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Know More About Infertility

Written and reviewed by
MBBS, MD - Obstetrtics & Gynaecology, DNB (Obstetrics and Gynecology)
IVF Specialist, Delhi  •  21years experience
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Today we are going to discuss what exactly is infertility and what are the causes behind it? and basically in today's topic we are going to discuss the causes in women which are responsible for her being infertile or we call it subfertile. So infertility actually refers to a condition where a lady is unable to get pregnant even after 1 year of trying without any contraceptives. In 30% of cases actually the women is responsible, in another 30% of the cases man is responsible and in 30% both are responsible we call it combined infertility where both men and women are responsible. So today I am going to elaborate on the cases where the woman is responsible, what are the causes where she is responsible. The most common in today's scenario is hormonal imbalance, every month an egg is released from the ovary at a particular time it is around day 13 or 14 of a normal menstrual cycle in a normal ovulatory lady, but in a lady where ovulation problem is there she will not ovulate or the egg is not released at the required time.

So if the egg is not released, obviously she is not going to get pregnant. The most common condition in such cases call polycystic ovary syndrome or PCOS. In PCOS there multiple small eggs none of them is growing, all of them are small or if we make them grow all of them starts growing, so the basic problems in PCOS she is not ovulating, egg is not released on day 14 of her cycle, the cycles are prolonged she doesn't bleed after every 28 or 30 days. She may get her periods after 3 months, 4 months whenever naturally her egg is released or it is not released at all. So polycystic ovarian syndrome or ovulatory dysfunction is one of the most common condition causing infertility in women. Second disease which we call common in today's scenario is ovary which is not able to make good quality egg, we called it premature ovarian failure or decreased ovarian reserve, I do not know the exact cause why it is increasing in today's time? it was not there previously but nowadays we see very young girls 22-23 years of age and her ovaries have stopped producing eggs maybe the environmental conditions or nutrition everything has changed now or pollution also.

So this condition is again coming to us more frequently than it was. Apart from ovulation problem, another common problem which we see in the woman is tubal problem, tubal blockage, it might be on one side, it might be on the both sides, sometimes it is not actually blockage, the tubes are very unhealthy which we find out on the laparoscopic examination. So in tubal blockage obviously the egg is getting released but it is not able to come to the uterus or the cavity where it has to implant so obviously she is not going to get pregnant because the pathway is blocked, the eggs are not coming towards the uterine cavity. Most common conditions where the tubes get blocked are pelvic inflammatory causes, there is some sort of infection which has caused the tubes to stick to each other, the walls of the tubes stick to each other so that is why there are blocked. In Indian circumstances, the most common cause for tubal blockage or pelvic infection is genital tuberculosis, it is very common and very difficult to diagnose. Another common pelvic infection are chlamydia or the various other conditions where there is an infection in the pelvis for a long time and it causes tubal blockage.

So in tubal blockage two situations. It can be seen at the extreme end, which is called fimbrial block or it can be near the uterine called cornual block, so in cases of tubal blockage ideally we reconfirm or re check it with the help of a laparoscopy procedure, it is daycare small procedure just to diagnose whether there is actually a blockage or not? or third whether we can treat the blocked at the same time, this is a small blockage which present in the fimbrial and 99% of the cases we are able to open it but if it is a block at the cornual end, most of the cases we are not able to open it. Secondly in laparoscopy we try to find out the cause behind the blockage, why there is block, if we can treat it beforehand, if we start IVF and we treat it before that then we get very good success rates in IVF also. Next common cause in cases of women is the uterus itself, so we have discussed the ovulation cause which is present in the ovary, we have discussed the tubal cause because the tubes are going to carry the eggs towards the uterus and now the causes of uterus, uterus as a lining which every lady shed of every month which is called a menstrual period.

So there is a problem in the lining then again she is not able to get pregnant, this lining problem can be seen on ultrasound or if a lady has got her menses very scanty, she is getting less menses nowadays then we start predicting that yes probably there can be a problem in the lining of the uterus so this lining can be checked by ultrasound and then again by hysteroscopy. If we can correct it at the time of hysteroscopy we try to correct it and reconstruct the uterus, so that she can conceive again.

Thank you.

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