Infertility
Treatment has come a long way in the last 30 odd years ever since
Louise Brown was born on 25 July 1978. Her parents, Lesley and John
Brown, had been trying to conceive for nine years. They faced
complications of blocked fallopian tubes and underwent what would later
become known as IVF/in vitro fertilization, a technique developed by
Patrick Steptoe and Robert Edwards. Edwards won 2010 Nobel Prize in
Medicine for this work. Although the media refers to ivf as "test tube
baby procedure", conception actually takes place in a Petri dish and
this mainly involves working with human gametes which is a challenging
job which very few people around the world are trained to do.
Infertility
means not being able to get pregnant after one year of trying. Or, six
months, if a woman is 35 or older. Women who can get pregnant but are
unable to stay pregnant may also be infertile. According to various
studies conducted across India 20%-30% couples face some kind of
infertility related issues at some point of time in their lives.
Causes of Infertility in Women
1. Failure to Ovulate
a) Hormonal Problems
Failure
to produce mature eggs: In approximately 50% of the cases of
anovulation, the ovaries do not produce normal follicles in which the
eggs can mature. Ovulation is rare if the eggs are immature and the
chance of fertilization becomes almost nonexistent. Malfunction of the
hypothalamus: The hypothalamus is the portion of the brain responsible
for sending signals to the pituitary gland, which, in turn, sends
hormonal stimuli to the ovaries in the form of FSH and LH to initiate
egg maturation. If the hypothalamus fails to trigger and control this
process, immature eggs will result. Malfunction of the pituitary gland:
The pituitary's responsibility lies in producing and secreting FSH and
LH. The ovaries will be unable to ovulate properly if either too much or
too little of these substances is produced.
b) Scarred Ovaries
Physical
damage to the ovaries may result in failed ovulation. For example,
extensive, invasive, or multiple surgeries, for repeated ovarian cysts
may cause the capsule of the ovary to become damaged or scarred, such
that follicles cannot mature properly and ovulation does not occur.
Infection may also have this impact.
c) Premature Menopause
Some
women cease menstruation and begin menopause before normal age. It is
hypothesized that their natural supply of eggs has been depleted or that
the majority of cases occur in extremely athletic women with a long
history of low body weight and extensive exercise. There is also a
genetic possibility for this condition.
d) Follicle Problems
Although
currently unexplained, "unruptured follicle syndrome" occurs in women
who produce a normal follicle, with an egg inside of it, every month yet
the follicle fails to rupture.
2. Causes of Poorly Functioning Fallopian Tubes
a. Blocked fallopian tubes Infection
Caused
by both bacteria and viruses and usually transmitted sexually, these
infections commonly cause inflammation resulting in scarring and damage.
Genital Tuberculosis: It is one of the commonest chronic/long standing
infections which results in Blocked fallopian tubes and is often
overlooked.
b. Abdominal Diseases
The
most common of these are appendicitis and colitis, causing inflammation
of the abdominal cavity which can affect the fallopian tubes and lead to
scarring and blockage.
c. Previous Surgeries
This
is an important cause of tubal disease and damage. Pelvic or abdominal
surgery can result in adhesions that alter the tubes in such a way that
eggs cannot travel through them.
d. Ectopic Pregnancy
This
is a pregnancy that occurs in the tube itself and, even if carefully
and successfully overcome, may cause tubal damage and is a potentially
life-threatening condition.
e. Congenital Defects
In rare cases, women may be born with tubal abnormalities, usually associated with uterus irregularities.
3. Endometriosis
This
condition is characterized by excessive growth of the lining of the
uterus, called the endometrium. Growth occurs not only in the uterus but
also elsewhere in the abdomen, such as in the fallopian tubes, ovaries
and the pelvis. The symptoms often associated with endometriosis include
heavy, painful and long menstrual periods, urinary urgency, rectal
bleeding and premenstrual spotting. Sometimes, however, there are no
symptoms at all, owing to the fact that there is no correlation between
the extent of the disease and the severity of the symptoms.
4. Behavioral Factors
It
is well-known that certain personal habits and lifestyle factors impact
health; many of these same factors may limit a couple's ability to
conceive. Diet & Exercise, Smoking and Alcohol are some of the major
reasons.
5. Environmental and Occupational Factors
The
ability to conceive may be affected by exposure to various toxins or
chemicals in the workplace or the surrounding environment.
Causes of Infertility in Men Lifestyle
• Smoking - significantly decreases both sperm count and sperm cell motility.
• Chronic Alcohol abuse.
• Anabolic steroid use - causes testicular shrinkage and infertility.
•
Overly intense exercise - produces high levels of adrenal steroid
hormones which cause a testosterone deficiency resulting in infertility.
• Inadequate vitamin C and Zinc in the diet.
• Tight underwear--increases scrotal temperature which results in decreased sperm production.
•
Exposure to environmental hazards and toxins such as pesticides, lead,
paint, radiation, radioactive substances, mercury, benzene, boron, and
heavy metals.
• Malnutrition and anemia.
• Excessive stress.
Hormonal
•
Hyperprolactinemia: Elevated Prolactin-Greater elevations of the
hormones may result in reduced sperm production, reduced libido and may
result in impotence.
• Hypothyroidism: Low thyroid
hormone levels may cause reduction of quality of semen, poor testicular
function and may disturb libido. This may be caused due to a diet high
in iodine.
• Congenital Adrenal Hyperplasia: This
condition occurs when the pituitary is suppressed by increased levels of
adrenal androgens. Symptoms for this include low sperm count, an
increased number of immature sperm cells, and low sperm cell motility.
•
Hypogonadotropic Hypopituitarism: Low pituitary gland output of LH and
FSH. This condition arrests sperm development and causes the progressive
loss of germ cells from the testes and causes the seminiferous tubules
and testosterone producing cells to deteriorate.
•
Panhypopituitafism: Complete pituitary gland failure-This condition
lowers growth hormone, thyroid-stimulating hormone, and LH and FSH
levels. Symptoms include: lethargy, impotence, decreased libido, loss of
secondary sex characteristics, and normal or undersized testicles.
Hormonal
•
Variocoele: This is an enlargement of the internal spermatic veins that
drain blood from the testicle to the abdomen (back to the heart) and
are present in 15% of the general male population and 40% of infertile
men.
• Damaged Sperm Ducts: Seven percent of infertile men cannot transport sperm from their testicles to out of their penis.
•
Torsion: Is a common problem affecting fertility that is caused by a
supportive tissue abnormality which allows the testes to twist inside
the scrotum and is characterized by extreme swelling.
•
Infection and Disease: Mumps, TB, Brucellosis, Gonorrhea, Typhoid,
Influenza, Smallpox, and Syphilis can cause Testicular Atrophy.
•
Klinefelter's Syndrome: Is a Genetic Condition in which each cell in
the human body has an additional X chromosome--men with Klinefelter's
Syndrome have one Y and two X chromosomes. Physical symptoms include
peanut-sized testicles and enlarged breasts.
•
Retrograde Ejaculation: Is a condition in which semen is ejaculated into
the bladder rather than out through the urethra because the bladder
sphincter does not close during ejaculation.
Assisted Reproductive technology/techniques
Intrauterine
insemination (IUI) is an infertility treatment also called artificial
insemination. This treatment is prescribed when there is a mild male
factor infertility or when women have problems with their cervical
mucus.
Assisted Reproductive Technology (ART):
The
main concept here is of removing eggs from a woman's body and these
eggs are then mixed with sperm of a male to make embryos. These embryos
are then cultured for 2 to 5 days in specialized compartments called as
Incubators and put back in the woman's uterus thereby resulting in a
successful pregnancy. ART has helped many couples conceive which
otherwise would not have been possible.
About the Doctor:
Dr.
Pratima Grover is a consultant at the Kiran Infertility Centre,
Hyderabad, India (KIC). She has trained in Reproductive Biology at the
Cleveland Clinic, U.S.A., one of the top most Infertility Centre's
across the globe. She is a Post Graduate in Obstetrics and Gynecology.
TREATMENT FOR INFERTILITY
Male Treatment Options
•
Sexual Issues: In this case doctors help men deal with impotence or
premature ejaculation through behavioral therapy and/or medicines.
• Antibiotics also are used to clear up infections affecting sperm count.
• Too few sperm: In such cases the main cause of the problem can be treated through surgery
•
Sperm movement: Sometimes blockage in Man's System results in no Sperm
in Semen.Surgery is one of the options to correct the problem.
•
In vitro fertilization/intra cytoplasmic sperm injection are advanced
techniques to help deal with poor sperm count and motility
Female Treatment Options
In
women,physical problems can be corrected with the help of surgery.There
are number of fertility medicines that are used to treat women with
ovulation problems.It is very important to talk to doctor about the
effects and side effects of these Medications.
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