Brief description of infertility and its treatment
I am Dr. Radhika gynecologist and infertility specialist from the Institute of Women's Health and Fertility. Infertility almost in about 10-15% of couples trying for pregnancy are facing the problem with conception. This is almost a rising trend that nowadays almost 1 in 6-7 couples have problem in conception.
When did we call it infertility? Infertility is nothing but when a couple is trying to conceive without any protection or without any means of protection for almost 1 year of unprotected intercourse we call it infertility. Let me just explain how an infertile couple is taken through an infertile clinic? During the first visit the couple is analyzed and they are taken in detail history as what is the cause to infertility? What is the duration of infertility? What is the duration of married life? What is the age of the couple that is the age of the female partner and the male partner? Had there been any pregnancy in the past? Is there any miscarriage in the past?
Once the examination and history are taken we go for workup of the patient. That is we see for the ovarian function to ensure that ovary is functioning well that is to ensure that ovulation is going fine. We also look for the tubal factors. Tubal factor analysis is done by a test called salpingogram or hysterosalpingogram. If there is a problem in hysterosalpingogram that is tubes are looking blocked then we analyze with the further test called further the surgical assessment; like laparoscopy.
Once the tubes are cleared we also analyze how the uterus is with the hysterosalpingogram? As I already told you male factor is analyzed by Semen analysis after abstinence of 2 to 5 days. Once all these are ruled out we get to analyze or we get to reach to a conclusion as what may be the probable cause of these infertile couples? There may be few factors like peritoneal factors like endometriosis. We have the endometrium of the inner layer of the uterus growing elsewhere outside the uterus. That is the inner layer of the uterus or endometrium grow in the ovaries or may grow in the pouch of Douglas. That is behind the uterus or may grow near the tubes.
These all cause addition or attachment of the uterus to the tubes. And they impair the easy pick up of the ovum or the egg from the end of the tube to the ovum end that is the inner end of the tube. When there is no egg pick up there is no pregnancy. Some most of the time in which simple infertility treatments and simple infertility counseling how they have to go about natural conception and when they have to try when the egg is being released? With all these things itself, 70% of the couples would conceive. And only in about 10 to 15% will go to the next step like IUI or further steps like test tube baby procedures. IUI is intrauterine insemination where the sperm sample is collected in the laboratory. It is washed off the impurities and the good motile sperms are injected into the uterus through a thin canella or a catheter. These sperms have to travel a very short distance from the uterine cavity into the tube when the egg is already picked up and stay. So this distance to be traveled is very short thereby increasing the chance of pregnancy. IUI is of major benefit in minimal or mild male factor infertility.
Once we have seen the other factors are also ruled out and ensure that everything is fine then we counsel the couple for IVF or test tube baby procedure. IVF is in vitro fertilization. What we do in this one is give injections or give continuous injections to the lady which will cause superovulation. Once the eggs attain a mature size we collect all of them through a thin needle into the test tube washed off the impurities and then incubated. The same time the sperm is collected in the laboratory. The egg under sperm is inseminated together and embryos are grown in the laboratory. Once these embryos are grown they are pushed back or transferred back to the womb using a thin capita that is the embryo transfer catheter. After 48 to 72 hours usually or even after 5 days sometimes.
But, in few men or in few couples the problem is the severe male factor infertility. That is we find only a few sperms or in the ejaculate, we find only a few sperms or sometimes not even a few sperms in the ejaculate. In that condition, we can surgically aspirate the sperm from the testicular tissue and see if it is already there. Once we get a good sperm from the testicular tissue we inject that good sperm tissue in the cytoplasm of the egg so that we have the maximum chance of fertilization. This particular process is called ICSI or Intracytoplasmic sperm injection. So this increases the chance of fertilization and this further increases the chances of pregnancy also. That's it about infertility over you.
Thank you And if you have any issues regarding infertility or regarding counseling about how conception occurs are how to go about the trial for pregnancy you can visit us.In case you have a concern or query you can always consult with IVF specialists in Pune City & get answers to your questions!