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Reproductive issues/Infertility


Know about Infertility and its Treatment

Being a mother is something many women dream of but some women find it extremely difficult to live this dream. A couple is said to be infertile if they are unable to conceive in 12 months or more of well-timed unprotected intercourse. The risk of infertility increases with age. Infertility can affect both men and women and can be triggered by a number of factors

The risk factors for infertility are-

  • increasing age of couple, more than 35 for female and more than 40 for male. Although fertility starts declining after 30 years in Indian woman.
  • Obesity
  • being extremely underweight,
  • smoking and alcohol consumption.
  • In addition, a diet that is deficient in zinc, folic acid and vitamin B12 can aggravate problems with conception.
  • Ovulation and sperm production may also be affected by stress and exposure to chemicals, pesticides, Diabetes, heart disease, certain drugs etc
Thankfully, in most cases, infertility is not a condition one has to live with and with the latest technology most of the couple can fulfil there dream of having a baby.
  • Infertility can be caused by the following:
  • Sperm disorders (≥ 35% of couples)
  • Ovulatory dysfunction or decreased ovarian reserve (about 20%)
  • Tubal dysfunction and pelvic lesions (about 30%)
  • Abnormal cervical mucus (≤ 5%)
  • Unidentified factors (about 10%)
  • Inability to conceive often leads to feelings of frustration, anger, guilt, resentment, and inadequacy.

Treatment for infertility depends on the factors triggering infertility. Hence, the first step to deal with infertility is to understand the factors that cause this condition.

Most common causes of infertility include:

Anovulation : Anovulation refers to the absence of ovulation. This condition is often caused by the polycystic ovarian syndrome. If an egg is not released by the ovaries, it cannot be fertilized by sperm and hence causes difficulties with conception

Tubal infertility: A blocked fallopian tube or scarring on the fallopian tube can by caused by pelvic inflammatory disease, STDS or endometriosis.

Male factor: Sperm may be too few in number ( Oligospermia), move too slowly (Asthanosperia0, or be structurally abnormal (Teratozoospermia)l, or their passage out of the body may be blocked or disrupted.

Diagnosis and Investigations in a case of infertile couples

A doctor’s evaluation

Various tests depending on the suspected cause

The diagnosis of infertility problems requires a thorough assessment of both partners. Usually, the assessment is done after at least 1 year of trying to achieve a pregnancy. However, it is done sooner if-
  • The woman is over 35 (usually after 6 months of trying to become pregnant).
  • The woman’s menstrual periods occur infrequently (fewer than nine times a year).
  • The woman has a previously identified abnormality of the uterus, fallopian tubes, or ovaries.
  • Doctors have identified or suspect problems with sperm in the man.
  • Age is a factor, especially for women. As women age, becoming pregnant becomes more difficult, and the risk of complications during pregnancy increases. Also, women, particularly after age 35, have a limited time to resolve infertility problems before menopause.

Tests are done depending on the suspected cause. Basic tests done are

  • TSH for thyroid disorders
  • Serum Prolactin levels, Increased levels may lead to ovulatory disfunction.
  • For problems with ovulation: Ultrasonography to determine whether and when ovulation occurs.
  • For tubal factor- HSG ( Hysterosalpingography)- HSG, is an X-ray test to outline the internal shape of the uterus and show whether the fallopian tubes are blocked. In HSG, a thin tube is threaded through the vagina and cervix. A substance known as contrast material is injected into the uterus.
  • Chromopertubation- Chromopertubation is a method for the study of patency of fallopian tube in suspected infertility in women. This is done through Laparoscopy.
  • For sperm disorders: Semen analysis

Fertility treatment includes:

Ovulation induction: This involves stimulating ovaries in women suffering from anovulation and infertility with the help of medication. This can also be used to treat infertility caused by the polycystic ovarian syndrome. Ovulation can be induced with oral and injectable medication. The success of this form of treatment depends on the age of the woman, cause and the type of medication used.

Artificial insemination:Intrauterine insemination can be used to treat unexplained infertility, early stages of Endometriosis, hostile cervical condition, including cervical mucus problems and ejaculation dysfunction in males. The age of the woman plays a significant role in determining the success of this form of treatment. Intrauterine insemination may be accompanied by the use of oral or injectable medication to stimulate ovaries

In Vitro Fertilization (IVF) or Inracytoplasmic sperm injection (ICSI) : Main indication of IVF is damaged or bilateral blockage of Fallopian tubes. This process involves stimulating Ovaries for developing multiple eggs which are then retrieved and fertilized in a laboratory and then embryos are transferred back into the uterus. IVF can be used to treat almost all forms of infertility except those caused by severe anatomic problems with the uterus and has a high success rate.