While some couples conceive with ease, conceiving a child can be extremely difficult for others. In cases where a woman is not able to get pregnant despite having regular intercourse in tune with her biological cycle, infertility tests may be suggested to investigate the reason behind this. In most cases, these tests are suggested if a year has gone by without intercourse resulting in a pregnancy. Women may also be said to be infertile, if they cannot carry a foetus to full term. 

Infertility can affect both men and women and can be triggered by a number of different reasons. In some cases, it is treatable while in others, alternative ways of having a family may need to be discussed. Hence, it is very important to understand the different types and triggers for infertility and to undergo complete infertility investigations. Some of the common types of infertility investigations are as given below.

Blood tests: A blood test of both partners is used to assess the general health of the couple and to identify any health factors that may be impeding fertility.
Tests for women: 
Hysterosalpingogram: This is an X ray that can identify if a blockage or any other issue in the fallopian tubes are the cause for infertility.
Pelvic ultrasound: This is used to have a look at the anatomy of the female reproductive system and to check for fibroids.
Laparoscopy / hysteroscopy: This is used to get a clearer picture of the ovaries, uterus and other parts of the reproductive system.
Tracking cycle: Ovulation and the thickness of the uterus lining may also affect infertility, This can be diagnosed by tracking and assessing the menstrual cycle.
Tests for men
Semen analysis:This test is used to get an idea of sperm concentration, motility and the appearance of sperm in a man s semen. In some cases, the semen may not include any sperm cells. In such cases, a follow up investigation may be required to assess if sperm cells are being created in the testicles. This is known as testicular sperm aspiration or a testicular biopsy.
Sperm DNA: The DNA in sperm also plays an important role in fertility. This test is used to assess the sperm DNA integrity and to see how it may affect embryo development and chances of an on-going pregnancy.
Infertility treatment depends on the cause identified by the above tests and hence it is important for both partners to undergo complete testing.

Complete Infertility Investigation - Why is It Important?

Almost every man and woman craves to have a child they can call their own. This makes an inability to procreate one of the most dreaded situations. Infertility can be defined as the inability to conceive a child within 12 months of biologically appropriately timed intercourse. Infertility exacts a huge psychological toll on the person.

Infertility often triggers depression in a person. This may be acute and result from specific events such as the holidays, family celebrations of the news of a someone else having conceived a child or could be cyclic and coincide with phases of their fertility cycle. This depression could lead to problems at work and communication with the spouse.

Infertility can also make a person feel helpless and affect their self esteem. Infertility accompanied by depression can trigger the feeling of having lost control over one s life and can make people withdraw into themselves.

An infertile person may also often feel guilty and make them blame themselves and their prior actions for the condition. This leads them to question their worthiness of being a good spouse and potential parent. A woman who has suffered from an STD earlier or has undergone an abortion earlier can become obsessed with blaming herself for being infertile. 

This affects their daily lives and ability to work. An infertile person may also feel guilty for having robbed their partner of the chance to become a parent. This can put a strain on their relationship and in many cases lead to a broken marriage.

When they find themselves unable to conceive a child, a couple may try to time their intercourse with ovulation tools, such as an ovulation thermometer etc. and may try different positions, some of which may be fairly uncomfortable. They may also end up having intercourse more often than desired. In order to prevent sperm from leaking out of the vagina, a woman may also find herself lying in an awkward supine position after intercourse. A combination of all these factors makes the act a chore and with time can lead to a loss of libido.

Infertility can also trigger anger against life for having been treated unfairly or towards other parents. This may also be displaced towards their family and friends leading to situations where they feel ostracized and unsupported.

When dealing with infertility, it is important to understand that neither partner is to blame. Infertility is a physiological condition and can be treated in most cases. It is important for both partners to support each other during this process and if need be consult a counselor.

Infertility - Its Impact on a Person's Mental Health

Female infertility is considered as the inability of conceiving. As per WHO it is described as the inability to be pregnant, maintain and carry forward a pregnancy to its full term. It is often of two types:

    Primary Infertility: This is the inability to give birth to a baby either due to the inability to become pregnant or maintain a pregnancy, which includes stillborn and miscarriage.
    Secondary Infertility: This refers to the inability to give birth when there is already a live birth or the woman was pregnant.

The causes of infertility can vary from being acquired or genetic. However, following factors are largely responsible for infertility:

    Genetic: Some genes can lead to mutation leading to infertility like, in case of BMP15 gene there is a hypergonadotrophic ovarian failure which causes infertility.
    Acquired: This is caused by factors like age, smoking, sexually transmitted diseases, obesity, body weight, eating disorders, diseases like diabetes, thrombophilia and also radiation and chemotherapy.

The treatment for infertility usually depends on the cause, age, duration of time for which a person has been infertile and preference of the patient. Infertility is believed to be a complex disorder and the treatment involves a huge amount of physical, financial and psychological commitments. All this also requires a lot of time. Some women might need just a minimum of two therapies to attain fertility while others might require different treatment before they can conceive.

Treatment is largely aimed to restore the fertility either by means of medication and surgery or help in reproduction with the help of some procedures.

Fertility Restoration through medication

This is the main treatment for women who are infertile because of ovulation disorders. These drugs include:

    Gonadotropins: These are injected to stimulate the ovaries. Drugs like Menopur, Repronex, Follistim AQ, Gonal-F, Bravelle restore the production of eggs, while Ovidrel and Pregnyl are used for maturing the eggs and for their release.
    Clomiphene citrate: This is taken orally and stimulates ovulation by releasing more Follicle Stimulating Hormone and Luteinizing Hormone from the pituitary gland.
    Metformin: This is used in females who have PCOS and also when insulin resistance plays a major role in infertility.
    Bromocriptine: Used when the infertility is caused due to excess prolactin production.
    Letrozole: This also induces ovulation

Fertility Restoration through surgery

Surgical procedures can amend the problem of infertility. However, these treatments are very rare these days owing to the success of other fertility treatments. These include:

    Tubal ligation reversal surgery: In case a tubal ligation has been performed it can be reversed by reconnecting the tubes again through surgery.
    Hysteroscopic surgery: This corrects or removes the abnormalities that cause infertility. This surgery can correct the shape of the uterus, remove endometrial polyps and improve chance of getting pregnant.
    Tubal surgeries: In case of blocked fallopian tubes laproscopic surgery can be performed to dilate the tubes, removed blockages or create a new opening.

Assistance in Reproduction through techniques

The most common used techniques for reproduction assistance are:

    Intrauterine insemination or IUI: In this about million healthy sperms are put in the uterus at the time of ovulation.
    Assisted reproductive technology: In this mature eggs are retrieved from a woman and this is then fertilized with sperms in a dish in the lab. Once the fertilization is done the embryo is placed in the uterus for further development. IVF is the most common and effective assisted reproductive technology. This procedure takes place over weeks with several blood tests and hormone injections.

Dealing with infertility is not easy and can be emotionally and physically draining. To cope with the various tests and treatments of infertility one should be fully prepared, eat a healthy diet, exercise reach out for help and support of family and friends and look for other options like a donor egg, adoption or no children.

Treatments of Infertility

Common causes of infertility in Women

Fertility in women can be affected because of various external or internal reasons. It is good to understand the problems since this fast becoming a very common problem. 

The causing factors usually include - 

1. Ovulation problems - One reason for female infertility is when eggs don't mature in the ovaries. This is known as ovulation problems. Possible symptoms of this are absent or irregular periods and the possible solution is keeping a check on body weight, taking fertility drugs and/or having IVF.

2. Uterus problem - There are tissues, known as endometrial tissues which form the lining of the uterus. When they grow outside the uterus, it is called endometriosis and can be a reason for infertility. While some women have no symptoms of this, some have painful periods. Fertility drugs, ivf and surgery to remove the tissue are its possible solutions.

3. Pcos - Pcos or Polycystic Ovarian Syndrome is of late one of the most common reasons of female infertility. It is characterised by unpredictable ovarian patterns and hormonal imbalances. Possible symptoms are acne, obesity, irregular periods, and excessive hair growth. Weight loss, changes in lifestyle, injected fertility drugs, ivf and ovarian drilling are its possible solutions.

4. Damaged fallopian tubes - Some women have blocked or damaged fallopian tubes which prevent the sperm from getting to the egg. This situation leads to stds and pelvic inflammatory diseases. There are no symptoms as such and the methods of solution are surgery to open the tubes and if that is not possible, to remove the tubes and try ivf.

5. Unidentified reasons - There are many unexplained fertility problems where none of the above mentioned problems exist. In such situations, fertility drugs - with or without artificial insemination or ivf are advised.

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5 Major Causes Of Infertility In Women

There are some commonest misconceptions about infertility and these misconceptions should be eliminated as soon as possible so that the actual facts can be known. There are many online sites where you can find detailed information on the scientific explanations regarding infertility and you can follow them.

List of myths and facts regarding infertility

1. Myth: The menstrual cycle of a woman is for 28 days.
Fact: Normal cycle ranges between 21 to 36 days.

2. Myth: A woman can have pregnancy on the day one of menstrual cycle.
Fact: The released eggs remain viable for almost 12-14 hours and a woman can get pregnant after an intercourse done two days after ovulation and five days before ovulation.

3. Myth: Infertility occurs due to stress.
Fact: Ovulation can surely get delayed due to hormone suppression, but infertility does not occur due to stress.

4. Myth: Sperms stay active for few hours.
Fact: Sperms stay alive at least for five days.

5. Myth: Men with a higher sexual drive will have a normal sperm count.
Fact: There is no relation in between fertility and virility. Sometimes, it has been found that men having a higher sex drive do not produce sperms.

6. Myth: Women have to wait for three months to conceive after stopping the usage of contraceptive pills.
Fact: As soon as a woman stops pill usage, hormonal levels go back to normal condition, as a result of which ovulation begins immediately.

7. Myth: Only females have infertility troubles.
Fact: Both women and men suffer from infertility troubles as per the current scientific studies.

8. Myth: Ovulation occurs in a woman on the 14th day of menstrual cycle.
Fact: Ovulation can be calculated by counting 14 days backwards from the past menstrual cycle's last day.

9. Myth: Daily sex can increase conceiving chances.
Fact: During ovulation, having sex each day, especially in between 12 to 16th day of the cycle can be the best timing.

10. Myth: Fertility troubles occur at 35.
Fact: Peak fertility timing in a woman's life is 20 and this might continue until late 30s. Fertility troubles might even arrive at a younger age. With age, conception chances get declined, especially after 35.

Myths & Facts About Infertility

One of the most important decisions a couple takes is to start a family. It fills them with hope and joy of new future, but if the attempts have been unsuccessful for more than six months, it can take a toll on the relationship and the mental health of the couple. This is the time to seek fertility specialist who will be appropriate to analyze the situation and provide proper guidance. Read on to find out the exact indications to see a fertility specialist:

1. If a woman who is under the age of 35 is unable to get pregnant even after a year of having regular unprotected sex
2. A woman who has had more than three miscarriages
3. Someone who has suffered from blocked fallopian tubes and is in need of surgery
4. One who experiences irregular ovulation
5. A couple who has suffered from genital infections
6. A pregnant woman who has consumed an estrogen derivative
7. A man who has been diagnosed with low semen count, also known as poor motility
8. A couple who has not been diagnosed with any irregularity but is infertile

Which specialist should you visit?

If you or your partner or both have shown signs of infertility, then visiting the following specialists can be helpful:

Specialists for men

Urologists and Andrologists are specialists who treat men for infertility. Urologists conduct an analysis of semen quality, semen count, hormone levels, reproductive organs and abnormalities in bladder and kidneys. Andrologists are medical professionals who specialize in hormonal conditions and physiology of male infertility.

Specialists for women

Hormonal imbalance is one of the potent obstacles to pregnancy. If a general obstetrician/gynecologist has not been able to successfully treat a woman then she can visit a reproductive endocrinologist who specializes in hormonal disorders. Depending upon the nature of the problem, she can also visit a reproductive surgeon who deals with uterine abnormalities, endometriosis, and reproductive organ surgery.

When Should a Couple See a Fertility Specialist?

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