A couple is said to be infertile if there is no pregnancy within 1 year of unprotected intercourse In spite of both the partners being normal.
Before we discuss the variety of diseases and conditions which may cause infertility, let us know how the pregnancy occurs naturally!.
A woman has a monthly cycle known as a menstrual cycle (periods). The day the periods begin is considered as the Day-1 of the cycle.Under the influence of the hormones only one egg (sometimes-two) dominates to grow over and above the others. By 14th - 16th day it is released from the ovary thr’ the process known as ovulation.
After the ovulation, the ovum (egg) released from overy enters the fallopian tube. When the intercourse happens the semen is deposited in the vagina. From the cervix and the uterine cavity, the sperms enter the tube and reach the ovum, millions in number. Only one sperm fertilizes the ovum and the pregnancy begins! Embryo develops!
Because of the peristaltic movements of the tubes, the developing embryo is gently pushed forwards towards the cavity of the uterus where it implants! This approximately takes 5-6 days after ovulation!
Thus, pregnancy is a kind of Orchestra involving many things (hormones, eggs, sperms, tubes, uterus, endometrium, and timing) and also the fine tuning between them! Any wrong note at the wrong time will spoil the harmony!
If both the partners are normal and not using any contraceptive method, with the regular frequency of intercourse, it may take one year for the couple to conceive. 85% of the couples conceive with 1 year. The rest 15% may require the treatment.
We at Patanakar Fertility Solutions,have the experts to counsel you regarding your fertility problems, the exact causes as well as the nature of treatment for it!
If both the partners are normal and not using any contraception then it may take a year for them to conceive.85% of the couples conceive and the rest 15% can be considered as infertile and may require treatment .
There are many causes of infertility.
- Male Infertility : Mainly because of the various abnormalities of the semen.It could be either the reduced sperm count or reduced sperm motility or the abnormalities of the sperms or the combination of these.
- Female Infertility : The female factors responsible for causing infertility are ovulatory dysfunction,tubal factor, uterine factor,hormonal imbalance or the combination of these.
- Combined Male & Female Infertility
- Unexplained : Where no cause is found either in male or the female partner.
Male infertility is seen on the rise not only because more and more males are now coming open heartedly for the treatment but also there is an actual rise in the male infertility. But with the new modalities of treatment of most of these conditions possible.
Abnormal Semen Parameters
- Hypospermia - Too less volume of the semen (<2 ml of semen)
- Azoospermia - No sperm in the semen. Can be of obstructive or non obstructive type. In obstructive type there is obstruction to the passage of the sperms and sperm production in the testis can be normal. In non obstructive azoospermia production of the sperms in testis is usually absent or decreased.
- Oligozoospermia - Less no of sperms in the semen (<20 million/ml)
- Asthenozoospermia - Less motility of the sperms (<50 % of the total progressive motility)
- Teratozoospermia - More no. of sperms with abnormal morphology (>30% abnormal) Any comlination of the above varieties, the worst being Oligoastheno teratoyoospermia
Globozoospermia - The sperms are with no acrosomal cap so unable to fertilize the egg although the count and motility are normal.
- Necrozoospermia : All sperms are dead
- Sexual dysfunction
- Genetic causes
Sexual Dysfunction as a cause of infertility is on the rise in the recent years. This may lead to non-consummation of marriage and so infertility. Stress is on the high rise and so are the career demands. Too much stress or exhaustion can affect sexual life badly resulting in infertility. Another important reason for infrequent intercourse is partners staying at different places.
Apart from excessive stress habits such as smoking, alcoholism,tobacco chewing affects the sperm parameters badly.
It is a condition in which there is stagnation of blood in the veins around the testes resulting in abnormal semen parameters. It can be treatetd surgically although the result may vary.
Treatment of abnormal semen parameters
Various medications are available for improving the semen quality, but all the medicines have their limitations and are not always successful in improving the semen parameters.
Patients with mild degree of abnormal semen parameters can be treated with intrauterine insemination technique (IUI) whereas patients with severe male factor infertility require intracytoplasmic sperm injection (ICSI)
Patients with Azoospermia are usually subjected to testicular biopsy and if the sperms are found in the testis, these patients can father their own child by TESA/MESA/PESA followed by ICSI.
Patients with higher grade of varicocele may be benefited immensely by undergoing varicocele repair.
Inability to consummate marriage can be caused by
- Erectile dysfunction
- Premature ejaculation
- Combination of factors
The treatment depends upon the nature and severity of problem.
The treatment can be as simple as counseling or tablets.
In patients who has impotency semen can be obtained by using a vibrator or electroejaculation and used further for IUI.
The details of the ART procedures like IUI, IVF and ICSI are discussed in details in treatment.
The female reproductive system consists of uterus with cervix and endometrium, fallopian tubes, ovaries and the hypothalamo-pituatary-ovarian axis through which the reproductive hormones are secreted and reproductive cycle is controlled.
Malfunctioning or disturbance of any or many of these can lead to infertility, major causes being ovulatory dysfunction and tubal diseases.
Uterine and cervical factors in infertility
Uterus plays an important role in reproduction. It acts as a transport vehicle not only for the sperms from vagina and cervix to the fallopian tubes but also carries and nurtures the embryo and the fetus upto delivery.
Uterus as a cause of infertility is seen in minority of cases. It is more responsible for abortions or premature delivery.
However, few uterine causes of infertility are
- Intrauterine Adhesions
- Leiomyoma (fibroids)
- Endometrial Polyps
- Congenital Uterine Defects
Endometrial Causes of Infertility
Endometrium (inside lining of the uterus) bears receptors for the attachment of the embryo & provides nourishment to the embryo. Endometrial causes of infertility could be because of the poor development of the uterus (thin) or excessive development (thick).
Intrauterine adhesions or polyps (growths) could also be the factors responsible for the infertility.
Abnormal thickness or growths of the endometrium prevents proper implantation (attachment) of the fetus
Endometrial causes are really difficult to tackle. Thickness can be improved with certain medicines (estrogen pills) but that does not necessarily improve the results.
Adhesions/polyps/septum present in the uterine cavity can be removed hysteroscopically.
Tubal cause of Infertility
One of the major causes of infertility. Tubes play an important role in the process of fertilization. They help in the transport of the gametes (eggs & sperms) as well as the embryo. The fertilization of the egg occurs in the outer part of the fallopian tube.
The infertility occurs because of the obstruction or blockage of the tubes, destruction of the endosalpinx (inside lining of the tubes) or peritubal adhesions (adhesions around the tubes disturbing the anatomy and functioning of the tubes)
Genesis has state of the ART facility and equipment to correct the tubal factor of infertility.
Proximal Blocks can be removed by hysteroscopic canulation. Fimbrial Blocks can be removed by laparoscopic fimbrial dilatation or fimbrioplasty. All the blocks (midtubal) cannot be removed as the tubes are very thin, delicate structures and the attempt itself may cause serious damage to the tubes. Those who desire pregnancy after the sterilization operation can be given the option of recanalization of the tubes by microsurgery. However, all these procedures do not guarantee pregnancy as the damage done could be irreversible.
But IVF is a boon to all these patients. In fact, it was discovered as a treatment for the patients with tubal blocks.
Endometriosis is a condition where the inside lining of the uterine cavity grows elsewhere i. e. on the ovaries (most common site), pelvis, tubes, muscles of the uterus. The condition could be totally asymptomatic or could present with one or more of the following symptoms
- Pelvic pain
- Menstrual irregularity
- Rectal pain/bleeding
Infertility because of endometriosis is caused due to dyspareunia, ovulatory dysfunction, impaired transfer of the gametes , impaired fertilization and impaired implantation.
Endometriosis cannot be cured completely. The condition can be suppressed with the help of injections, medicines and or surgery (Laparoscopy.) This is the condition which may require multiple injections and/or surgeries.
Polycystic Ovarian Disease
Polycystic ovarian disease (PCOD) is the most common entity causing infertility. It contributes to > 50% of cases of infertility. The woman usually presents with irregular/delayed/scanty periods, obesity. Some woman may have hirsuitism (excessive facial hair growth), insulin resistance or else the woman could be totally symptom-free.
The basic problem in PCO is lack of ovulation or delayed ovulation. Every month the follicles (eggs) start growing but they fail to progress to the maturation level & theses fail to ovulate. The result of this is accumulation of multiple follicles of small size (6-10mm diameter) in the periphery of the ovaries.
This could be associated with the hormonal imbalance between FSH & LH.the LH is high.
- Those who are overweight or obese must reduce weight
- Induction of ovulation with the help of the drugs like clomiphene citrate, letrozole
- Some women may require ovarian drilling by laparoscopy. This is nothing but creating multiple holes on the surface of the ovaries
- A small group may require injections along with the tablets or even test tube baby
Prolactin is the hormone secreted by the pituitary gland of the brain. The primary function is to enhance the breast development & induce lactation after delivery. It also has significant effect on female as well as male fertility.
In females more than normal levels of it may cause menstrual irregularities by causing disruption of the normal follicular development and ovulation.
In males, it may adversely affect spermatogenesis & also causes structural changes in the tests. Increased levels of prolactin may be due to the primary cause such as pituitary tumor or due to the secondary cause such as associated PCO or hypothyroidism. Some women may also complain of breast secretions (galactorrhoea) due to elevated prolactin levels. Men may have decreased libido, impotence, gynecomastia & infertility.
Easily controlled with the help of drugs like bromocryptine or cabergolin. Tumors (Prolactinomas) can be managed by observation medical therapy, irradiation, or surgery.
Abnormal thyroid levels both high as well as low have profound effect on reproduction & pregnancy.
Increased thyroid levels can lead to ovulatory dysfunction with either irregular/delayed or no periods at all or heavy periods & also the bleeding in between the periods. In males, it may lead to decreased libido & impaired sperm parameters mainly sperm motility.
Treatment consists of tablets of carbimazole & PropylThiouracil.
Low thyroid levels (moderate-severe) causes not only infertility due to irregular menses but also increase the chances of 1st trimester abortions, premature deliveries & unexplained stillbirths.
Replacement with thyroid hormones with thyroid extract. Dose adjustments are necessary which are done by periodic checking of the hormonal levels.
Combined (Male + Female) infertility
When the couple faces the problem of infertility, it is not always that either of the partners is at fault. Many a times it is seen that both the partners are at having one or more problems.
So although cause/(s) of infertility is established in one partner, the other partner cannot be assumed as normal & must be evaluated!
Unexplained infertility is the term applied to those couples who fail to conceive despite the investigations which are normal or after the correction of the factors identified as probably responsible for the infertility.
In other words, in unexplained infertility the ovulation is established, tubes are patent, there is no evidence of, adhesions, intrauterine pathology & the male partner has normal seminal parameters.
As many as 20% of the infertile couples have unexplained infertility.
Many a times, certain investigations may have to be repeated to re-evaluate the problem.Also,the fact remains that many of the processes necessary for conception cannot be evaluated with the available diagnostic methods.
Counseling forms the main part of the treatment & so is the reassuarance. Treatment -free break also helps. The couples can conceive during this period. The chances are higher in women with younger age. Most patients conceive with simple treatments but few may require IVF/ ICSI.
Rarely,the couples may have to be offered the use of donor eggs, donor sperms or donor embryos as well.
At Patankar Fertility Solutions so many couples with unexplained infertility have been blessed with the child!
Infections & infertility
Infection is a common cause of infertility. Although due to awareness, improved & newer approaches to infections, the incidence has dropped considerably, still a considerable percentage of infertility is due to the infection. This is so because many of the infections involving the reproductive tract are silent. Since they do not produce any symptoms they are not diagnosed and treated. As a result, the infection becomes chronic (long standing) causing damage which many a times is irreversible impairing the fertility in males as well as females.
Most of the infections are sexually transmitted. The common infections are gonococcal and chlamydial and also tuberculosis of the genital tract. In males it may affect the semen quality reducing the number of spermatozoa, reduction of motility, changes in their morphology and fertilization capacity. It can also damage the testicular tissue affecting the production of sperms (spermatogenesis). Infections can also give rise to the development of antisperm antibodies. Infection can affect the accessory glands in males e. g. Prostate, epididymis the screening cab result in obstruction of the duct.
In females, the infection can affect tubes, uterus, cervix, endometrium. The effects are blockage of tubes, or destruction of the inside lining of the tubes leading to malfunctioning, formation of antisperm antibodies, affecting cervix and its glands, affecting implantation.
Diagnosis is very important as is the treatment! Patankar Fertility Solutions offer you the best guidelines for the diagnosis as well as treatment of various infections. Many a times, the conditions improve and fertility returns but not always! In such cases, IVF-ICSI remains the treatment of choice.
In this type of infertility the body produces cells against its own cells affecting the function, that can result in infertility or the fetal wastage.Those responsible for the infertility are the antisperm antibodies.In males it causes agglutination or immobilisation of the sperms.
In females it could be the antioocyte antibodies impeding the fertilization of the egg,development of the embryo or the implantation of the embryo. Immunological infertility could be as a result of trauma,infection,abnormal sexual behaviour or homosexuality. The treatment could be in the form of either immunotherapy, immunosupression which are difficult. However ART procedures like IUI, IVF ICSI give better results.