Infertility is the term used to denote women’s condition of not getting pregnant even after trying for one year. Women who is not able to get pregnant for some underlying issues is said to be in infertile condition. Fertilization takes place by a sequence of events. Firstly the egg will be released from the ovaries during ovulation process. This egg will travel down through the fallopian tube to reach the uterus.
In the midway of its travel, the egg will have to fuse with the sperm received from a man. This fertilized embryo will finally move forward to get implanted inside the uterus. Any change or disturbance in any of these steps can cause infertility. According to the report submitted by the center of disease control and prevention, it is believed that around 10-15% of women living in the USA of age group from 15-45 have infertility problems. And infertility is not confined to problems of women alone. Men can also be the reason for infertility. The tendency of not becoming pregnant after repeated attempts of having unprotected sex for at least one year is described as infertility.
Often many couples will achieve pregnancy within 6-8 months of vigorous trying. At the most it can take one year if they are practicing unprotected sex. More than 90% of people will get pregnant and only 10% will have infertility problems.
When to see your doctor?
The couple should not be very much concerned about getting pregnant for the first 6 months of trying. If you feel strongly that you are trying regularly but still not able to conceive then you can visit your health care provider. Women of age 35 years or above can have problems in getting pregnant. The chances are less if she has crossed 40 years. Women with irregular periods and heavy bleeding during periods should discuss the issue with the doctor if they are planning to get pregnant.
Women with pelvic inflammatory disease or endometriosis, women who have often had miscarriage and those who are taking chemotherapy for cancer should inform their doctor about this issue. Similarly men with low sperm count and men with history of prostate problems or other problems in sex can discuss it with his doctor.
Infertility in Men – Causes :
A condition called varicocele occurs in men where the veins of his testicles become enlarged affecting the number of active sperms. Any injury on the reproductive organ can cause damage to the sperms reducing their count considerably. Cystic fibrosis and chronic diabetes can cause infertility in men. Men, who are in the habit of prolonged drinking and using drugs, and those who are exposed to poisonous toxins like lead, having serious health problems, men who are undergoing chemotherapy and those who are aged can have infertility issues.
For some men genetic defects can affect the sperm production. Some sexual problems like premature ejaculation or decreased erection or erectile dysfunction and structural problems like blockage in the testicles can affect the sperm count.
Infertility in Women – Causes :
For women infertility occurs due to irregular menstrual periods and problems in the process of ovulation. Eggs will not be fertilized if the periods are not regular or if the menstrual cycle is absent. There are many causes for disturbed or missing ovulation. It can occur due to polycystic ovarian syndrome caused by hormonal imbalance and due to primary ovarian insufficiency problem.
For some women infertility occurs due to block in fallopian tubes, fibroids or cysts in uterus, endometriosis and any other physical problems in the uterus. It can also occur due to thyroid problems, chemotherapy procedure and influence of certain drugs. Infertility can be caused due to problems in both men and women and sometime due to unknown causes.
Who are at risk?
Women and men who are aged, those using tobacco in any form, those who are in habitual drinking and substance abuse, those who are obese and having diabetic problem have increased chance for developing infertility issues. Men/women who are affected with sexually transmitted disease and those who lead a stressful lifestyle will have delayed pregnancy or infertility problems in life.
Aged women cannot produce more number of eggs and even if she can produce more eggs it may not be healthy enough to fuse with sperms. The chance of becoming pregnant decreases rapidly with age and women who are above 30 years will have difficulty in getting pregnant.
Tests and Diagnoses :
The testicles of the man should be healthy enough to produce active sperms and it must be ejaculated rightly into the woman’s vagina to get conceived. Testing procedure for men include semen analysis in the laboratory to determine the health of the sperm. Your doctor may also order for hormone testing, scrotal ultrasound scanning to rule out problems like retrograde ejaculation and obstruction during ejaculation.
For a woman her ovaries should be able to produce healthy eggs and it must pass through the fallopian tubes to facilitate fusion with the sperm and further the fertilized egg should travel till the uterus to get implanted in the lining. The doctor will conduct pelvic examination and order for ovulation testing to rule out any ovulation problems. Further hysterosalpingography is done for checking the condition of the uterus. She would then check for the quantity and quality of the eggs that are ready for ovulation. Lastly imaging tests of pelvic region is done to rule out any block in the fallopian tubes. For some women, laparoscopy method of invasive surgery is done for clearing any obstruction/blockage in the fallopian tubes.
Many methods are available for treating infertility like medications, artificial insemination procedure and surgery. Often, combination of two or more approaches will be effective for couples with delayed pregnancy. Based on the results of the testing procedure and considering the health condition and age treatment is given.
For men with premature ejaculation counseling with behavioral therapy and medications are highly effective. If he has very low sperm count, surgery is done for repairing the testicles. In case of clearing any blockage that hinders the movement of sperms, surgery is done. Hormone injection is given for correcting the problem of sperm count. Men with spinal cord injury may have problems like sperm retrieval which can be corrected using surgical sperm aspiration process.
For women many varieties of treatment have to be done for achieving fertility. To begin with fertility drugs like clomid, human menopausal gonadotropin injection, and follicle stimulating hormone are given for speeding up the process of fertility and for clearing ovulation disorders. Intrauterine insemination is another process in which healthy sperm is inserted into the uterus when the ovary is ready to release the eggs so that fertilization takes place easily. Surgery can be done for clearing endometrial polyps, ovary cysts, or scar tissue in the uterus.
Assisted Reproductive Technology :
This is the most effective method for getting resolved from infertility problem. A team of doctors comprising of physicians, embryologist, psychologist, and lab technicians will work together for achieving pregnancy for infertile couples.
IVF (In Vitro Fertilization) is one of the commonly used ART method in which number of mature eggs will be fused with the active sperm in a lab setting and after fertilization, the embryo will be implanted into the uterus. Thousands of babies are born using this method in many countries. However if the age of women is more than 35 years the success rate cannot be guaranteed.
Intra cytoplasmic sperm injection is another method in which a single sperm is injected into the egg for fertilization. Further in a technique called assisted hatching the outer layer of the embryo is opened and implanted into the uterus. In case there are severe problems with men causing infertility, donor sperms are used for fertilizing the egg. In Gestational carrier method another women will be carrying the embryo in her uterus in the place of affected woman.
What are the complications?
The major complication of artificial fertilization technique is multiple pregnancies. It can cause two or more fetuses which can increase the risk of premature labor and complications in delivery. Giving more of fertility injections and drugs to the woman can pose risk of getting ovarian hyperstimulation syndrome causing severe abdominal cramps and bloated sensation. In rare cases, infection can happen if things are not handled with hygienic aspect. For women with multiple pregnancies through artificial methods the fetus will have low birth weight and can have birth defects.
Nobody can prevent infertility problems caused by genetic or uncontrolled factors. It is for the couples to have regular intercourse in the right time of ovulation to increase the chance of getting pregnant. Both men and women should avoid using tobacco and alcohol and should stay on healthy diet. Above all they should have optimistic approach of getting pregnant.