Infertility
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what is infertility?
Infertility is the failure of a couple to conceive
● After 12 months of regular intercourse without use of contraception in women less than 35 years of age
● After six months of regular intercourse without use of contraception in women 35 years and older
In general, infertility can be attributed to the
● Female partner one third of the time
● Male partner one third of the time
● Both partners in the remaining one third
Types
Primary infertility: No prior pregnancies
Secondary infertility: Referring to infertility following at least one prior conception.
Causes of infertility
In Females
- Ovulatory factors: polycystic ovarian syndrome (PCOS), premature ovarian failure, hypothyroidism, hyperprolactinemia, hypothalamic-pituitary disorder, anorexia nervosa
- Tubal/peritoneal factors: previous PID(pelvic inflammatory disease), previous tubal surgery, ectopic pregnancy, benign polyps, tubal endometriosis, mucus debris, pelvic tuberculosis
- Uterine abnormalities: Congenital (uterine septum, bicornuate uterus, unicornuate uterus, uterine didelphys) Acquired (intrauterine liomyomas, polyps, asherman syndrome)
- Cervical factors: congenital malformation, trauma to the cervix
- Diminished ovarian reserve: maybe caused by advanced age, smoking, genetic conditions, prior ovarian surgery, chemotherapy, pelvic irradiation
In Males
- Pre testicular causes: congenital (Kallmann’s syndrome) Acquired (Tumors, infiltrative disease, chronic disease, hyperprolactinemia, drugs)
- Testicular causes: congenital (Klinefelter’s syndrome, Y chromosome defects, Cryptorchidism, Varicoceles, Androgen insensitive syndromes, 5-alpha-reductase deficiency Acquired (infection, drugs)
- Post-testicular causes: Bilateral obstruction, ligation, or altered peristalsis of the vas deferens
- Idiopathic male infertility
Treatment of the infertile couple
Lifestyle Therapies
- Weight Optimization
- Stop Smoking
- Exercise
- Nutrition
- Stress Management
- Explain fertile period
Correction of an Identified Cause
- Ovulation induction: weight modulation, clomiphene citrate or other selective estrogen receptor modulators (SERMs), Gonadotropin therapy, Aromatase inhibitor, laparoscopic ovarian diathermy
- Correction of anatomic abnormalities: correction of tubal factors (periadnexal and tubal disease), uterine factors (myomectomy, polypectomy, adhesiolysis) and cervical factors (IUI, IVF)
Assisted reproductive technology
Invitro fertilization (IVF)
Mature oocytes from stimulated ovaries are retrieved transvaginally with sonographic guidance. Sperm and ova are then combined in vitro to prompt fertilization. Viable embryos are transferred transcervically into the endometrial cavity using sonographic guidance. Optimally, 10 to 20 ova are harvested, and from these, one healthy embryo is ideally transferred back to the uterus. Unfortunately, methods to determine embryo health are imperfect. Therefore, to maximize the probability of pregnancy, more than one embryo is typically transferred, thus resulting in increased risk of multifetal gestation.
Intracytoplasmic Sperm Injection (ICSI)
During the micromanipulation technique of ICSI, cumulus cells surrounding an ovum are enzymatically digested, and a single sperm is directly injected through the zona pellucida and oocyte cell membrane.
Indications
- Semen analysis shows less than 2 million motile sperm
- Less than 5% motility
- If surgically recovered sperm are used
Non–male factor indications for ICSI include
- History of fertilization failure with conventional IVF
- The fertilization of oocytes before preimplantation genetic diagnosis
Gestational carrier surrogacy
A fertilized egg is placed into the uterus of a surrogate rather than into the “intended mother.”
Indications
- Women with uncorrectable uterine factors
- For those in whom pregnancy would pose significant health risks
- For those with repetitive unexplained miscarriage
Egg donation
Indication
- Ovarian failure or diminished ovarian reserve.
- In fertile women when offspring would be at risk for maternally transmitted genetic disease.
Egg donors may be known to the recipient couple or more commonly are anonymous young women recruited by an agency or IVF center. It is performed using “ fresh” oocytes or cryopreserved eggs. Fresh egg donation cycles require synchronization of the recipient’s endometrium with egg development in the donor.
What you need to know about medical travel for the above conditions
- Arrange an appointment to visit our medical consultant
- Come as a couple/ with your partner
- Bring your separate investigation results:
- Both male and female:- Complete blood count, Blood group, Organ Function Test etc…
- For male:- Sperm analysis (PH, number, motility, morphology etc…)
- For female:- Abdominopelvic Ultrasound, HSG (Hysterosalpingography) test, Ovarian reserve test (for women above 35)