Understanding Infertility

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What is infertility?

Human conception is a delicate process. Of all couples trying to conceive, about 84% will conceive in 1 year of trying, but only about additional 8% will conceive after trying naturally for one more year. Hence, infertility is defined as the failure to achieve conception after twelve months of regular unprotected sexual intercourse.

What is necessary for conception?

The woman releases an egg (ovum) from the ovary around 14th -16th day of a 28-30 days menstrual cycle. This egg is collected by the fallopian tube. The man deposits millions of spermatozoa in the vagina of the woman during sexual intercourse. The spermatozoa are produced continually in the man’s testes. The motile spermatozoa then ascend up the woman’s reproductive tract. In the fallopian tube, a single sperm combines with (fertilize) the egg. The embryo grows initially inside the fallopian tube and then reaches the womb (uterus).  It attaches to the lining of the womb, and with rapid growth produces a baby.

Why does infertility happen?

A couple faces difficulty in conceiving, if there is a problem with any of the processes mentioned above. The problem may lie with the male partner or the female partner, or both. In about 10-20% case, after basic evaluation, no definite cause can be ascertained.

  • Common causes in female:
    • Ovulation disorders (failure to ovulate) due to PCOS, early menopause etc.
    • Fallopian tubal damage- due to previous infection or surgery
    • Advanced age > 37 years
    • Endometriosis
    • Fibroid uterus
    • Chronic illnesses
    • Hormonal disorders (thyroid/ prolactin)
  • Common causes in male:
  • Low sperm count
  • Low sperm motility
  • Erectile/ ejaculatory difficulty
  • Complete absence of sperm in semen sample

How is a couple with infertility evaluated?

  • First step is thorough history taking and review of reports, followed by clinical examination
  • Clinical investigations, like baseline and serial sonography, semen analysis
  • Specific targeted tests to assess various fertility factors, like hormonal evaluation, tubal patency tests

After assessment, a treatment plan is formulated, in a stepwise manner, starting with the simplest option.  The options and prognosis is explained to the couple.

What are the fertility treatment options available at Currae Gynaec IVF Birthing Hospital?

Fertility Counseling:

Stress is commonly associated with infertility and the treatment procedures. Counselor helps couples in informed decision making and guides them through treatment procedures.

Ovulation Induction:

Egg production is stimulated with oral or injectable medication. This is combined with planned intercourse or intrauterine insemination.

Intrauterine insemination (IUI):

Processed and concentrated highly motile spermatozoa are placed directly in the uterine cavity close to the time of ovulation.

Fertility Enhancing Surgery:

Surgical treatment for correction of problems like endometriosis, tubal blockage, fibroid removal through laparoscopy & correction of uterine problems like septum, polyp or adhesions through hysteroscopy

In Vitro Fertilization (IVF) & ICSI (Intracytoplasmic Sperm Injection):

Here, multiple follicles are developed in the ovaries through daily injections. These eggs are collected through aspiration under sonography guidance. In IVF cycles, eggs are placed in the same dish as the sperm and are allowed to fertilize. In case of ICSI, a single sperm is injected in an egg to produce embryo. Embryos are grown in stringent culture conditions in the laboratory and one or two or three of them transferred back into the uterus.

Cryopreservation:

This is the process of keeping gametes (egg/ sperm) or embryos frozen for future use. Sperm freezing is applicable if husband is unavailable on the required day or has difficulty in semen collection. Embryos are frozen for use in subsequent cycle or for another pregnancy.

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