Vijaya Maternity Home & Metro IVF centre

The inability to conceive after indulging in unprotected sex is known as infertility. It can also be referred to the biological incapability of a male to cause the conception or a woman being unable to carry the pregnancy for full term. Research has shown that female problems contribute to over half of all the infertility cases while a majority of the other causes include sperm disorders.

Treatment of infertility depends on:

1. Cause of Infertility
2. Duration of Infertility
3. Age of both partners
4. Personal preferences

Causes:
Causes of infertility in women include:
1. Ovulation disorders: This is regarded as the most common cause of infertility in women. The disorders can be caused due to the following

• Premature ovarian failure
• PCOS (polycystic ovary syndrome)
• Poor egg quality
• Hyperprolactinemia
• Overactive or Underactive thyroid gland
• Chronic conditions like cancer or AIDS.

2. Problems in fallopian tubes or uterus: Abnormalities in the uterus or fallopian tubes render the woman incapable of conceiving naturally. This might be due to:

• Submucosal fibroids
• Surgery
• Endometriosis
• Previous sterilization treatment

3. Medications: There is a possibility that treatment will cure infertility. Examples include NSAIDs (non-steroidal anti-inflammatory drugs), Chemotherapy and Radiotherapy.
Treatment of infertility might involve a significant amount of psychological, physical, temporal and financial commitments.
In men, treatment is done to treat lack of healthy sperm or general sexual problems. The treatments include:

1. Medications
2. Surgery
3. Change in lifestyle
4. Sperm retrieval

Even though it is possible to restore fertility in women using only one or two therapies, a number of treatments might be required before conception is possible. Some of these treatments include:

1. Intrauterine insemination (IUI)
2. Stimulation of ovulation with fertility drugs
3. Surgery to restore fertility

In situations where pregnancy does not happen spontaneously, Assisted Reproductive Technology (ART) can be used by couples to achieve pregnancy. It is a form of fertility treatment which involves the handling of sperm and egg. The entire ART team consists of psychologists, physicians, embryologists, nurses and lab technicians.

One common ART technique is In vitro fertilization (IVF). It is a process where an egg and sperms are manually combined in a laboratory dish, followed by transfer of embryo to the uterus. Some aspects involved in an IVF cycle are:

1. Intracytoplasmic sperm injection (ICSI)
2. Assisted hatching
3. Donor eggs or sperm
4. Gestational carrier

Some complications that may occur during the treatment of infertility are:

1. Multiple pregnancy
2. Ovarian hyperstimulation syndrome (OHSS)

If you wish to discuss about any specific problem, you can consult a Gynaecologist.

A problem in any one of a number of key processes can result in infertility. Male and female factors can exist in isolation or combination and fertility investigations, diagnoses and treatment should always be considered in the context of the couple.

Male factor
Sperm problems will contribute to about 40% of infertility cases. The normal working of the male reproductive system involves first the production of sufficient numbers of functional sperm cells and then the delivery of these sperm to the ejaculate. Key to the diagnosis of male infertility is a semen analysis, which assesses primarily sperm numbers, sperm movement and sperm form.

Female factor
Dysfunction of the female reproductive organs is also apparent in around 40% of infertile couples. The most common identifiable causes of female fertility problems are outlined below:

1. Ovulatory dysfunction, (or anovulation) where an egg is not released from the ovary every month, is the single most common cause of female infertility. Predominantly anovulation is caused by hormonal imbalances such as Polycystic Ovarian Syndrome (PCOS) but ovarian scarring and premature menopause can also result in failure to ovulate.
2. Tubal disease, comprising anything from mild adhesions to complete blockage of the fallopian tubes, prevents fertilised eggs from travelling from the site of fertilisation to the uterus. It may also prevent the sperm from reaching the egg. Normal uterine implantation can therefore not occur. The main causes of tubal infertility are pelvic infections caused by bacteria such as chlamydia, previous abdominal disease or surgery and ectopic pregnancy.
3. Endometriosis is characterised by excessive growth of the lining of the uterus. These endometrial cells can extend as far as the outside of the fallopian tubes, the ovaries and the bladder. As they respond to hormones the same way as they would do in the uterus, that is by growing and shedding cyclically, endometriosis can cause both fallopian tube and ovarian scarring.
4. Repeated pregnancy loss - Some people may not have difficulty conceiving, but have suffered from miscarriages. This is obviously extremely distressing for the couples involved. Our miscarriage clinic can help investigate these issues and attempt to help couples with any future pregnancy.

Less common factors
The following other factors may also be responsible for infertility in a smaller proportion of cases:

1. Genetic abnormalities within eggs, sperm or both
2. An abnormal uterine cavity, including the presence of fibroids or polyps
3. Immunological infertility, whereby either the male or female partner produces anti-bodies against sperm cells or implantation of an embryo
4. Abnormal cervical mucus which hinders the passage of sperm to the uterus and fallopian tubes
5. Unexplained infertility - Even when investigations have been extensive, some couples will have no reason with which to explain their infertility. This can often be a frustrating diagnosis. In these cases the duration of the infertility is the best parameter by which to judge the chances of future natural conception; the longer the time of infertility then the sooner intervention should be considered.

Please do consult a competent sexologist for unexplained infertility problems.