Infertility

Female Reproductive System

DEFINITION

Infertility is the inability of a couple to become pregnant after one year of unprotected sexual intercourse. Infertility is a problem that involves both partners. It should be understood that chances of getting pregnant drops, as a woman gets older, fewer women become pregnant in the first 12 months when they are more than 35 years old.

There are some things that may increase chances of becoming pregnant like lifestyle changes and sometimes medical treatments. Fertility will be best when you are close to your ‘ideal’ body weight – that is, you are not overweight and not underweight.

When a couple are having trouble getting pregnant, it should be agreed that Male infertility is just as common as female infertility or it could be due to some other cause. Environmental and occupational factors, age, too much exercise are few problems related to infertility for men and women both.

Couples should consult a doctor after a year of trying to conceive unsuccessfully, which is the main sign of infertility.

CAUSES

Common problems for infertility with men include:

• Low sperm count

• Poor sperm motility

• Malformed sperm

• Blocked sperm ducts

• Sexual problems such as impotence – the inability to get or maintain an erection sufficient for sexual intercourse

• Hormone problems

• Sperm antibodies

• Abnormal shape

Common problems for infertility with women include:

• Irregular ovulation (release of eggs)

• Blocked fallopian tubes

• Abnormalities in the cervix or uterus

• Having irregular periods – this may indicate problems with ovulation or due to Polycystic Ovarian Syndrome

• Past pelvic infection

• Unusual pain with intercourse or when you have your periods, possibly due to Endometriosis

For men, the most common cause of infertility in the couple is with the sperm, and for women the most common cause of infertility factor is an ovulation disorder.

DIAGNOSIS

Normally, a complete medical history and a physical exam are the first steps in diagnosing a fertility problem. After that, some of the diagnostic tests for infertility might include:

Semen analysis-To check the health and quality of sperm. A man may produce no sperm for various reasons. He may produce few sperm or sperm that have defects that prevent them from reaching or fertilizing the egg.

Female Hormonal Assay: For a woman, the first step in testing is to find out if she is ovulating each month. There are several ways to do this. One method is a home ovulation test kit, which can be bought at a pharmacy. Blood tests for hormone levels or ultrasound tests of the ovaries can be another method for the same. If the woman is ovulating, more tests will need to be done.

Evaluation of Women’s Reproductive system– Any of several procedures may be used to examine the woman’s reproductive organs:

Hysterosalpingogram: An imaging study of the uterus and Fallopian tubes,which displays the shape of the uterus and if the Fallopian tubes are open.

Laparoscopy: If the gynaecologist suspects ovarian or fallopian tube scarring or endometriosis, a woman may undergo a laparoscopy. It’s a minimal invasive surgery that allows the doctor to see directly inside the pelvis.

Ultrasound: is used to detect uterine fibroids, endometrial polyps, ovarian cysts, and other abnormalities in the uterus and ovaries

Hysteroscopy: is used to check the interior of the uterus with an instrument.

Endometrial biopsy: To determine whether the menstrual cycle is normal and whether ovulation has occurred.

Pap smear: For cervix cancer screening and cervical infection if any,

Magnetic resonance imaging (MRI): for further evaluation of the internal organs if needed

Sometimes, a complete infertility evaluation may take up to two menstrual cycles before the factors causing the infertility can be found. After the evaluation is completed, an outline of treatment plan according to the diagnosis, duration of infertility, and the woman’s age is made.

TREATMENT

The type of treatment one may undergo depend on individual’s situation, doctor recommendations, and preferences. The treatment that is best for a couple will depend on what is causing the problem.

Sometimes simple medication will help or one might need surgery with a laparoscope, treatment for ovulation problems. Fertility treatments can be grouped into three categories:

Medicines to improve fertility – Can be used alone or in addition to assisted conception. Medicines are mainly used to help with ovulation.

Surgical treatments – these may be used when a cause of the infertility is found that may be helped by an operation. For Fallopian tube problems, Endometriosis, Polycystic ovary syndrome, Fibroids, Male infertility

Assisted conception – this includes several techniques such as intrauterine insemination (IUI), in vitro fertilisation (IVF), and intracytoplasmic sperm injection (ICSI),Egg donation, Embryo donation

Each of these is discussed briefly below considering treatment for Men and Women separately.

Treatment for Men

• Treating infections- are directed towards treating infection in reproductive tract

• Treatments for sexual intercourse problems (Erectile dysfunction or premature ejaculation)

• Hormone treatments and medications

• Surgery-Sperm may often be retrieved directly from the testicles, where no sperm are present in the ejaculate.

• Assisted reproductive technology (ART) – obtaining sperm through normal ejaculation, surgical extraction or from donor individuals, depending on your specific case and wishes. The sperm is then inserted into the female genital tract, or used to perform in vitro fertilization or intracytoplasmic sperm injection (ICSI).

Treatment for Women

• Stimulating ovulation-fertility drugs can be used to regulate or induce ovulation.

• Intrauterine insemination (IUI) – A procedure where healthy sperm that have been collected and concentrated are placed directly in the uterus around the time the woman’s ovary releases one or more eggs to be fertilized

• Surgery to restore fertility –

Hysteroscopic surgery– Uterine problems such as endometrial polyps, a uterine septum or intrauterine scar tissue can be treated.

Tubal cannulation – is a procedure to help clear a blockage in the fallopian tubes, a common cause of female infertility. Tubal cannulation may be done immediately after hysterosalpingography or hysterosalpingogram

Most infertility can be treated with conventional therapies, such as drug treatment (fertility drugs) to promote ovulation or surgery to repair problems with reproductive organs.