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Infertility


If getting pregnant has been a challenge for you and your partner, you're not alone. It is estimated that one in seven couples worldwide have problems conceiving. In general, 84 out of every 100 couples who have regular unprotected sexual intercourse will get pregnant within a year. About 92 out of 100 couples will get pregnant within 2 years.

 

The term infertility refers to the inability to conceive despite regular and unprotected intercourse for at least one year. 

Infertility is classified into two types:

  • Primary infertility - if there was no previous pregnancy after at least 1 year of unprotected sex (intercourse)
  • Secondary infertility - if there was a previous pregnancy at least once

 

Causes

Infertility can be caused by various physical and emotional factors. It may be due to female factors, male factors or both that may prevent a pregnancy from occurring and continuing. In some cases, environmental factors can contribute to infertility.  In other cases, genetic conditions or other health problems are the main cause of infertility. Women become less fertile as they get older. The effect of age upon men's fertility is not totally clear.

 

The main symptom of infertility is the inability for couple to get pregnant. The other symptoms are usually absent. In particular cases, an infertile woman may experience abnormal menstrual periods. An infertile man may have change in sexual function or hair growth.

 

Fortunately, there are many safe and effective medical interventions for overcoming infertility. These interventions significantly improve your chances of becoming pregnant.

 

Female Infertility


In women, the term infertility is used to describe those who haven't been able to get pregnant after at least one year of unprotected intercourse. If a woman keeps having miscarriages, it is also called infertility. Female infertility can result from physical problems, hormonal problems, and lifestyle or environmental factors.

 

Most common causes of female infertility include: fallopian tube damage or blockage, endometrioses, elevated prolactin, ovulation disorders, polycystic ovary syndrome (PCOS), menopause, pelvic adhesions and uterine fibroids.

 

Infertility can be effected by: age, lifestyle, environmental factors, sexually transmitted infections, being overweight or underweight, medical conditions.

 

 
Fallopian Tube Damage or Blockage

 

Fallopian tube damage is usually caused by infection and inflammation of the fallopian tube (salpingitis). There are two types of salpingitis: acute salpingitis and chronic salpingitis. The infection usually starts in the vagina and ascends to the fallopian tube. Infection in one fallopian tube usually leads to infection of the other, as it can spread via the lymph vessels. Chlamydia, a sexually transmitted disease, is estimated to be the cause in about 60% of cases of salpingitis.

 

Tubal inflammation may go without any symptoms or may cause pain and fever. Tubal infection may cause fertility difficulties. It increases the risk of ectopic pregnancy, infection of ovaries and uterus, infection of sex partner. The risk of ectopic pregnancy increases with each occurrence of tubal infection. The more times one has the infection, the greater the risk of infertility. With one episode of salpingitis, the risk of infertility is 8-17%. With 3 episodes of salpingitis, the risk is 40-60%, although the precise risk depends on the severity of each episode.

 

Endometriosis

 
Endometriosis is a medical condition in women in which the uterine tissue implants and grows outside of the uterus, most commonly on the ovaries. It is estimated that endometrioses effects about 5-10% of women, typically during the reproductive years.

Endometriosis often affects the function of the ovaries, uterus and fallopian tubes. Implanted uterine tissue responds to the hormonal cycle and grows, sheds and bleeds each month that can lead to scar formation and inflammation. Symptoms may depend on the site of active endometrioses. It may cause pelvic pain in various manifestations. Symptoms often worsen with the menstrual cycle.  Endometriosis is a common finding in women with infertility.

Elevated Prolactin (Hyperprolactinemia)

Hyperprolactinemia is the presence of abnormally- high level of prolactin in the blood. The hormone prolactin stimulates breast milk production. High levels in non-pregnant women may affect ovulation. An elevation in prolacitin levels may be indicator of a pituitary tumor, disease of liver, kidneys, ovaries and thyroid.  It also can be elevated by use of some drugs, medical herbs.  Milk flow not related to pregnancy or nursing, as well as disruptions in the normal menstrual period can be a sign of high prolactin.

 
Ovulation Disorders

Female infertility can be caused by ovulation disorders. Disruption in the part of the brain that regulates ovulation can cause low levels of luteinizing hormone (LH) and follicle-stimulating hormone (FSH). Even minor irregularities in the hormone system can prevent the ovaries from releasing eggs (anovulation). Specific causes of hypothalamic-pituitary disorders that can result in anovulation include: injury, tumors, excessive exercise and starvation. In addition, some medications can be associated with ovulation disorders.


Polycystic Ovary Syndrome (PCOS)

 
Polycystic ovary syndrome (PCOS) is one of the leading causes of female infertility and affects approximately 5-10% of women of reproductive age. It is a condition, when the body produces too much androgen hormone, which affects ovulation. The main features are: obesity, anovulation (resulting in irregular menstruation) or amenorrhea, acne. The symptoms and severity of the syndrome differ greatly among women.  Insulin resistance, diabetes, and obesity are all strongly correlated with PCOS.

 

Early Menopause (Premature Ovarian Failure) 

 
Early menopause is the absence of menstruation and the early depletion of ovarian follicles before age 40. It is not caused by the normal effects of aging. Spontaneous premature ovarian failure affects 1% of women by age 40 and 0.1% of women by age 30.

In the majority of spontaneous cases of premature ovarian failure, the cause is often unknown. However, certain conditions are associated with early menopause, including autoimmune system diseases, thyroid disease, diabetes mellitus, radiotherapy or chemotherapy and smoking.

 

 
Pelvic Adhesions

 
Pelvic adhesions are fibrous bands of scar tissue that form between tissues and organs. It is mostly result of pelvic infection, appendicitis, abdominal or pelvic surgery. This scar tissue may impair infertility.


Uterine Fibroids
 


 

Fibroids are benign tumors in the wall of the uterus. Fibroids cause infertility by interfering with proper implantation of the fertilized egg. Sometimes, they me cause blocking of the fallopian tubes.  Fibroids are more common in women in their 30s and 40s.

A woman's risk for infertility can also be affected by certain lifestyle and environmental factors, including (but not limited to):

 Age

Woman's fertility potential gradually declines with age.  There is a higher rate of chromosomal abnormalities in older women as eggs also age.  Older women also may have health problems that may interfere with fertility. The risk of miscarriage increases with age as well.

 Poor Diet

Sedentary lifestyle and being overweight can interfere with infertility. Women with eating disorders are at particular risk, as well as women following a very low calorie or restrictive diet and strict vegetarians.

 Smoking and Alcohol

Women who smoke have more frequent miscarriages. As to alcohol, there is no safe level of it during conception or pregnancy.

 Medication

The use of certain medications can cause temporary infertility. In most cases, fertility is restored when the medication is stopped.

 Sexually Transmitted Diseases

Sexually transmitted diseases are a leading cause of infertility. They often express few, if any noticeable symptoms. This increases the risk of failing to seek proper treatment in time to prevent decreased fertility.


Thyroid problems

Disorders of the thyroid gland, either too much thyroid hormone (hyperthyroidism) or too little (hypothyroidism), can affect the menstrual cycle and cause infertility.

 
Cancer and its Treatment

Certain cancers often severely impair female fertility.  Both radiation and chemotherapy may affect a woman's reproductive system.  

 
Other Medical or Genetic conditions

Medical conditions associated with delayed puberty or amenorrhea, such as Cushing's disease, sickle cell disease, kidney disease and diabetes can have effect on a woman's fertility.

 

 
Diagnoses

 
Woman who have not been successful to get pregnant, is older than 35, has irregular menstruation or any medical problems that affects her fertility, should see the doctor shortly. Diagnoses of infertility start with a medical history and physical exam. Specific tests may include:

 

Ovulation Testing

Ovulation is one of the most important factors in conceiving a child. There are many factors that can prevent or disrupt ovulation and cause infertility. A blood test is sometimes performed to measure hormone levels to assess the ovulation. There are several ways to detect ovulation: urine test kits to measure LH level, transvaginal ultrasound, endometrial biopsy, blood tests to measure hormone levels and the basal body temperature (BBT) chart. Determining if and when ovulation is occurring may be the vital step toward achieving pregnancy.  A woman and her doctor generally decide together which method of ovulation detection is best to use.

 

 

Hysterosalpingogram (HSG)

This test evaluates the condition of uterus and fallopian tubes. An HSG is an outpatient procedure and mostly is done after menses have ended and before ovulation. Fluid is injected into uterus, and an X-ray is taken to determine whether the fluid progresses out of the uterus and into fallopian tubes. Blockage or problems often can be detected and located.  An HSG may cause mild uterine cramping for several minutes. An HSG is considered a safe procedure, but some complications can occur, such as: infection, fainting, iodine allergy, spotting.

 

Laparoscopy

Problems that cannot be discovered by an external physical examination can be discovered by laparoscopy that allows inspecting the pelvic organs. This procedure may be recommended as part of infertility care. Laparoscopy can help doctor to diagnose various gynecological problems: endometrioses, uterine fibroids, ovarian cysts, adhesions and ectopic pregnancy.

 
It is performed under general anesthesia. A thin viewing device is inserted into abdomen and pelvis to examine fallopian tubes, ovaries and uterus. A small incision (8 to 10 millimeters) is made underneath navel, and a needle is inserted into the abdominal cavity. A small amount of gas is injected into the abdominal cavity to create space for entry of the laparoscope - a fiber-optic telescope. If abnormalities are discovered, diagnostic laparoscopy can become operative laparoscopy.

 

Postoperative bladder infection and skin irritation are the most common complication of laparoscopy. Other risk may include: adhesions, hematomas, pelvic or abdominal infection, and damage to organs. Certain conditions may increase the risk of serious complications. These include a history or presence of pelvic adhesions, obesity, pelvic infections, and previous abdominal surgery. Allergic reactions, nerve damage and anesthesia complications are very rare.

 

The most common problems identified by laparoscopy are endometriosis and scarring. Blockages or irregularities of the fallopian tubes and uterus can be detected as well. Laparoscopy generally is done on an outpatient basis. Patient recovery time is brief.

 

Hormone Testing

Hormone tests are usually performed to check levels of ovulatory hormones as well as thyroid and pituitary hormones. Follicle-Stimulating Hormone (FSH) is often used in conjunction with other tests (LH, Testosterone, Estradiol and Progesterone) in the workup of infertility in both females and males.   

 
Ovarian Reserve Testing

Testing may be done to find out the potential effectiveness of the eggs after ovulation.  Several tests may be useful in assessing fertility potential (ovarian reserve) in woman, such as: day 3 level of FSH and Estradiol; Clomiphene Citrate Challenge Test; Antral Follicle Count; Response to Gonadotropins.  

 
These tests are used to qualitatively predict a woman's response to fertility treatment and her chances of success compared to other women of the same age.

 

Genetic Testing

Genetic testing may be done to determine the presence of a genetic defect causing infertility (cystic fibrosis, sickle cell, Tay-Sachs or other genetic disorders).

 

 
Pelvic ultrasound

Pelvic ultrasound may be done to exclude uterine or fallopian tube disease.


Treatment


Infertility can be treated with medicines, surgery, artificial insemination or assisted reproductive technologies. Often these treatments are combined. Fortunately, two-thirds of couples treated for infertility successfully conceive and are able to have babies.

Doctors recommend specific treatments for infertility based on: test results, the age of partners, the overall health and preference of the partners.

Many couples become parents with support of Assisted Reproductive Technology (ART) provided by fertility clinics all over the world. It is used primarily in infertility treatments and refers to methods used to achieve pregnancy by artificial or partially artificial means. The term includes any reproductive technique involving a third party e.g. a sperm or egg donor.

 
There are different types of assisted reproductive technology (ART). The common methods of ART include: In vitro fertilization (IVF); Intracytoplasmic Sperm Injection (ICSI); Tubal Embryo Transfer.

 
 

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