A woman's body must release an egg from one of her ovaries (ovulation).
A man's sperm must join with the egg along the way (fertilize).
The fertilized egg must go through a fallopian tube toward the uterus (womb).
The fertilized egg must attach to the inside of the uterus (implantation).
Infertility may result from a problem with any or several of these steps.
Is infertility just a woman's problem?
No, infertility is not always a woman's problem. Both men and women contribute to infertility.
Many couples struggle with infertility and seek help to become pregnant; however, it is often thought of as only a women's condition.
What causes infertility in men?
Infertility in men can be caused by different factors and is typically evaluated by a semen analysis. A specialist will evaluate the number of sperm (concentration), motility (movement), and morphology (shape). A slightly abnormal semen analysis does not mean that a man is necessarily infertile. Instead, a semen analysis helps determine if and how male factors are contributing to infertility.
What are the Conditions that can contribute to abnormal semen analysis ?
Varicoceles, a condition in which the veins on a man's testicles are large and cause them to overheat. The heat may affect the number or shape of the sperm.
Medical conditions or exposures such as diabetes, cystic fibrosis, trauma, infection, testicular failure, or treatment with chemotherapy or radiation.
Unhealthy habits such as heavy alcohol use, testosterone supplementation, smoking, anabolic steroid use, and illicit drug use.
Environmental toxins including exposure to pesticides and lead.
what causes infertility in women?
Women need functioning ovaries, fallopian tubes, and a uterus to get pregnant. Conditions affecting any one of these organs can contribute to female infertility.
What is Ovarian function?
Ovulation - Regular predictable periods that occur every 24-32 days likely reflect ovulation. A woman's menstrual cycle is, on average, 28 days long. Day 1 is defined as the first day of "full flow."
What is Tubal Patency? (whether fallopian tubes are open, blocked, or swollen).
Tubal evaluation may be performed using an X-ray which is called a hysterosalpingogram (HSG), or by chromopertubation (CP) in the operating room at time of laparoscopy, a surgical procedure in which a small incision is made and a viewing tube called a laparoscope is inserted.
Hysterosalpingogram (HSG) is an X-ray of the uterus and fallopian tubes. After injecting dye into the uterus through the cervix and simultaneously takes X-ray pictures to see if the dye moves freely through fallopian tubes. This helps evaluate tubal caliber (diameter) and patency.
Chromopertubation is similar to an HSG but is done in the operating room with laparoscopy
What are the risk factors for blocked tubes?
Risk factors for blocked fallopian tubes (tubal occlusion) can include a history of pelvic infection, history of ruptured appendicitis, history of gonorrhea or chlamydia, known endometriosis , or a history of abdominal surgery.
What are the Uterine factors needing evaluation?
Depending on a woman's symptoms, the uterus may be evaluated by transvaginal ultrasound to look for fibroids or other anatomic abnormalities. If suspicion exists that the fibroids may be entering the endometrial cavity, a sonohystogram or hysteroscopy may be performed to further evaluate the uterine environment.
What things increase a woman's risk of infertility?
Female fertility is known to decline with :
Age. Many women are waiting until their 30s and 40s to have children.
About one-third of couples in which the woman is older than 35 years have fertility problems. Aging not only decreases a woman's chances of having a baby but also increases her chances of miscarriage and of having a child with a genetic abnormality.
Excessive alcohol use.
Extreme weight gain or loss.
Excessive physical or emotional stress that results in amenorrhea (absent periods).
Aging decreases a woman's chances of having a baby in the following ways. Her ovaries become less able to release eggs.
- She has a smaller number of eggs left.
- Her eggs are not as healthy.
- She is more likely to have health conditions that can cause fertility problems.
- She is more likely to have a miscarriage.
How long should women try to get pregnant before VISITING their doctors?
Most experts suggest at least one year for women younger than age 35. However, women aged 35 years or older should see a health care provider after 6 months of trying unsuccessfully. A woman's chances of having a baby decrease rapidly every year after the age of 30.
Some health problems also increase the risk of infertility. So, women should talk to a doctor if
Irregular periods or no menstrual periods.
Very painful periods.
Pelvic inflammatory disease.
More than one miscarriage.
How will doctor find out if a woman and her partner have fertility problems?
Doctors will begin by collecting a medical and sexual history from both partners. The initial evaluation usually includes a semen analysis, a tubal evaluation, and ovarian reserve testing.
What is Involved in the Fertility Evaluation?
History and physical examination -Transvaginal ultrasound - Ultrasound is an important tool in evaluating the structure of the uterus, tubes, and ovaries.
Laboratory testing - estradiol and FSH; TSH,; and prolactin, AMH.
Hysterosalpingogram (HSG) - This test is essential for evaluating fallopian tubal patency, uterine filling defects such as fibroids and polyps, and scarring of the uterine cavity Many uterine and tubal abnormalities detected by the HSG can be surgically corrected.
Semen analysis - The semen analysis is the main test to evaluate the male partner. There are four parameters analyzed:
1) semen volume
2) sperm concentration
3) sperm motility or movement
4) morphology, or shape
How is it treated?
Infertility can be treated with medicine, surgery, intra-uterine insemination, or assisted reproductive technology. Many times these treatments are combined. Gynaecologist recommends specific treatments for infertility based on -
The factors contributing to the infertility.
The duration of the infertility.
The age of the female.
The couple's treatment preference after counseling about success rates, risks, and benefits of each treatment option.
What are some of the specific treatments for male infertility?
Male infertility may be treated with medical, surgical, or assisted reproductive therapies depending on the underlying cause.. they will be offered intrauterine inseminations (IUIs) or in vitro fertilization (IVF) to help overcome male factor infertility.
What medicines are used to treat infertility in women?
Some common medicines used to treat infertility in women include
Clomiphene citrate/LETROZOLE .
Gonadotropin-releasing hormone (GnRH) .
Human menopausal gonadotropin or hMG / Follicle-stimulating hormone or FSH
What is clomiphene?
Clomiphene is a non-steroidal fertility medicine. It causes the pituitary gland to release hormones needed to stimulate ovulation (the release of an egg from the ovary).
Clomiphene is used to cause ovulation in women with certain medical conditions (such as polycystic ovary syndrome) that prevent naturally occurring ovulation
WHAT IS Intrauterine insemination?
IT is a process by which sperm is washed and prepared for placement into the uterine cavity, therefore bypassing the cervix and bringing a higher concentration of motile sperm closer to the tubes and ovulated egg. At least one open tube is required for IUI, and the sperm abnormality cannot be severe otherwise the sperm will not be able to swim to and fertilize the egg.
WHAT IS Intracytoplasmic sperm injection?(ICSI)?
is a process by which semen is washed and prepared for direct injection of one sperm into each egg collected during the IVF process. In order to perform ICSI, an egg is held via a small suction pipette, while one sperm is injected into that egg using a very fine glass needle. This process bypasses the normal fertilization process, which may be compromised due to poor sperm function. Your doctor will analyze your semen analysis carefully and help you decide if ICSI is an appropriate treatment for you.
HOW DOES Endometriosis CAUSE INFERTILITY?
Endometriosis is a condition whereby cells very similar to the ones lining the uterine cavity, or endometrium, are found outside the uterine cavity.
Endometriosis causes infertility by producing inflammation and scarring, which can result in not only pain but also potentially detrimental effects on egg, sperm or embryo.
Endometriosis can only be confirmed by surgery, usually laparoscopy. If endometriosis is found, it can be surgically removed by various methods, and its removal may lead to a decrease in pain as well as improvement in the ability to conceive naturally .
HOW DOES POLYP CAUSE INFERTILITY ?
Endometrial polyps are finger-like growths in the uterine cavity arising from the lining of the uterus, called the endometrium, polyps are can decrease fertility by up to 50% .Removal of polyps by the minimally invasive procedure hysteroscopy is associated with a doubling of pregnancy rate. In some cases, simply removing the polyp solves infertility.
HOW DOES FIBROIDS AFFECT FERTILITY?
Fibroids are very common (approximately 40% of women may have them) and the mere presence alone does not necessarily cause infertility.
Submucosal fibroids are the type if fibroid that has clearly been demonstrated to reduce pregnancy rate, roughly by 50%, and removal of which will double pregnancy rate. In some cases, simply removing the submucosal fibroid solves infertility
HOW IS IVF is Generally Performed ?
The woman undergoes gonadotropin injections, which stimulate the ovaries to produce many eggs.
Once the follicles (fluid filled sacs containing the eggs) reach a mature size, an HCG injection is administered which leads to final development and maturation of the eggs.
Just before those eggs would otherwise be ovulated, they are retrieved under mild anesthesia in an operating room.
The sperm can either be mixed with the eggs to allow normal fertilization (conventional insemination) or by injecting one sperm into each mature egg (ICSI).
The fertilized eggs, now embryos, are allowed to grow and develop in culture media for typically 3 to 5 days.
Then, generally one or two embryos, which have demonstrated appropriate development, are carefully and gently transferred into the uterine cavity.
The pregnancy test is then performed 2 weeks after the embryo transfer.
What Is Third Party Reproduction?
The four types of third party reproduction are :
1) sperm donation - a process by which donated sperm is used for insemination in the uterus, or for fertilization of eggs in the IVF process.
2) egg or ovum donation - a process by which an egg donor undergoes an IVF cycle in order to obtain her eggs which are then donated and fertilized. The resulting embryos are then transferred into the uterus of the future mother, known as the recipient
3) embryo donation - a process where a fully developed embryo from another person in combination donor sperm, or couple who underwent IVF, are donated to another woman, the future intended mother, for transfer into her uterus; and
4) gestational surrogacy - a process where another woman will undergo an embryo transfer and carry the pregnancy for another person.
WHAT IS THE ROLE OF LAPAROSCOPY?
Laparoscopy is an operation performed in the abdomen or pelvis through small incisions, generally no more than a centimeter, with the assistance of a laparoscope attached to a camera which projects to a screen.
It can either be used to inspect and diagnose certain conditions or to surgically correct an abnormality such as removing scar tissue, endometriosis, or a damaged fallopian tube. The procedure is performed in an OT and recovery time can be as little as a few days.
WHAT IS HYSTEROSOPY?
Problems with male fertility can be caused by a number of health issues and medical treatments. Some of these include:
Varicocele - A varicocele is a swelling of the veins that drain the testicle.
Infection. These include inflammation of the epididymis (epididymitis) or testicles (orchitis) and some sexually transmitted infections, including gonorrhea or HIV.
Ejaculation issues. Retrograde ejaculation occurs when semen enters the bladder during orgasm instead of emerging out the tip of the penis.
Antibodies that attack sperm.
In some cases, surgery, radiation or chemotherapy to treat tumors can affect male fertility.
Problems with sexual intercourse.
Heavy metal exposure.
Radiation or X-rays.
Overheating the testicles.
Illicit drug use.
What is treatment for male infertility?
Treatments for male infertility may be based on the underlying cause of the problem, or in the case of no identified problem.
Treatments include surgery to correct or repair anatomic abnormalities.
use of medical procedures to deliver sperm to the woman, fertilization of the egg in a laboratory, and
using a third party for donating sperm or eggs and/or carrying a pregnancy.
Medication can treat some issues that affect male fertility, including hormone imbalances and erectile dysfunction.
Surgery can be effective for repairing blockages in the tubes that transport sperm. Surgery can also be used for repair of varicocele.
Assistive reproductive technologies, such as in vitro fertilization, can be effective if other treatment do not restore fertility.
How is Semen analysis done?
You can provide a semen sample by masturbating and ejaculating into a special container at the lab after 3 days of abstenience.
Your semen is then sent to a laboratory to measure the number of sperm present and look for any abnormalities in the shape (morphology) and movement (motility) of the sperm. The lab will also check your semen for signs of problems such as infections.
Often sperm counts fluctuate significantly from one specimen to the next. In most cases, several semen analysis tests are done over a period of time to ensure accurate results. If your sperm analysis is normal, your doctor will likely recommend thorough testing of your female partner before conducting any more male infertility tests.
When treatment doesn't work
In rare cases, male fertility problems can't be treated, and it's impossible for a man to father a child. Your doctor might suggest that you and your partner consider using sperm from a donor
What is Embryo donation?
is a form of third party reproduction. It is defined as the giving of embryos remaining after one couple's in vitro fertilisation to either another person or couple for implantation.
Where it is given for the purpose of implantation, the donation is followed by the placement of those embryos into the recipient woman's uterus to facilitate pregnancy and childbirth in the recipient.
The resulting child is considered the child of the woman who carries it and gives birth, and not the child of the donor.
This is the same principle as is followed in egg donation or sperm donation.
Most often, the embryos are donated after the woman for whom they were originally created has successfully carried one or more pregnancies to term.
What Is Egg Donation?
Is the process by which a woman donates eggs to enable another woman to conceive as part of an assisted reproduction treatment.
For assisted reproduction purposes, egg donation typically involves in vitro fertilization technology, with the eggs being fertilized in the laboratory; more rarely, unfertilized eggs may be frozen and stored for later use.
Egg donation is a third party reproduction as part of assisted reproductive technology (ART).
What is Assisted reproductive technology?
Assisted reproductive technology (ART) is any fertility treatment in which the egg and sperm are handled.
In vitro fertilization (IVF) is the most common ART technique. IVF involves stimulating and retrieving multiple mature eggs from a woman, fertilizing them with a man's sperm in a dish in a lab, and implanting the embryos in the uterus three to five days after fertilization.
Other techniques are sometimes used in an IVF cycle, such as:
Intracytoplasmic sperm injection (ICSI). A single healthy sperm is injected directly into a mature egg. ICSI is often used when there is poor semen quality or quantity, or if fertilization attempts during prior IVF cycles failed.
Assisted hatching. This technique assists the implantation of the embryo into the lining of the uterus by opening the outer covering of the embryo (hatching).
Donor eggs or sperm. Most ART is done using the woman's own eggs and her partner's sperm. However, if there are severe problems with either the eggs or sperm, you may choose to use eggs, sperm or embryos from a known or anonymous donor.
Gestational carrier. Women who don't have a functional uterus or for whom pregnancy poses a serious health risk might choose IVF using a gestational carrier. In this case, the couple's embryo is placed in the uterus of the carrier for pregnancy.