Overview;- Infertility is not a disease but a condition where in a particular couple is not able to conceive. Infertility problems in a couple can be due to either the woman or the man, or it can be even due to problems in both partners. We consider a couple to be infertile if: The female is under the age of 34 and the couple has not conceived after 12 months of contraceptive-free intercourse. 12 months has been used as the lower reference limit for Time to
Pregnancy (TTP) by the World Health Organization.
The female is over the age of 35 and the couple has not conceived after 6 months of contraceptive-free intercourse. The declining egg quality of females over the age of 35yrs is the reason for the age-based discrepancy as when to seek medical intervention.
A couple that has tried unsuccessfully to have a child for a year or more is said to be subfertile
meaning less fertile than a typical couple. The couple’s fecundability rate is approximately 3-5%.
Many of its causes are the same as those of infertility. Such causes could be endometriosis,, or
polycystic ovarian syndrome.
Couples with primary infertility are the ones who have never been able to get pregnant.
Whereas, secondary infertility is defined as the difficulty in conceiving after already having conceived (and either carried the pregnancy to term, or had a miscarriage). Technically, secondary infertility cannot be considered, if there has been a change of partners.
Psychological Counseling
Medical Management
Treatment for Sexual Dysfunction
Varicocele Surgery
Trans-Vaginal Ultrasound with Follicular Monitoring
Saline Sonosalphingography (SSG)
3D/4D Uterine Scan
Intra Uterine Insemination
Semen Cryopreservation
IVF-ET
ICSI (Intra-Cytoplasmic Sperm Injection)
IMSI ( Intracytoplasmic Morphologically selected Sperm Injection)
Blastocyst Culture
PESA( Percutaneous Epididymal Sperm aspiration) / TESA (Testicular Sperm Aspiration)
Micro TESA
Endometrial Receptivity Assay (ERA)
Fertility Preservation Program
For Cancer Patients & Working Women.
Sperm Cryopreservation
Oocyte and Embryo Cryopreservation
Ovarian Tissue Cryopreservation
Treatment; – Before treating infertile couple, it is very important that both are evaluated thoroughly. A detailed menstrual history, sexual history and through examination of both the couples are mandatory. Statistics say that about eighty percent of the couple that approach for infertility treatment can be treated by counselling alone and it is only twenty percent of them that require some form of infertility treatment. Even in this category only less than ten percent will require higher modality of infertility treatment like IVF (In Vitro Fertilization) or ICSI (Intra Cytoplasmic Sperm Injection).
For men, after your doctor had finished studying health history, medications, sexual history, sex habits, physical examination, sperm analysis and for women tests like pelvic examination,ovulation study, blood tests, hormone levels, ultrasound findings, x-rays etc, the doctor can arrive the possible reasons for infertility. Based on the above said studies your doctor can start thetreatment for infertility Semen analysis and infertility treatment for male Men need to be treated when some abnormality is found in the semen analysis. The sperm count test analyses the quality and health of man’s semen.
First and the most important in infertility treatment is the correction in lifestyle or some change in lifestyle, improved sexual life etc that can help improve the semen parameters. Further to that there are also antioxidants in the form of medications that will help improve the quality of semen. There are also certain situations that can be corrected by surgery like Varicocele, Hydrocele, Phimosis etc, the correction of which can be beneficial. In cases of severe male factor, we have options like ICSI (Intra Cytoplasmic Sperm Injection) that can overcome the semen problem. In instances where there is no sperms in the semen sample (Azoospermia), the option will be to try and do sperm retrieval from the Epididymis Percutaneous Epidydimal Sperm Aspiration (PESA) or testis (Testicular / Epididymal Sperm Aspiration or Extraction TESE, Micro TESE) and use those sperms for Intracytoplasmic sperm injection (ICSI) as a part of infertility treatment.
Female Infertility Treatment
The treatment for female infertility may be based on what causes the infertility. The reason for female infertility can be the damages to your fallopian tubes or some hormonal problems or it can be cervical issues. There may be cases where the female infertility remains unexplained. Women are primarily treated depending on the cause that is identified. If not, the first option is to promote or improve ovulation with fertility drugs in the form of tablets or injections. In situations where it is associated with male factor problem or even in unexplained infertility, a procedure called IUI (Intra Uterine Insemination) is done. This is a procedure of washing the
husband’s sperm and concentrating it and injecting it into the uterus of the female at the time of ovulation. In situations, where we have diagnosed some cyst, fibroid, tubal block while evaluation then the next option is to correct it by a surgery, preferably a Laparoscopy. And then as the last resort we have option of these advanced reproductive techniques like IVF(In Vitro Fertilization), ICSI (Intra Cytoplasmic Sperm Injection) etc.
Assisted Reproductive technology (ART) using Sperm and Egg in infertility treatment Assisted Reproductive Technology (ART) is the general term used to express the different procedures of infertility treatment with the primary goal of achieving pregnancy through these infertility treatment procedures. This reproductive technology includes fertility treatment that handles both a woman’s egg and a man’s sperm.
There are several types of assisted reproductive techniques available even though they are commonly referred to as test tube treatment in infertility treatment.
Invitro Fertilization (IVF) The first option of (In Vitro Fertilization) IVF treatment means that we have just added the sperms and eggs in a particular dish and leave it for some time so that the sperm can naturally penetrate the egg and become an embryo. The second option ICSI (Intracytoplasmic sperm injection) is where in we will inject one sperm into one egg by use of an instrument called micromanipulator. ICSI is primarily done in situation where there is very poor semen parameter or some fertilization issues with the egg. When we select the sperm under high magnification (7000-10000 times) contrary to what happens in ICSI (200-400 times) and then inject the sperm into the egg, it is called IMSI (Intracytoplasmic morphological sperm injection).
Complications in infertility treatment
One of the most common complications in infertility treatment is multiple pregnancies. The multiple pregnancies primarily happens when we try and produce multiple follicles or try and transfer more number of embryos to improve the pregnancy rate during the infertility treatment.Other complication is OHSS (Ovarian Hyper Stimulation Syndrome) which is an iatrogenic complication which happens when we give medicines to produce more number of eggs. Now we have devised strategies to reduce the chances of multiple pregnancies and OHSS in our infertility treatment protocols. Other lesser common complications are bleeding or infections which are very rare and easily managed.
Multiple Pregnancies
Multiple pregnancy babies can come from the same egg or from different eggs. The cases when the babies that comes from the same egg are called identical. This is usually happened when one egg is fertilized by one sperm. Twin pregnancies are common, but multiple pregnancies especially, after infertility treatment may lead to complications. Most of treatment options available for infertility treatment involve ovulation induction (producing more number of eggs) so it is sometimes impossible to avoid multiple pregnancies. Especially while ovulation induction is done for IUI and we see multiple follicles developing then the only option being deferring or cancelling the procedure. Whereas in IVF (In Vitro Fertilization) / ICSI (Intracytoplasmic sperm injection) procedures, it can be avoided by doing blastocyst culture and doing a single embryo transfer. Even in patients with multiple pregnancies who are not willing to proceed with the same, there are also options of reducing the fetuses by selective fetal reduction, which is also a very standard procedure nowadays.
Ovarian Stimulation – Ovarian hyper stimulation syndrome
(OHSS)
Ovarian hyper stimulation syndrome (OHSS) is one of the most dreaded complications of ovarian stimulation, primarily because the treatment itself is the cause for the complication. Sometimes fertility medication to stimulate egg growth leads to a condition affecting ovaries are called ovarian hyper stimulation syndrome (OHSS). So when you stimulate to produce more number of eggs, ovaries may hyper respond even with very little dose. It is again unavoidable in majority of the situations, as it is very difficult to predict the response of all individuals to the particular stimulation protocol. There had been several strategies developed to reduce the incidence of Ovarian hyper stimulation syndrome (OHSS) which include cancelling the procedure itself, using antagonist protocol, avoiding a fresh embryo transfer, other medications etc. It is important that a patient when diagnosed with a severe form of Ovarian hyper stimulation syndrome (OHSS) gets
immediate medical attention preferably at a centre, who is used to managing such conditions.
Bleeding or infection
Both extremely rare complications which are when identified and treated can be managed completely. There is a very rare instance of bladder hematoma that can present when the needle goes through the bladder during the time of ovum pickup.
When to see a doctor? – Complication following ART (Assisted Reproductive technology) procedure It is very important that you understand when you need to see the doctor in case of complication following ART (Assisted Reproductive technology) procedure. It is accepted to have minimal pain, abdominal bloating and mild spotting or discharge after the procedure. But you would require immediate medical attention in the below circumstances
Severe abdominal distention.
Severe reduction in urine output.
Severe pain abdomen.
Breathing difficulty.
Excessive bleeding per vaginum.
Excessive foul smelling vaginal discharge.
Giddiness and fainting attacks.
Diagnosis;- Infertility diagnosis is performed initially, by collecting complete medical history and
physical examination. It will then followed by diagnostic tests for infertility. The common tests are urine
tests, blood tests, hormone levels testing etc.
Diagnosis for male as a part of infertility treatment
Semen Analysis – Is the first and most important investigation while evaluating a man. It is also important that you do a semen analysis in a standardized lab following all precautions. This is a infertility diagnosis that can show high variation and for the same reason, treatment should not be started based on one semen
analysis. Hormonal testing is another infertility diagnosis done to rule out other hormonal abnormalities and also the
functional capacity of the test is to produce sperms.
Genetic tests are also done in cases of severe male factor abnormality.
Testicular Biopsy can be done as an infertility diagnosis in situation to confirm the presence of sperms in the testis in cases of Azoospermia (no sperms in semen sample).
What are the infertility diagnosis for female in the treatment?
The tests for female in infertility treatment may be the following:
Ovulation testing – is the primary infertility diagnosis done in the form of a follicular study (repeated
trans-vaginal scans around the period of ovulation) to confirm the presence and pattern of ovulation. Ultrasound diagnosis is also done to evaluate the uterus and ovaries to rule out presence of fibroids, cysts,endometriosis, uterine abnormalities etc. that causes infertility.
Tubal evaluation by Hysterosalpingography or Saline Sonosalpingography can be done and we can rule out any block in the tubes and also the uterine cavity.
Hormonal evaluation can be done to assess the ovarian reserve testing and also to rule out any endocrine problems. Diagnostic Hystero-Laparoscopy – Is a infertility diagnosis procedure done not only to diagnose any problem inside the abdomen which cannot be diagnosed on ultrasound but also to treat the patient.
It is done when there is some suspected adhesions, previous surgeries or sometimes to right of flimsy adhesions.
Causes of Male Infertility
What causes infertility – Some of the causes of male infertility is as follows:
Abnormal sperm production or function may lead to infertility condition.
Poor quality semen causes infertility.
Overexposure to environmental factors causes infertility – smoking, alcohol, tobacco use, and stress, prolonged exposure to heat or chemical fumes, use of recreational drugs or anabolic
steroids.
Decreased sexual activity causes infertility.
Genetic abnormalities like Y chromosome micro deletion, Klinifelter’s syndrome.
Damage because of some co-existing disease or cancer or its treatment can be the infertility causes.
Hormone abnormalities cause infertility.
Surgical problems like Varicocele, Hydrocele etc.
If the testicles are damaged, it causes infertility.
Side effect of certain drugs causes infertility.
Complete absence of sperm in the semen.
Can be because of complete or partial damage of testis causing either no sperm production or
very little sperm production (not enough to travel through to the ejaculate).
Hypothalamus – Pituitary Dysfunction.
Complete blockage or absence of the tube taking the sperm from the testis to the penis.
Female Infertility Causes
Female infertility causes can be the following:
Ovulation disorder causes infertility – This is the most common cause of female infertility. Female
infertility can also because of endocrinological problems like Polycystic Ovary Syndrome
(PCOS), Thyroid disorders, Hyperprolactinemia, or other hormonal problems.
Fallopian tube damage or blockage causes infertility – It can be in the form of complete tubal blockage or dysfunction in the tube because of several causes like infections, surgery, pelvic
adhesions, distortion of the pelvis anatomy etc.
Pelvic factors – Issues like Endometriosis, uterine fibroids and cysts that distort the pelvic
anatomy and make it difficult for the sperm and egg to meet each other or the embryo to implant in the uterus. This condition causes infertility. Problems like endometriosis can cause severe pelvic adhesions. This is one of the causes of female infertility.
Primary ovarian insufficiency – Either premature ovarian ageing or failure can happen because of
several factors like genetic problems, endometriosis, multiple ovarian surgeries. It can also be
idiopathic.
The mucus in your cervix may not be thin enough for sperm to swim easily while you are ovulating causes infertility condition.
Low level of testosterone causes infertility and the condition is known as Hypogonadism.
Fertility and Risk Factors
Some of the other risk factors and fertility causes are:
Age is the most important factor that influences the potential for pregnancy in a female. As the age increases the ovarian reserve (total no of eggs) in the ovary will significantly come down (especially after 33 years) and there seems to be issues in women like fibroid, endometriosis etc which are more common in women of this age group. These factors combined together will decrease the chances of pregnancy as the age increases and it falls to a critical level after the female becomes 40 years. The age factor causes infertility condition.
Being overweight or underweight, both seems to make getting pregnant more difficult. It is mainly because of its influence on the ovulation of the women. It is important that the females follow a healthy lifestyle and diet while they are trying to get pregnant.
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