg (embryo) moves back into the womb. If the tubes are blocked or absent, then this cannot occur. This is a cause of infertility in 20% of women (with or without PCD).

The most common cause of tubal damage is pelvic inflammatory disease (PID) caused by chlamydia or gonorrhoea following unprotected intercourse. Other causes of tubal damage include surgery appendectomy, tubal ectopic, sterilisation and ovarian surgery or infection/inflammation in the abdomen such as peritonitis. Rarely tubal surgery can be used to repair damaged tubes.

In females with PCD, the cilia in the tube may not move effectively and there may be tubal damage secondary to previous ectopic pregnancies. If the tubes are not functioning normally then IVF is recommended.

Anovulation

This is the inability to release an egg every month and is a cause of infertility in 25% of women with PCD. Commonly women who do not ovulate have irregular or infrequent menstrual cycles. Polycystic ovary syndrome is the most common cause of anovulation.

Other causes include thyroid dysfunction, anorexia and obesity, disorders of the pituitary and hypothalamus (structures in the brain that control hormone levels). Lastly it can be caused by ovarian failure after chemotherapy, radiotherapy or surgery to the ovaries or chronic illness.

In women with PCD, like other chronic illnesses when you are unwell you may lose weight and the cycles may become irregular due to lack of ovulation. More rarely medication or serious illness may cause irreversible damage to the ovaries.

Restoring weight to normal can allow menstrual cycle to become regular again. Medication like clomiphene or treatments like intrauterine insemination (IUI) can be given to restore ovulation. If there is ovarian failure, then egg donation is the only fertility option.

Unexplained Infertility

This is when the sperm is normal, the tubes are patent and there is normal ovulation. This condition affects 25% of couples. If you are young, it is sensible to continue trying naturally. If there is no success after 3 years, IVF is the best option.

For anyone trying to get pregnant it is important to be healthy to have a normal weight (BMI between 18 and 30), to eat a healthy diet and exercise regularly, to avoid excessive alcohol, smoking and recreational drugs and for the women to take folic acid. The chances of getting pregnant decrease dramatically with age, especially beyond the age of 39.

Access to fertility services can be arranged through your GP. The GP can organise basic tests such as hormone levels and a semen analysis. If these are abnormal, you should be referred to a fertility specialist.

If you require IVF/ICSI you may be eligible for Primary Care Trust (PCT) funded treatment. Each PCT has strict criteria for eligibility.

Broadly speaking you must have no existing children, be less than 40 years of age and have a BMI under 30. Most PCTs will fund one cycle of treatment including the drugs. If you have to pay for treatment the cost can range between £3000 and £20,000.

Risks of IVF/ICSI must be considered. The main risk is multiple pregnancy (twins or triplets) if we put back more than one embryo. In women with PCD we would recommend avoiding multiple pregnancies by placing only one embryo at a time as all the risks of pregnancy are greater with twins. There is a chance of decreased respiratory function as the growth of the baby compresses the lungs. Twins are also more likely to be born prematurely and could end up with long-term health problems.

An egg collection requires an anaesthetic or deep sedation, so it is advisable for the respiratory function to be optimal in women with PCD when they start IVF/ICSI treatment.

School children
Additional information

Fertility and PCD with Dr Robert Wilson