Fertility is one among the most basic rights of every individual or couple. Many do not realize that they have a problem until it is too late! Many hesitate to come forward and seek help even after realizing that something is wrong, may it be due to social stigma or fear of relatives knowing about the same, the scare of intimidation etc.
Yet for many a couple seeing a doctor for infertility could be a daunting experience – fear about what you are going to uncover about the diagnosis, new medical terms, new procedures , hopes of success, fear of failure…the list could go on and on…
In the era of modern Reproductive Medicine anyone can have a child if they really want to.
Modern reproductive medicine equips you to have your child by choosing the right method from the vast array of treatment options and technologies applied in the right way by the skilled hands.
All you need to do is to break the silence and come forward and seek help!
Keep your questions ready when you meet your doctor…
Q1. What does Infertility mean?
A couple has infertility / sub fertility when they are not able to conceive even after trying for a period of one year.
If the woman’s age is >35, even 6 months of trial is enough to call it infertility, you should be seeking medical help.
Q2. What are the causes of Infertility?
For a successful pregnancy to happen there are some important events which should occur in a sequence:
- Ovulation / Release of egg from the female’s ovary.
In a normal healthy young female every month one egg gets released from one of the ovaries.
- This egg is captured by the fallopian tubes.
- Fertilization– This is the process by which a man’s sperm joins with the egg to create something called an Embryo. The Embryo which is formed by this process travels to the uterus through the fallopian tube in 5-6 days time. It is in the uterus where it gets implanted (attached) and grows further.
So the process of capture of egg by the fallopian tube, fertilization of egg by sperm and the further travel of the Embryo to reach the fallopian tube requires at least one healthy, open (patent) fully functional, supple fallopian tube.
- Implantation: The embryo travels through the fallopian tube reaches the uterus (womb) and gets attached to the inner lining of the womb. This process is called implantation.
A healthy functioning womb with a good blood supply hence becomes quintessential for a successful pregnancy to happen.
When anything goes wrong at any level in the above mentioned complex sequence of events, the couple ends up with Infertility.
The common causes of Infertility include:
- Age of female
- Hormonal imbalances like PCOS where natural ovulation does not happen easily.
- Problems causing poor movement of fallopian tubes Eg: Adhesions, pelvic infections, previous pelvic/abdominal surgeries or blocked fallopian tubes.
- Problems with uterus: Eg: poor/ thin lining of womb, fibroids, and adenomyosis.
- Poor stock of eggs in some females is a huge problem faced by fertility specialists worldwide. This is called poor/Diminished Ovarian reserve.
- Anything affecting the general health of a female can have huge impact on her fertility. Eg: Obesity, lifestyle, habits, environmental pollutants.
- Other hormonal problems Eg: thyroid disorders, hyperprolactinemia etc.
- Problems with production of sperms in a man. Eg: Producing less sperm/no sperm etc.
- Problems with the proper transportation of sperm and successful ejaculation.
- Sexual dysfunctions/Erectile dysfunction.
- Inherent problems with sperm. Eg: abnormal shape (morphology), low motility (slow sperms), low number (count), genetically abnormal sperms.
- General health and lifestyle of a man could adversely affect his fertility. Eg: Smoking, alcohol intake, diabetes, drugs which he take for other medical conditions, environmental pollutants.
Q3. How common is Infertility?
The prevalence of infertility in India is between 4-17% Worldwide the prevalence is 15% this is a high burden. This means at least 1 in every 10 couple in the reproductive age group face this problem!!
This calls for the need for increased awareness about the condition. More and more couples needs to break the silence and come forward to seek help.
Q4. Why am I not able to bear a child? Who is having a problem? Is it just the woman’s problem? Is it the man’s problem?
Not at all! It is not just the woman’s problem. In one third of the cases it is the woman’s factors which cause Infertility.
In another one third it is the male (Man’s) factors which cause Infertility.
In yet another one third it is a mixed effect of male and female factors which cause Infertility.
Q5. How long should we try before seeing a doctor?
It is advisable to get medical help if there is no successful pregnancy even after trying for 1 year (12 months). If the woman’s age is >35 they are advised to visit the doctor if they don’t achieve a successful pregnancy after trying for 6 months, If you have irregular or very painful periods it is advisable to seek help earlier than this.
Q6. I am young, healthy and I am concentrating on career currently. Can I postpone my pregnancy?
In the modern world where career and family life holds equal importance to the vast many, there is a high chance that the couple wants to postpone pregnancy for some time until their careers kick off. Such a couple can opt for getting their basic fertility tested so that if there are gross abnormalities in which time factor definitely plays a role, they can have all the information to take their decisions. Fertility specialists come across so many couples who want to get their fertility tested for the same matter as this approach has become very common these days.
Q7. Will my lifestyle/habits affect my fertility?
Definitely yes! When it comes to fertility lifestyle/habits play a huge role.
These are some of the factors which have definite negative impact on fertility:
- Obesity/over weight
- Sedentary lifestyle/ lack of regular exercise
- Stress, (oh yes!! Be it mental/ physical stress)
- Unhealthy eating habits (Eg: Junk food)
- Alcohol intake
- Environmental pollutants
In short – Eat healthy, do regular exercise and take effective measures to cut down your stress levels for a successful pregnancy to happen.
Q8. What are the tests available for testing my fertility?
A detailed evaluation by a fertility specialist is essential for the best of results. This includes detailed history taking and examination of the couple.
Tests for female:
- Tests for detecting ovulation disorders :
- Serial ultrasound scans aka natural cycle monitoring / follicular monitoring / follicular scans.
- Urine testing using specialized kits to detect ovulation.
- Blood tests for hormonal evaluation to detect ovulation.
- Fallopian tube testing – to see if fallopian tubes are patent and functioning:
- X ray dye test called HSG (Hysterosalpingogram)
- Scan test called Sonosalpingogram
- Laparoscopic tube testing
- Tests for lining the womb:
- Ultrasound Scan
- Testing of lining material of the womb for infections
- General hormonal evaluation of female for hormonal imbalances Eg: Thyroid, prolactin etc.
Tests for Male:
- Semen Analysis: to find out gross abnormalities with the sperm.
- Ultrasound Scanning: In case if there is any abnormality found in the routine semen analysis then we go ahead with further testing which includes scan to know if the reproductive organs are normal in appearance.
- Hormonal testing: Blood tests for detailed evaluation of the male.
- Special Semen tests: to understand in detail about the subtle defects in sperm.
Q9. What are the treatment options available for infertility?
There is a wide range of treatment options available:
- Natural cycle monitoring for planned pregnancy
- Ovulation Induction
- Artificial Insemination/ IUI
- IVF/ ICSI
Q10: What are the success rates with each method of treatment?
Success rates per cycle of:
- Ovulation induction with Natural try is 5-7%
- IUI – 12 – 15%
- IVF – ICSI =50%
Success rates tend to differ with a fresh transfer 40-45% and frozen embryo transfer (60-70%)
The above blog is written by Dr Devi