Infertility is defined as the failure to conceive after a year of regular unprotected intercourse, or the inability to carry a pregnancy to a live birth.
Most infertility results from physical problem in either man or woman’s reproductive system. Some causes includes
- Problems with man’s reproductive system
- Problems with (in/associated with) woman’s fallopian tubes
- Problems with woman’s uterus and / or cervix
- Problems with woman’s ovulation
- Unknown reasons / Unexplained
Infertility in a woman may stem from many causes, such as hormonal imbalance, problems in reproductive system, illness or unknown factors. The most likely causes for female infertility are: –
- Pelvic Inflammatory disease [PID] PID is the most common cause for infertility. It is an infection of the pelvis. One or more of the reproductive organs, like ovaries and / or tubes, cervix or uterus are infected.
- Polycystic ovary syndrome [PCOS] In PCO, the ovaries produce high amounts of male hormones especially testosterone. LH hormone level remains abnormally high while FSH levels are low, thus the follicles do not produce eggs. Instead they form fluid filled cysts that eventually cover the ovaries. Endometriosis refers to a condition in which sections of the uterine lining implant in the vagina, ovaries, fallopian tubes or pelvis. These implants eventually form cysts that grow with each menstrual cycle, and may eventually turn into blisters and scars. The scars can then block the passage of the egg.
- Ovarian problems Problems within the ovaries may inhibit reproduction.
- Hormonal problems Decreased production of any one of the five hormones (what hormones?) that regulate a woman’s reproductive cycle may result in infertility.
- Thyroid deficiency may cause ovarian problems.
- High prolactin level can also prevent ovulation.
- Immune system Problems / Problems associated with Immune system Woman may develop antibodies that attack the man’s sperm, mistaking it for a toxic invader. Certain autoimmune diseases, in which the immune cells attack normal cells in her own body, may also contribute to the ovarian problems
- Luteal Phase Defect [LPD] In LPD, corpus luteum, the mound of yellow tissue produced from the egg follicle  may fail to produce enough progesterone to thicken the uterine lining. Then the fertilized egg may be unable to implant.
- Fibroids Fibroids or benign growths may form in the uterus near the fallopian tubes or cervix. As a result, the sperm or fertilized egg cannot reach the uterus or implant there.
- Other Uterine Problems Abnormal reproductive organs or endometritis [an abnormal swelling of the uterine lining] may make it difficult for the fertilized egg to implant.
- Surgical Complications Scar tissue left after abdominal surgery can cause problems in the movements of the ovaries, fallopian tubes and uterus, resulting in infertility.
- Frequent abortions Frequent abortions may also produce infertility by weakening the cervix or by leaving the scar tissue that obstructs the uterus.
- Uterinemuscle problems During ovulation, uterine contraction usually push the sperm up to the fallopian tube, Weak , infrequent or abnormal contraction causes problem.
- Poor quality cervical mucous Some times a cervical mucous fails to thin around the time of ovulation & consequently it prevents the sperm from travelling through it.
- Illness Long illness may also cause infertility. High blood sugar level or high blood pressure can also be a cause.Other factors that contribute to infertility include excessive exercise, obesity, stress or anorexia.
The most common cause for male infertility is the problem with sperm production. Sperms of poor quality cannot move rapidly forward and reach the egg to fertilize it. Some conditions that may contribute to sperm problems include: –
- Under developed testes
- Swollen – veins in the scrotum
- Undescended testes
- Problems in ejaculation
- Infection
- Exposure to metals
- Certain medications
- Injury to testicles
- Chronic prostate infections
- Deficiency of testosterone.
- Auto immunity in which antibodies of the man’s immune system attack sperm cells, mistaking them for toxic invaders. The antibodies bind themselves to the sperm and may cause clumping of sperms, or may stop them from penetrating the cervical mucous or the egg.
- Retrograde Ejaculation: In this condition, the muscles of the urethra do not force the sperm out. Instead, the sperms travel backward into bladder.
Woman’s most fertile time is during ovulation. Ovulation typically occurs within day 11 through day 21 of a woman’s cycle.
Counting from the first day of a woman’s last period, day 1 is the first day a woman starts bleeding; the 11th day is most likely the earliest day a woman will ovulate. The 21st day is most likely the last. A woman’s period for next cycle can occur between the 28th and 32nd day of the cycle. This pattern may differ slightly with each woman depending on a variety of factors.
A complete medical history and a physical exam are the first step in diagnosing with fertility problem. Both husband and wife / partners need to be evaluated. The couple may need to undergo blood tests, semen analysis and ultrasound exams or exploratory surgery for the woman.
Infertility is a medical condition that is found in both men and women, and men and women are affected almost equally.
- With men, declining sperm counts, testicular abnormalities, and decreased reach of climax are common causes of infertility.
- With women, the most common causes are tubal blockage, endometriosis, PCOS, and advanced maternal age, which affect egg quality/quantity.
- Infertility is a growing issue for many couples. Infertility affects 30 million Indian couples (approximately 10% of Indian couples of childbearing age). This is growing at an alarming rate of 20% year on year almost like an epidemic.
- 25% of infertile couples have more than one cause of infertility.
- The current increase in infertility might be the result of more women choosing to delay starting a family until later in life, when their reproductive health can be affected.
- The increase of some STD’s such as Chlamydia can result in conditions such as blocked tubes, preventing pregnancy from occurring.
The American Society of Reproductive Medicine recommends that a woman consult her health care provider if she is:
- Under 35 years old and has been trying to conceive for more than 12 months, or
- Over 35 years old and has been trying to conceive for over 6 months.
One always have the option of asking her health care provider to conduct a complete examination to determine if either partner has possible fertility issues. One can also choose to avail at home fertility testing, available for both men and women.
After ejaculation, enough sperm will remain inside the woman to fertilize an egg. Therefore, there is no significant advantage of one intercourse position over another.
For woman
- The quality of eggs in the ovaries decline with age.
- The ability of an egg to become fertilized may also be decreasing over time, lowering the odds of conception
- There are fewer eggs with time.
- Overtime, changes in hormones can cause difficulties with ovulation.
- Miscarriage rates increase with age.
Once the cause for infertility is determined, treatment can be planned. Some times, a simple instruction or few medications will solve the problem. Instructions about the ideal time to have intercourse, resulting in pregnancy is provided. In most of the cases, medications are prescribed to treat infertility while in some cases surgery is required. In cases where the medications and surgery does not produce the desired result, we need to proceed with Assisted Reproductive Technology(ART) or IVF treatments.
Problems in the male reproductive organs can often be resolved with medicine and if required with surgery.
Sperm quality and quantity can be affected by overall health and life style. Some factors that may reduce sperm number and / or quality includes alcohol, drugs, stress, environmental toxins, smoking, health problems, certain medicines, radio or chemotherapy and age.
Factors that affect woman’s fertility include age, stress, poor diet, obesity, underweight, smoking, sexually transmitted diseases (STD), hormonal problems and other health problems.
For a person who wants to be a father again after vasectomy, vasectomy reversal surgery should be the first choice. Under skilled and experienced medical professionals, the success rate for reversals is 70 – 80%. The other procedure is extraction of sperm from testes or from epididymis. These sperms are used to inject an ovum through a procedure called ICSI [Intra Cytoplasmic Sperm Injection].
One in six couples are affected by some degree of infertility.
Couple who have been having intercourse during ovulation for one year without protection and wants to have a baby soon can consult a doctor.
Most infertility problems are not hereditary. If your grand-mother, mother or sister conceives late or had difficult in conceiving, it is not a rule that you will not conceive.
Painful periods do not affect fertility. In fact it is a signal of ovulatory cycles. But if one has consistent pain, doctor consultation is advised.
It is a procedure that restores blocked or tied fallopian tubes to restore fertility in a woman. The procedure is called tubal reversal because it is performed to reverse the effects of a tubal ligation, a procedure that involves blocking of the fallopian tubes to prevent pregnancy.
No, many couples are successful in their attempts to conceive using simple and “low-tech”procedure. ~10 – 20% couples seeking infertility treatment will undergo ART procedure. All ART procedures are established medical treatment.
Improvements in medication, surgery and ART make pregnancy possible for a majority of the couples pursuing treatments. Success rates have drastically improved in couples taking ART treatment, when compared to past.
Conception occurs when the male’s sperm meet the woman’s egg and successfully penetrates it(fertilization). This typically takes place in one of the woman’s fallopian tube and the fertilized egg then travels to the uterus and implants in the uterine lining(endometrium). For pregnancy to occur, fertilization of the egg must be followed by a successful impanation. Only one egg is released for fertilization in each menstrual cycle. If this egg is not fertilized, conception will not be possible again until the next cycle.
Fertility treatments can increase the likelihood of getting pregnant. Treatments can include lifestyle changes, supplements, surgery, medication, or assisted reproduction. There are several treatments under assisted reproduction such as in vitro fertilization (IVF), intra cytoplasmic sperm injection (ICSI), gamete intra fallopian transfer (GIFT), and zygote intra fallopian transfer (ZIFT). All these procedures involve harvesting a number of eggs in the hope of fertilizing at least one egg, and then insert the fertilized egg(s) into the uterus.
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