About Infertility

One in six couples experiences difficulty in conceiving a child even after having reproductive age. If you have been trying to become pregnant for more than six months then you should go for medical advice.
It helps you to firstly understand how your reproductive system works, what factors may affect your fertility, and what you can do to maximize the conceiving chances and become pregnant.
You should understand Female Reproduction and Male Reproduction first before understanding Infertility.

Natural Ovulation Cycle: It is suggested that you should have unprotected intercourse very regularly and particularly just prior to the female partner ovulating. Every month from puberty to menopause, an egg is released from a follicle within one or both of the ovaries. This happens in the middle of the monthly cycle.
Two hormones are responsible for the development of eggs within your ovaries:

• Follicle Stimulating Hormone (FSH)
• Luteinizing Hormone (LH)

Thus, Ovulation occurs about 14 days after the start of your period, where and when the egg matures and is released. The egg can survive for about 24 hours as it moves through the fallopian tube, waiting for fertilization by a sperm.
Your pregnancy window is the time when ovulation occurs and the egg is ready for fertilization.
Once you know your pregnancy window, aim to have sexual intercourse about 2 days before ovulation time, when sperm is already present in the fallopian tubes. Sperm can survive for 2 to 3 days, waiting for the egg to be released.

Sperm Production: Sperm production starts in the testes, where the hormone testosterone is also produced. An average of 100 million sperm is produced every day in healthy young men. After sperm is produced, it will need to travel along a long channel system starting at the epididymis, where they mature along the way, before exiting via the ductal structures called vas deferens and then out the urethra as part of the ejaculate.
A sperm consists of the head, tail and midpiece sections. To successfully fertilize an egg, the sperm will need to be able to move its tail (motility) to propel itself through cervical mucus to then travel through the uterus and fallopian tube to reach the egg. It will also need to be normally shaped in order to penetrate the outer shell of the egg to deliver its genetic package contained in the head.

How to treat Infertility: With the advances in reproductive technology, IVF treatment and other forms of assisted conception now provide a much higher chance of success than that of natural conception. There are also simple treatments such as ovulation tracking, ovulation induction or intrauterine insemination (IUI) that can effectively help some couples conceive naturally. At your initial consultation with your fertility specialist, they will give you an indication of your likelihood of conceiving. This will vary between 5 to 55% per treatment cycle depending on your individual circumstances and the treatment recommended. Your chance of success is affected by:

• both partners’ ages
• how long you have been trying to conceive
• whether either partner has been a parent previously
• any prior treatment for infertility
• how well the eggs and sperm are likely to fertilise and develop into good quality embryos

What are the causes of infertility: Infertility is defined as a couple not conceiving after 12 months of regular unprotected sexual intercourse.
Infertility occurs if Either of the partner is diagnosed with.

• Endometriosis
• Problems with the uterus or fallopian tubes
• Problems with ovulation
• Antibody problems that harm sperm or eggs
• The inability of sperm to penetrate or survive in the cervical mucus
• An Unexplained fertility problem

Age Factor: The women’s age is out most important factor influencing the chance of conceiving. Once women turn 36, her chance of conceiving naturally is halved compared to that chance of at 20 years of age. At the age of 41, this chance falls to just 4% and so on. There is a decline in fertility with time because the number of eggs you produce rapidly declines as you get older, especially after the age of 36.

Endometriosis and Fertility: Endometriosis is a condition in which uterus lining cells called endometrium grow in places outside the uterus such as the pelvis. It is quite a common, especially in women over 30 who have not yet had children. It is also a common cause of infertility, as severe endometriosis can distort the tubes and ovaries and cause the body to resist foreign material – such as sperm. It may also block the egg’s release by producing mucus.

How do I know if I have endometriosis: Symptoms of endometriosis are painful periods, pain during intercourse and premenstrual spotting. If experience these problem you should take medical advice.

Fibroids:Fibroids are nothing but they are benign lumps of tissue made up of uterine cell tissues. They can grow around and inside your uterus, and are very common – up to 80% of women have at least one fibroid.
If the location of fibroids are located inside the uterus (submucosal fibroid), they highly be affect the fertility and it is recommend its removal.

How do you treat fibroids: They can be removed very easily by laparoscopy in few steps resulting into faster recovery.

Polycystic Ovarian Syndrome (PCOS): PCOS (Polycystic Ovarian Syndrome) is a common hormone problem, and one of the leading causes of infertility in women. The term ‘polycystic ovaries’ describes the appearance of the ovaries on an ultrasound scan – they contain many small follicles 10 or more in no. and the dominant follicle does not develop as easily. Many of the small follicles produce differing levels of hormones.
As many as ten percent of women of childbearing age have PCOS, but most don’t even know that they have it. They rarely get a diagnosis until they begin trying to get pregnant.

Symptoms of PCOS: Symptoms of PCOS include irregular periods (or no periods at all), increased hair growth, acne, obesity and difficulty falling pregnant. You might experience very heavy yet infrequent periods, along with pain, bloating and tenderness. There may also be a mild increase in testosterone levels, causing darker and thicker hair growth and acne. Hormonal imbalances also cause problems with sugar metabolism, leading to weight gain - and a higher risk of gestational diabetes if you do fall pregnant.

PCOS and Fertility: The symptoms of PCOS, along with a documented increase in the risk of miscarriage, mean the chance of getting pregnant naturally is low if you have PCOS, and you should seek medical support.
It is important to remember that the presence of polycystic ovaries is not always bad news. Many younger women can have severe side-effects from the syndrome caused by the hormone imbalance associated with polycystic ovaries, however, as women age, the follicle number drops and the hormone imbalance corrects itself.
The result is that women who suffer polycystic ovary syndrome in their teens and twenties can sometimes end up having more eggs in their thirties without the syndrome and therefore a better chance of conception.

After a woman’s age, a little known fact is that male infertility is the single biggest factor influencing a couple’s chance of conception [40% sperm related cause]. The good news is that the most common causes of male infertility are easily diagnosed, and most can also be treated.
In 10-20% of couples no cause will be found, this is called Unexplained Infertility, which can be particularly frustrating for you and your partner.
Abnormal Sperm Production or Problems with sperm production The most common causes of male infertility are called:

• Azoospermia, No sperm cells are produced.
• Oligospermia, Where few sperm cells are produced
• Teratospermia, Where a high proportion of sperm is abnormally shaped Sometimes, sperm cells are malformed or die before they can reach the egg. In rare cases, a genetic disease such as cystic fibrosis or a chromosomal abnormality can cause male infertility.

Other factors that affect sperm quality include:

• Smoking
• Excessive drinking
• Drugs, including steroids and recreational use
• Weight and Body Mass Index (BMI)
• Frequent exposure to extreme heat (working in hot temperatures, or regular saunas)
• Working in cramped conditions (for example, truck drivers)
• Acute viral illness
• Hernias

Semen Analysis: Semen analysis is the most important test in the evaluation of a male’s fertility. The test provides an accurate measurement of the number of sperm [stated in millions per ml] the motility of the sperm, their size and shape as well as the volume and consistency of the sample. A semen sample is produced via masturbation, following 2-5 days of abstinence, into a clean, dry container either at home and delivered within an hour to our lab, or in a discreet room within the Clinic.
A normal semen analysis result will show a sperm count of at least 15 million sperm per ml, with at least 40% of the sperm showing forward progressive movement.
A minimum of 4% of the sperm should be normally formed and anti-sperm antibodies should affect less than 50% of the sperm. A repeat test will be undertaken if the initial results are poor to rule out natural fluctuations in sperm quality. If no sperm are present, this may suggest a blockage in the vas deferens [the tubes that transport the sperm from the testes], or that sperm are failing to be produced. A physical examination and hormone assessment may confirm the cause.

Treatment for Male Infertility: ICSI or Intracytoplasmic Sperm Injection, is usually recommended for couples where male infertility is a problem, especially relating to the number or quality of sperm produced. ICSI can also be used in cases where a man has had a vasectomy. It involves the direct injection of a single sperm into each egg using sophisticated equipment.