Infertility
A couple is said to be infertile if
- The couple has not conceived after 12 months of contraceptive-free intercourse if the female is under the age of 34.
- The couple has not conceived after 6 months of contraceptive-free intercourse if the female is over the age of 35.
- The female is incapable of carrying a pregnancy to term.
Women reach the peak of fertility in their early twenties. Couples in their twenties who are in good physical health and engage in regular sexual activity have about a 25% to 30% chance per month of conceiving.
Women in their thirties, particularly those over the age of thirty-five, have less than a 10% chance per month of becoming pregnant.
What causes infertility?
Infertility may be due to problems in the female, the male or a combination of both. In some cases, the cause is not known.
Common Female Factors
Following female factors may cause or contribute to infertility:
- Damage to the Fallopian tubes following infection or surgery.
- Uterine fibroids: These are benign tumors which grow from the muscle layers of the uterus.
- Endometriosis: This condition is characterized by presence of tissue similar to the lining of the uterus elsewhere outside the uterus causing pain especially during periods and intercourse.
- Hostile cervical mucus. This is a condition in which the cervical mucus creates a thick barrier that sperm cannot penetrate.
- The production of sperm antibodies i.e. when a woman develops antibodies to her partner’s sperm.
- Sexually Transmitted Diseases such as Chlamydia, Gonorrhea etc. are one of the most preventable causes of infertility.
- If left untreated, STDs can cause up to 40% of women to develop pelvic inflammatory disease (PID). PID causes infertility by producing scarring of the fallopian tubes.
- Tuberculosis can affect various body systems including the reproductive system in females as well as male infertility.
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- Hormonal Imbalances:
- Altered levels of thyroid hormone (a chemical released into the blood circulation from a tiny organ in front of the neck called thethyroid gland).
- Increased levels of prolactin hormone due to a brain tumor called prolactinoma. This condition is usually associated with galactorrhea (milk leaking from the breasts).
- Increased levels of insulin.
- Diabetes mellitus and Adrenal gland dysfunction.
- State of being over or underweight.
- Polycystic Ovarian Syndrome (PCOS), a condition characterized by development of multiple cysts in the ovaries due to failure of maturation and expulsion of eggs from them.
- Inconsistent ovulation due to obesity, thyroid dysfunction, peri-pubertal (13 to 16 years) or peri-menopausal stage (40-45 years).
- Psychological issues, such as anxiety resulting from a lack of emotional support, can lead to hormonal problems that affect a woman’s fertility
Unexplained Infertility:
In about 15% of cases the infertility investigation will show no abnormalities. In these cases abnormalities are likely to be present but not detected by current methods.
Possible problems could be that the egg is not released at the optimum time for fertilization, that it may not enter the fallopian tube, sperm may not be able to reach the egg, fertilization may fail to occur, transport of the zygote (fertilized egg) may be disturbed, or implantation fails. It is increasingly recognized that egg quality is of critical importance and women of advanced maternal age have eggs of reduced capacity for normal and successful fertilization.
Recent research suggests that psychological issues, such as anxiety resulting from a lack of emotional support, can lead to hormonal problems that affect a woman’s fertility.
Male infertility is often caused by a low sperm count or an anatomical abnormality, such as a palpable dilation of veins in the scrotal area known as varicocele.
Other contributing factors can be attributed to how the sperm moves (motility), or an abnormal sperm type
What tests are used to diagnose infertility?
Typically, couples are seen together when diagnosing infertility. The doctor will take a note of the couple’s full medical histories and this will be followed by an examination.
They will also be asked about the use of prescribed or illegal drugs, alcohol and tobacco, and whether there is a family history of infertility or genetic disorders.
Women can expect questions about their menstrual history, the age of onset and any difficulties with menstruation. They will also be asked whether they have noticed milk leaking from their breasts.
Women may have to undergo a genital examination, as well as a cervical smear.
Blood tests are taken to measure prolactin levels and thyroid function and sometimes to test for certain hormone levels, such as progesterone and estradiol.
A post-coital test, which is similar to a cervical smear, may be required to see if the sperm can penetrate the cervical mucus.
Sometimes an ultrasound scan of the pelvis is taken to check for fibroids in the uterine cavity.
A laparoscopy may also be performed, in which a lighted camera is passed through a hole in the abdomen to look at the pelvic structures.
Occasionally, a hysteroscopy is required, in which a thin, lighted tube is passed into the uterus to directly examine it.
Men will be required to provide a semen analysis. They must abstain from sexual intercourse for three days before providing the sample.
Genetic blood test is performed to make sure that there are no chromosomal abnormalities or defective genes that could be passed on to potential offspring.
Blood tests also may be taken to determine levels of testosterone.
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What treatments are available?
There are various treatment options for infertility available such as natural method i.e. intercourse should take place around the time of ovulation, infertility drugs, male-infertility treatment, and assisted reproductive techniques such as IVF, ICSI, GIFT, etc., that you can discuss with your infertility specialist according to your case.
Can complementary therapies help?
There are herbs that may enhance sexual functioning in men and women. Most of these herbs are available in tablet form from health food shops. However, you should consult a qualified herbalist and check with your physician before taking them.
As anxiety may contribute to infertility, incorporate stress management techniques into your daily routine.
The importance of preconceptual care
If you are trying to get pregnant, regardless of the method, you should drink only in moderation, do not smoke and avoid any drugs other than those prescribed by your physician. Exercise only lightly and avoid hot tubs and saunas, as they may lead to a lowered sperm count or changes in ovulation. Be sure to get plenty of fresh fruit and vegetables into your daily diet, as they containfolic acid, which helps prevent neural tube defects in the baby.
Maintain an appropriate body weight, as being over or underweight can affect fertility. Also, make sure you receive a rubella vaccination if you have not already had one. It is important to note that pregnancy should be avoided for three months after a rubella immunization.
