What are the factors that make a woman fertile? + The most effective way to address infertility

Infertility is the inability to get pregnant after a year of unprotected intercourse. Both men and women can be infertile.

In about one-third of cases, the cause of infertility involves only the male.

In about one-third of cases, the cause of infertility involves only the female.

In the remaining cases, the cause of infertility involves both the male and female or no cause can be identified.

Women are born with a finite number of eggs. Thus, as the reproductive years progress, the number and quality of the eggs diminish. The chances of having a baby decrease by 3% to 5% per year after the age of 30 and this reduction is noted to a much greater extent after age 40.

Female infertility can also be caused by a number of factors including:

1. Damage to fallopian tubes

Damage to the fallopian tubes can prevent contact between the egg and sperm. Pelvic infections, endometriosis, and pelvic surgeries can lead to fallopian tube damage.

2. Hormonal causes

This can lead to ovulation disorders which prevent the ovaries from releasing eggs such as in polycystic ovary syndrome ,  hyperprolactinemia or disorders of the thyroid gland - hyperthyroidism / hypothyroidism, can interrupt the menstrual cycle and cause infertility.

3. Cervical causes

A small group of women may have a problem in which the sperm cannot pass through the cervical canal. Whatever the reason is , this problem may be treated with intrauterine inseminations.

4. Uterine causes

Abnormal anatomy and distortion of the uterine cavity due to the presence of polyps and fibroids or problem with the endometrial lining can lead to failed implantation of the embryo.

Endometriosis occurs when endometrial tissue grows outside the uterus - often affecting the function of the ovaries, uterus, and fallopian tubes.

5. Primary Ovarian Insufficiency:

Also called as Premature Menopause, when the ovaries stop working prematurely before the age of 40. Certain conditions are associated with early menopause like immune system diseases, radiation or chemotherapy and smoking.

Causes of male infertility may include:

1. Abnormal sperm production or function due to various problems, such as undescended testicles, genetic defects, health problems including diabetes, prior infections such as mumps, trauma or prior surgeries on the testicles or inguinal region.

2. Problems with the delivery of sperm, due to sexual problems, such as premature or retrograde ejaculation, certain genetic diseases, such as cystic fibrosis, structural problems, such as blockage of the epididymis, or damage to the reproductive organs.

3. Overexposure to certain chemicals and toxins, such as pesticides, radiation, tobacco smoke, alcohol, frequent exposure to heat can elevate the testicular temperature, impairing sperm production.

4. Damage related to cancer and its treatment, including radiation or chemotherapy for which timely cryopreservation can be done for future use.

5. Unexplained infertility, In approximately 20% of couples the cause cannot be determined using the currently available methods of investigation.

Why is IVF the best way to treat infertility in women?

Conception is a complicated process that depends on upon many factors:

On the production of healthy sperm by the man and healthy eggs by the woman

The sperm's ability to fertilize the egg when they meet.

The ability of the fertilized egg (embryo) to become implanted in the woman's uterus

IVF (or in-vitro fertilization) is a lab procedure where the sperm and the egg are combined in a dish (where fertilization takes place) and is followed by transferring the embryo (the fertilized egg) into the uterus. It is increasingly being used as a method to conceive as it has been established as a safe procedure that helps bypass a number of complications women may face while conceiving such as ovulation problems and issues with the fallopian tube.

Even women who face issues such as PCOS, endometriosis, and premature ovarian failure can conceive through this process. Moreover, IVF has been in practice since 1978 and has a safe track record. The success rates of IVF are high as well, making it a preferred procedure for couples who suffer from fertility problems. Unexplained infertility can also be treated with the help of this procedure.



What factors that  make a woman fertile? + The most effective way to address infertility

Daljindar Kaur's inspiring story of motherhood: How IVF became her savior

The success of In vitro fertilization continues in India as a septuagenarian woman gives birth to a baby boy. Even after 46 years of marriage, the couple from Amritsar was childless. Daljinder Kaur, along with her 79-year-old husband, Mohinder Singh Gill, had been visiting National fertility and the Test Tube Baby Centre in Hisar since 2013 and did not give up even after two failed IVF cycles. They had faced ridicule for their inability to have a baby and yet they kept their hopes up.
On the 19th of April, the couple was blessed with a baby boy who is nothing less than a miracle. The groundbreaking achievement of the embryologists from Hisar has been an inspiration and a beacon of hope for couples all across the country. Once again, IVF has proved to be one of the most successful procedures to have babies for couples with fertility issues. Following are some of the advantages of In vitro fertilization, which you should know about-
1. It can be used by anybody
In-vitro fertilization is not necessarily used by the going to be a mother. It can be used by gestational carriers or by a surrogate as well. So it depends on whether the parents want to take the help of a surrogate or themselves want to be involved in the pregnancy. IVF gives an opportunity to single women and same-sex couples to become parents.
2. Use of donated eggs and sperms
There might be circumstances when the doctor can recommend using donated sperms or eggs. In that case, the eggs can be fertilized manually in the lab and the fetus developed can be used for in vitro fertilization. This increases the chance of pregnancy by a fair amount.
3. Control over timing
In vitro fertilization is a solution for couples who have a very engaging professional life, and can be an option for people who want to have babies after a certain point of time. Eggs and embryos can be preserved for future use. It is also helpful for couples who already have a child and plan to have another later.
4. Decreases chances of miscarriage
Genetic abnormality is one of the primary causes of miscarriage. The technique of preimplantation genetic diagnosis (PGD) is used to ensure the viability of the embryo much ahead of time so that the mother can have an uncomplicated pregnancy and carry her baby full term.



Daljindar Kaur's inspiring story of motherhood: How IVF became her savior

It is as important for the man as it is for the woman to undergo certain tests before the IVF cycle is started. Fertility is not only an issue for a woman, but it also might be for the man in question. There are certain tests that need to be conducted on men before they can gear up for IVF:

1. Semen Analysis: One of the most important tests for male infertility is semen analysis. Sometimes, a man may be completely healthy, but his sperm production could be of poor quality. Semen analysis is done to provide an accurate evaluation of sperm number, the ability to move (motility), size and shape (morphology), as well as the consistency and volume of the sample collected.

2. Binding Test: Sometimes agglutination occurs where the sperms might stick to each other by their heads or tails. Sperm antibodies might cause this problem. The IVF treatment's success might be compromised if this happens. A simple binding test is done to determine this.

3. Trial Wash: This is also known as sperm wash. It is mostly done to remove chemicals from the sperm. Not doing a sperm wash might end up affecting the later stages of the IVF treatment. In this process, the misshapen and immotile sperm is separated so a clean sample of motile and healthy sperm can be collected.

4. TUNEL Assay: Since sperms build up about half of a child's genetic makeup, a TUNEL Assay or 'sperm DNA test' is required. This test is done to measure the sperm population that have fragmented DNA. Negative impacts on genetics can hamper the success of the fertility treatment.

TUNEL Assay is usually recommended to men with:
a) Leukocytes detected by the sperm analysis
b) Age approaching 50
c) A history of diabetes II type or prostatitis
d) Exposure to chemicals or prolonged heat at workplaces

5. Screening for Infectious Diseases: This test is done for both the partners to check for diseases like AIDS, Hepatitis C, and so on.

Tests Suggested for Men Before IVF

In vitro fertilisation, commonly known as IVF, is the process of fertilising single or multiple eggs outside the body. This treatment can be performed by either using your own egg and sperm or using donated egg or sperm or sometimes both. The resulting sperms and eggs are evaluated for quality and then one or more of them are positioned properly in the uterus through the cervix. IVF is regarded as one of the most commonly opted treatment plans, and it accounts for more than 99% of assisted reproductive technology processes.

Who are suitable for IVF?
IVF can be helpful for you in case you have some issues with the egg quality or ovulation, fallopian tubes that are blocked in some way or endometriosis. It can also help you to get pregnant if your partner has problems with mortality and sperm count and when you have opted for donor eggs. About 1.5% of babies in the United States are conceived through the IVF process.

How does IVF work?
There are several steps through which IVF process works and the timeline follows the following steps:

    Stimulation for ovary: You will have to take a special kind of fertility drug for 8 to 14 days near the start of your menstruation cycle. This drug aids in the stimulation of your ovaries for developing multiple mature eggs to fertilise instead of a single one. You may also need to take an artificial hormone-like cetrofelix and leuprolide for keeping your body from releasing eggs very early.
    Development of follicle: When you are under all these medications, you will have to visit your doctor s office often for checking the hormone levels as well as ultrasound measurements for the ovaries.
    Getting the trigger shot: Once the follicles are ready, you are likely to receive a trigger shot, which is an injection causing the eggs for maturing fully and becoming capable of being fertilised. Your eggs are ready for being retrieved after about 36 hours of receiving this shot.
    Gathering the eggs: At this stage, you are likely to receive an aesthetic or ultrasound probe that is inserted through the vagina for checking the ovaries and identifying the follicles. Normally, about 8 to 15 eggs are retrieved through the insertion of a thin needle.
    Fertlisation: This is the most vital step, where an embryologist is going to examine the eggs before they are combined with the sperm and incubated overnight. Fertilisation happens at this particular time, but abnormal eggs are not fertilised.

Then the embryos slowly develop and are planted on the basis of your age and clinical condition. When the treatment is working, an embryo is implanted in the uterine walls and starts developing. 

IVF - How Does it Work?

Frozen Embryo Transfer or FET is an extremely effective method to conceive a pregnancy. Recent studies have proved that there is a increased chance for pregnancy when the embryos, which get used are frozen and get placed inside the uterus at a time right after the ovaries are stimulated. Still, certain issues can arise with the transfer of frozen embryo, such as:

A Thin Lining of the Uterus
Research has shown that there are not many women who get pregnant if the lining in their uterine does not tend to thicken enough. It is not clear exactly why this problem occurs in most women and moreover there is no sure shot treatment to make the lining of the uterine thick. The experts on fertility would try out different methods like increasing the amount of estrogen or change the way how estrogen is given. There are other instances when women might be given supplemental medicines, while for some, the problem will continue to exist.

What Should Be Done In Case The Problem Persists?

In case the problem continues for some women, then there are certain approaches which experts might look to adopt. The first one is to cancel the transfer of embryo and try once again at any later stage, that too with a different treatment method.
The second option which they could think of is to go ahead with the transfer, wherein they might feel that a thin lining does not necessarily mean that it is impossible for a woman to get pregnant but definitely the efficiency would be reduced.
One last option is to make use of the opportunity for undergoing additional tests which would help them to assess the ability of the uterus to allow implantation of the embryos.
Unexpected Ovulation
For enabling the embryos to get implanted into uterus, placing them very precisely and at the appropriate time is important. This is regarded as the window of implantation. The time taken, is based on the time frame since progesterone reaches the lining of the uterine.

Doctor knows the exact time to place the embryos, right from the time he or she instructs a woman to start having progesterone supplements. In case a woman was to ovulate, the production of progesterone would begin earlier than the normal time and would lead to the shift of the window of implantation. As identifying the correct time of ovulation is almost impossible, so that would lead to some sort of uncertainty into the timing.

Due to this reason, there are doctors who would use medication in order to prevent unexpected ovulation from occurring. Generally an injection called Lupron is usually used as medication.

Timing for the Embryo Transfer is Inappropriate
This is a problem related to early ovulation. There are case when the implantation window is shifted, still the timing of the transfer becomes accurate. Recent studies have shown that quite a nominal percentage of women might have a window of implantation, which could be either earlier or later than normal time. A test called the Endometrial Receptivity Array can help determine at what time is the window of implantation open.

Frozen Embryo Transfer - Complications Associated With It!

When we talk about infertility attention usually falls on treatment for women. However, infertility can affect men as well. The condition of infertility, can be described as the inability to become pregnant for a period of 1 year despite having unprotected, well-timed sexual intercourse. A low sperm count is one of the primary reasons for infertility in men.

Typically there should be fifteen million sperm per milliliter of semen. Low sperm count refers to the ejaculation of less than a normal amount of sperm in semen. This can also be termed as oligospermia. A complete absence of sperm in semen is known as azoospermia. Low sperm count does not mean that you cannot impregnate your partner but it reduces the chance of a successful conception. Thus, one of the most common ways to treat infertility caused by low sperm count is IVF.

IVF involves harvesting eggs from the woman s uterus and sperm from the male partner and combining them in a laboratory to form a zygote. When IVF is used to treat male infertility, a semen analysis is the first step. This helps determine the patient s sperm count, sperm motility, volume, pH levels, white blood cell levels etc.
The ejaculated semen is then processed so as to separate the sperm cells from the plasma. In this process sperm cells with higher motility are identified and segregated. These cells have a higher chance of fertilizing the egg.
Sperm cells are then injected into the harvested egg. Some techniques may require the injection of 50,000 or more sperm cells while others such as intracytoplasmic sperm injection (ICSI) can be effective with a single sperm cell. Once the egg is fertilized, it is allowed to develop for a few days in the laboratory. 
Two or three embryos are then selected to be reintroduced into the woman s uterus with the help of a catheter. The remaining fertilized embryos are preserved in an embryo bank in case the pregnancy is not successful. If these need to be used later, the woman does not have to go through the initial stages of IVF treatment to stimulate the follicles and harvest eggs from the ovaries.
When it comes to IVF, the success rates are very high. However, one of the most common side effects is the birth of twins or triplets. This is because multiple embryos are inserted into the uterus. The number of babies born then depends on the number of embryos that are implanted successfully.

Declining Sperm Count - How IVF Can Help Deal With It?

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