Infertility

Infertility

(For Male and Female)

Infertility primarily refers to the biological inability of a man or a woman to contribute to conception. Infertility may also refer to the state of a woman who is unable to carry a pregnancy to full term. There are many biological causes of infertility, some which may be bypassed with medical intervention.

Women who are fertile experience a natural period of fertility before and during ovulation, and they are naturally infertile during the rest of the menstrual cycle. Fertility awareness methods are used to discern when these changes occur by tracking changes in cervical mucus or basal body temperature.

Female

Why you may have trouble Conceiving

Although getting pregnant may seem like the easiest thing in the world, it is actually not so for many people. There are several reasons for this, and any one or more of the following may be applicable.

Late planning (advanced age)

The trend today is for women to complete their education and establish their careers before they think of settling down and starting a family. However, for a woman over the age of 35, conceiving becomes a problem. Infertility increases with age. Fertility peaks for both sexes in their mid-twenties and then appears to decline steadily in women over thirty and men over forty. Tubal infections, fibroid tumours and endometriosis are more common in older women and are a common cause for infertility.

Excessive drinking, smoking, drug use

Research has shown that the excessive consumption of alcohol or the use of illicit drugs like marijuana, cocaine, heroin and crack, by a potential father prior to pregnancy can be the cause of infertility. Illicit drugs can also reduce the sperm count, damage the sperm, reduce testosterone levels, and change testicular functioning. (These are generally ejaculated with the sperm.) Heavy drinking can affect a woman's menstrual cycle as well. Note however, that as long as drinking, smoking and drug use have been curtailed before getting pregnant, prior use seems to pose almost no risk to the baby.

Ovulation/menstruation problems

Ovulation is a pre-requisite for getting pregnant. In women with regular menstrual cycles of 28-35 days, ovulation takes place once every cycle. However, many women have erratic menstrual cycles (often getting periods 3-4 times a year or even less). This means that they have fewer chances of getting pregnant not only because they have fewer possible fertile periods, but also because they may not be ovulating in every cycle. (Note that ovulation does not necessarily take place in every menstrual cycle).

Low sperm count (for males)

The normal sperm count ranges from 20 million to 100 million sperm per cubic centimetre. Counts below 20 million may be a cause for difficulty in conception. Factors such as fatigue, excessive alcohol, smoking or other drug abuse, prostate gland infection, poor diet, or occupational exposure to chemicals can cause a small, temporary decrease in the sperm count. Varicose is a condition when there are varicose veins on the scrotum. This is another cause for infertility and can only be corrected through surgery.

Retroverted uterus

Many women are born with their uteruses facing backward (retroverted) instead of forward. This condition can be diagnosed either by your gynaecologist, or through an ultrasound. One simple way to compensate for this problem of a retroverted uterus is for the woman to lie on her stomach after intercourse. (Women with regular uteruses who are planning to get pregnant are asked to lie on their backs and lift their legs from their hips after sex in order to improve the chances of fertilization). If retroverted uterus is the only problem, then in most cases the woman will conceive. However, if she still does not get pregnant, then the doctor may advise surgery.

Polycystic ovaries

Cysts are formed when the follicle fails to rupture at the time of ovulation and begins to grow instead. This condition occurs due to hormonal imbalance and is marked by absent or infrequent menstruation. Women having this condition have a chronic tendency to have their periods at intervals ranging from every six weeks to six months. Conception becomes difficult due to irregular ovulation.

Intercourse pattern

Very often, you may simply be mistiming your intercourse. In order for you to get pregnant, it is essential for you to have sex during your fertile days. It could also be possible that you may be trying too often in a particular cycle, and thereby causing a reduction in sperm count.

Do you have an Infertility Problem?

When most couples get married they expect to have their own babies. Many naively expect they will get pregnant the very first month they try - and are concerned when a pregnancy does not occur. All of us go through a brief interlude of doubt and concern when we do not achieve pregnancy the very first month we try - and we start wondering about our fertility.
Only a 25% chance!

Before worrying, remember that in a single menstrual cycle, the chance of a perfectly normal couple achieving a successful pregnancy is only about 25%, even if they have sex every single day. This is called their fecundity, which describes their fertility potential. Humans are not very efficient at producing babies! There are many reasons for this, including the fact that some eggs don't fertilize and some of the fertilized eggs don't grow well in the early developmental stage.

Getting pregnant is a game of odds - it's a bit like playing Russian Roulette and it's impossible to predict when an individual couple will get pregnant! However, over a period of a year, the chance of a successful pregnancy is between 80 and 90%; so that 7 out of 8 couples will be pregnant within a year. These are the normal "fertile" couples - and the rest are "labelled” infertile - the medical text book definition of infertility being the inability to conceive even after trying for a year. Couples, who have never had a child, are said to have "primary infertility,” those who have become pregnant at least once but are unable to conceive again, are said to have "secondary infertility."

Factors that determine fertility

The chances of pregnancy for a couple in a given cycle will depend upon many things, and the most important of these are:

· The age of the woman. At the biologic clock ticks on, the number of eggs and their quality starts decreasing.

· Frequency of intercourse. While there is no "normal" frequency for sex, the "optimal" frequency of intercourse if you are trying to get pregnant is about 3 times a week in the fertile period. Simply stated, the more sex the better! Couples, who have intercourse less frequently, have a diminished chance of conceiving.

· "Trying time" - that is, how long the couple have been trying to get pregnant. This is an important concept. The longer a couple has been trying to conceive without success, the lesser their chances of getting pregnant without medical help.

· The presence of fertility problems.

What happens when a couple has a fertility problem?

The chances of their getting pregnant depend upon a number of variables multiplied together. Consider a couple where both the husband and wife have a condition that impairs their fertility. For example, the husband's fertility, based on a reduced sperm count is 50 percent of normal values. His wife ovulates only in 50 percent of cycles; and one of her fallopian tubes is blocked. With three relative infertility factors, their chance of conception is 0.5 (sperm count) X 0.5 (ovulation factor) X 0.5 (Tubal factor) = 0.125, or 12.5 percent of normal. Since the chance of conception in normal fertile couples is only 25% in any one cycle, the probability of pregnancy in any given month for this couple without treatment is only 3 percent (0.125 X 25 = 0.03125)! Even if they kept on trying for 5 years, their chance of conceiving on their own would be 60% only. Thus, infertility problems multiply together and magnify the odds against a couple achieving a pregnancy.

This is why it is important to correct or improve each partner's contributing infertility factors as much as possible in order to maximize the chances of conception.

If infertile couples had 300 years in which to breed, most wives would get pregnant without any treatment at all! Of course, time is at a premium, so the odds need to be improved - and this is where medical treatment comes in.

Causes of Male Infertility

What are the indications for male infertility

Statistics show that in at least 40% of infertile couples, there is a male factor contributing to the problem. Male fertility screening is done through semen analysis. The general rule is that the lower the sperm count and the poorer the sperm quality, the longer it will take and the more difficult it may be for a pregnancy to occur. However, even men with very low sperm counts may eventually be successful in causing a pregnancy. The sperm count only needs to be high enough for that one time that ovulation occurs, in order for a pregnancy to be possible.

What are the major factors affecting sperm production

Oligospermia is the term used to describe the condition when the sperm count is low. If there are no sperm at all in the semen sample, the condition is termed azoospermia. In such cases, the clinic will wish to see your husband to take a more detailed history and to examine him. In his history, specific questions will be asked about any past condition that may have affected the testicles. For instance, he will have to answer queries regarding whether he has had any operations in the groin area or for undescended testicles in childhood. The specialist will also ask questions to determine whether there has been any major injury or infection in the genital area.

Infected semen can be a cause of infertility. Earlier, it was believed that mumps could cause sterility in men. However, it is now known that even when the testicles are involved in mumps orchitis (very painful swelling of the testicles); it is extremely rare for this to lead to sterility.

What other factors affect sperm production

1. Heat can have a detrimental effect on normal sperm production. It is for this reason that nature has placed the testicles outside the body in the scrotum rather than in the abdomen like the ovaries. Some infertile men soak themselves in a bathtub full of scalding water and emerge looking like lobsters. This can almost stop sperm production completely. Obese men can also become sterile because the sagging layers of fat can overheat the testicles. Men whose jobs involve long hours of sitting, e.g. long distance lorry-drivers may have infertility due to the increased heat to the genital area.
2. Very frequent intercourse can lead to the demand exceeding the supply. There are quite a number of infertile men whose sex drive is such that they must ejaculate 2-3 times a day. This explodes the myth that links infertility to lack of virility. It can be extremely difficult for these men to reduce their ejaculation rate to every 48 hours.
3. Smoking over 20 cigarettes a day has been shown to reduce both the sperm count and the sperm motility to quite a major degree.
4. Excessive alcohol intake will lead to infertility mainly because a man loses both the inclination and the ability to rise to the occasion! Alcohol can also lower the production of sperm and of the male hormone testosterone.
5. The workaholic husband can find that fatigue can have similar effects on his interest in intercourse as excessive alcohol intake.

What problems can be identified during examination

Every infertile man must be carefully examined. The examination of the external genitalia in the male rarely shows anything out of the ordinary. However, sometimes one or both testicles are very small or rarely may even be absent. Additionally there may be congenital absence of each vas deferens, the ducts through which sperm pass from the testicles to the female at intercourse.

Other factors which may contribute to lowered fertility, and which can be identified on examination include:

1. Varicocele is a term used to describe a condition where there are varicose veins around the testicle and vas deferens. In the case of varicoceles, there is an increase in the blood flow and temperature around the testicle. Even a small varicocele may be significant and affect sperm production.
2. The presence of excessive fluid around the testicle is known as a hydrocele.
3. There can occasionally be anatomical defects in the development of the penis. Consequently, during intercourse and ejaculation the sperm cannot be deposited within the vagina very easily. Retrograde ejaculation is a rare condition when some men ejaculate backwards into the bladder. This could be the result of earlier surgery to the urethra (the outflow tube from the bladder).
4. A rectal examination can help determine whether the prostate gland may be a source of chronic infection.

Various Male Fertility Disorders

Azoospermia

Azoospermia characterized by the absence of sperm is either due to an obstruction in the outflow system from the testicle, in the epididymis or vas deferens, or due to a failure in sperm production (spermatogenesis). If a biopsy of the testicle showed that spermatogenesis was normal, this would then indicate that an obstruction was the cause of his azoospermia. Vasograms, which are X-rays of the vas deferens can then be performed to identify the location of the obstruction.
Presence of Antibodies

Sometimes, a semen sample when seen under a microscope, will show sperm clumping. This may indicate the presence of sperm antibodies that are causing the sperm to stick together. A blood sample can be tested for the presence of agglutinating and other sperm inhibiting antibodies.
Klinefelter's Syndrome

Very small testicles may be the manifestation of Klinefelter's Syndrome. This is caused by a chromosomal aberration. Thus, a chromosome investigation will show the presence of an extra X (female) chromosome.
Hormone Disorders

Hormone disorders are rare causes of male infertility, but it may sometimes be helpful to check his F.S.H., L.H., testosterone (male hormone), prolactin and thyroid hormone levels.
Bacterial Infection

The existence of an excessive amount of white blood cells in the semen sample may indicate that an infection may be reducing the ability of the sperm to fertilise an egg. The semen sample should then be cultured to determine the type of infecting bacterial organism.

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