Infertility ( now commonly called as SUBFERTILITY ) is a condition of the reproductive system often diagnosed after a couple has had one year of unprotected, well-timed intercourse (in women under 35, after six months in women over 35) or if the woman has been unable to carry a pregnancy that results in a live birth.
How common is infertility?
One in every eight couples of childbearing age has an infertility problem. There is a female problem in 35% of the cases, a male problem in 35% of the cases, and a combined problem of the couple in 20% of cases. Therefore, it is essential that both the man and the woman be evaluated during an infertility work-up. In 10% of cases, the problem is “unexplained”, meaning that all testing yielded normal results.
When should one seek help for infertility evaluation & treatment?
If a female partner’s age is less than 35 years and after one year of intercourse she is not able carry a pregnancy or If a female partner’s age is more than or equal to 35 years and after six months of intercourse she is not able carry a pregnancy then the couple should seek expert medical advice for evaluation of cause and treatment of infertility.
If the male partner has a known or suspected low sperm count or the female partner has a history of pelvic inflammatory disease, prior ectopic pregnancy, painful periods, recurrent miscarriage, or irregular periods, it is advisable to start treatment soon as the couple decides to plan baby.
What are “primary” and “secondary infertility”?
Primary infertility is infertility without ever conceiving or successfully carrying a pregnancy to a live birth. Secondary infertility is the inability to conceive again after one or more successful pregnancies.
How infertility is diagnosed in females ?
Blood investigations and ultrasound / imaging of pelvic organs in females are conducted to find out the cause of infertility in women.
Is infertility exclusively a “women’s problem?”
Infertility is a medical problem. Approximately 35% of infertility is due to a female factor and 35% is due to a male factor. In the rest of cases the cause of the infertility cannot be explained.
How is infertility treated?
Currently there are many treatment options available which help the couple to conceive a baby. Treatment options include hormonal treatments, ovulation induction, Intrauterine insemination, in vitro fertilization (IVF), ICSI, surrogacy, egg/sperm donation and even embryo donation.
What are the risk factors for infertility?
There are risk factors for both, men and women.
Women’s factors include:
Age
Smoking
Excess alcohol use
Stress
Poor diet
Athletic training
Being overweight or underweight
Sexually transmitted infections (STIs)
Health problems that cause hormonal changes, such as polycystic ovarian syndrome (PCOS)
Radiation treatment and chemotherapy for cancer
Male factors include:
Heavy alcohol use
Drugs
Smoking
Age
Environmental toxins, including pesticides and lead
Health problems such as mumps, serious conditions like kidney disease, or hormone problems
Medicines
Radiation treatment and chemotherapy for cancer
Varicocele
What causes infertility in Women?
Most cases of female infertility are caused by problems with ovulation. Without ovulation, there are no eggs to be fertilized. Some signs that a woman is not ovulating normally include irregular or absent menstrual periods.
Ovulation problems are often caused by polycystic ovarian syndrome (PCOS). PCOS is a hormone imbalance problem which can interfere with normal ovulation. PCOS is the most common cause of female infertility.
Other causes of fertility problems in women include:
Blocked fallopian tubes due to pelvic inflammatory disease, endometriosis, or surgery for an ectopic pregnancy
Physical problems with the uterus
Uterine fibroids, which are non-cancerous tumors of muscle tissue within the walls of the uterus
What all is done in evaluation of cause of infertility ?
Basic infertility work-up includes only a few tests. Commonly the following 4 factors are helpful in providing the correct diagnosis
Detailed Patient History and Examination
Ovarian Function Testing
HSG ( Hysterosalpingography )
Partner Semen Analysis
What are the treatments for infertility?
Treatment of infertility is according to the cause of infertility. For example, in cases of hormonal imbalance treatment is conducted with medicines. Depending on the diagnosis, in specific conditions, the assisted conception (in vitro fertilisation – also called IVF or ICSI ) is performed.
What is in vitro fertilization?
In vitro fertilization (IVF) is a technique used to treat more difficult forms of infertility and is effective because it bypasses some of the most common causes of infertility such as damaged tubes or poor sperm function. It is normally reserved for cases in which more conservative and less invasive methods have failed.
In vitro fertilization (IVF) means that the oocyte or egg is fertilized in a laboratory dish under highly controlled circumstances. The woman must first inject drugs to cause her body to produce and mature multiple oocytes. Approximately 36 hours after a trigger injection to complete the maturational steps, a doctor inserts a slender needle through the woman’s vagina to remove the mature oocytes from her ovary. A laboratory specialist then exposes the oocytes to her partner’s sperm cells, fertilizing the eggs to create embryos and leaving them to grow for three to five days. In cases where sperm are defective or few in number, or there are difficulties with the fertilization process, the sperm cells may be injected directly into the oocytes using a process called intracytoplasmic sperm injection (ICSI).
The resulting embryos are placed into the woman’s uterus through the vagina using a small catheter. For the following three to five days, the embryos float freely in the uterus and then implant onto the uterine walls. The pregnancy hormone human chorionic gonadotropin (HCG) is first detectable in a woman’s blood about 10 days after fertilization and three to five days before the first missed menstrual cycle. Pregnancy testing will usually take place two weeks after the trigger injection.
