Fertility and assisted reproduction in Marrakech

After a year of regular intercourse without pregnancy, after six months if the woman is over 35, or sooner if there is a known cause (very irregular cycles, gynaecological history).

Difficulty conceiving can come from the woman, the man or both. The assessment therefore involves the couple, including a semen analysis for the man.

It includes medical history, examination, a pelvic ultrasound, a hormone profile as needed and, if necessary, examination of the tubes and uterus.

Ovulation problems, tubes, uterus, endometriosis, polycystic ovary syndrome, male factor: the cause identified guides care.

Advice to optimise chances, treatment of a cause, ovulation stimulation and, when indicated, assisted reproduction. Laboratory steps take place in a specialist centre, with which follow-up is coordinated.

We speak of difficulty conceiving when pregnancy has not occurred after twelve months of regular intercourse without contraception, or after six months when the woman is over 35. Even in a perfectly fertile couple, the chance of conceiving in each cycle is only about one in five: it is therefore normal for it to take time.

Consulting earlier is justified with very irregular or absent cycles, a history of surgery or pelvic infection, known endometriosis or a known problem in the partner.

The work-up is chosen according to your history. It may include:

• a pelvic ultrasound, which examines the uterus and counts the small follicles in the ovaries;
• hormone tests, done at a specific time in the cycle;
• an assessment of the tubes, by a specific X-ray or another test;
• serology and a general work-up as needed.

Each test answers a specific question: is ovulation taking place, is the uterus normal, are the tubes open?

In about one case in two, the partner is involved in the difficulty conceiving. The first test is a semen analysis, simple and painless, with a few instructions about the abstinence period and collection.

It is done at the same time as the woman's work-up, not afterwards: this avoids losing months. Depending on the result, a specialist opinion may be offered.

For some couples, finding the fertile window is enough: cycle tracking, ovulation tests, even ultrasounds to see ovulation. Intercourse is advised in the days around ovulation, without making it an obligation that exhausts the couple.

If ovulation is irregular or absent, a treatment to stimulate it may be offered, with monitoring to avoid excess.

When the work-up justifies it, several steps are possible, from the simplest to the most complex: simple ovulation stimulation, intrauterine insemination, in vitro fertilisation. The choice depends on the cause, age, duration of infertility and your plans.

Success rates depend mainly on the woman's age and the cause. No method guarantees a pregnancy. When an advanced technique is needed, care continues, if necessary, with a team specialised in assisted reproduction.

The months of waiting, the tests and the failures weigh on morale and on the couple. It is normal to feel tired, sad or angry. Talking about how you feel is part of the consultation, and psychological support can help.

Diet, weight, sleep, tobacco and alcohol influence the fertility of both partners: the doctor advises you without making you feel guilty.

The process can be long. The doctor explains each step, the real chances and the limits, without promises.