What is Infertility

An Overview
In simple words infertility is defined as the inability to conceive. And this is the reason, it requires thorough diagnosis of both the partners. Once, this malady is diagnosed, there is every possibility that it could be treated successfully.

However, there are other factors as well like age, general health etc., that may affect the success of treatment.

At the same time, with technological advancements in the field of surgery and/or assisted reproductive technologies (ART), such as in vitro fertilization (IVF), majority of infertility cases can be treated successfully.

Infertility in women
The common cause of Infertility in women is disruption of ovulation symphony by disturbances in menstrual cycle. Instead of a regular cycle, the women suffering from infertility undergo irregular cycles. In the wake of this, menstrual history is considered to be the first instance of infertility, which one should seriously take care of and immediately consult the doctor.

The Menstrual Pattern is the simplest screening test to guide medical investigations.

Menstrual Patterns

• The regular menstrual period: In this category, the periods are regular from month to month, beginning like clockwork every twenty-five days or every thirty-five days. The consistently irregular menstrual cycle, where one month you begin menstruating after twenty-five days, the next month after thirty-four, and the next in thirty, may indicate that you have fertility problem.
• Irregular menstrual periods or Amenorrhea for six or more months: Irregular periods aren't unusual, they affect about 30% of women in their reproductive years. The woman's menstrual periods occur infrequently and at unpredictable intervals. Even in some of the cases, the menstruation at a period of time, may suddenly stop altogether.
• Nonexistence of the menstrual period: If a women does not have menstruate even after the age of 16 years, which is considered to be the maximum limit to start menstruating, it is considered to be a serious condition. The cause of such conditions may include genetic abnormalities, congenitally deformed reproductive organs, delayed puberty, or a pituitary malfunction.

Ovulation is the process in the menstrual cycle by which a mature ovarian follicle ruptures and discharges an ovum (also known as an oocyte, female gamete, or casually, an egg) that participates in reproduction. The entire process of ovulation is controlled by the hypothalamus of the brain and through the release of hormones secreted in the anterior lobe of the pituitary gland, Luteinizing Hormone (LH) and Follicle-Stimulating Hormone (FSH). A spike in the amount of FSH triggers ovulation and LH is released from the pituitary gland.

There are various conditions that may cause infertility in the women. These conditions include the following:

Endometriosis:
It is a common medical condition in which the endometrial tissue, the tissue that normally lines the uterus, grows outside the uterus and attaches to other organs in the abdominal cavity such as the ovaries and fallopian tubes. Endometriosis is a progressive disease that tends to get worse over time and can reoccur after treatment.

The most common symptom of endometriosis is pelvic pain. The pain often correlates to the menstrual cycle, but a woman with endometriosis may also experience pain that doesn’t correlate to her cycle. The other symptoms include abnormal menstrual bleeding and pain during or after sexual intercourse. Endometriosis can also cause scar tissue and adhesions to develop, that can distort a woman’s internal anatomy.

A laparoscopy, an outpatient surgical procedure, is necessary to confirm a diagnosis of endometriosis after a medical history review and pelvic exam. After the diagnosis, our physician will classify your condition as stage 1 (minimal), stage 2 (mild), stage 3 (moderate) or stage 4 (extensive). Based on the stage of the Endometriosis, the physician may decide the best treatment plan.

Polycystic ovary syndrome (PCOS)
Polycystic ovary syndrome (PCOS) is the most common endocrine abnormality that affects six to ten percent of women, who are in the reproductive age group. PCOS is a leading cause of infertility and also affects the woman's cardiovascular health. The causes of PCOS are unknown. Researchers believe that the causes of PCOS may be insulin resistance and an imbalance of female hormones (estrogens and progestins, those important for the menstrual cycle) contribute to the development of this condition.

The symptoms of the disorder include acne, difficulty becoming pregnant (infertility), irregular menstrual periods, obesity, skin discolorations and unwanted hair growth or loss.

New medical researches have revealed different methods of treatment including insulin-reducing ovulation medication (clomiphene, glucophage, metformin), dietary changes (low glycemic diet) and surgery (ovarian drilling). Women who undergo treatment for PCOS, but are still unable to conceive naturally, often turn to assisted reproductive technologies such as IVF.

Tubal diseases
One of the more common causes of infertility is - blocked or damaged fallopian tubes. The fallopian tubes are necessary for picking up the egg, released from the ovary. It is in the inside of the fallopian tube that natural fertilization occurs. Scar tissue resulting from endometriosis or abdominal or gynecological surgery, such as bowel surgery, cesarean section or a ruptured appendix, can block an egg from entering or traveling down the fallopian tube to meet the sperm, preventing fertilization.

Such condition may cause infections including chlamydia, can damage the cilia, the tiny hairs lining the fallopian tubes that help transport the egg, often preventing the sperm and egg from meeting. One result of damaged cilia is an ectopic pregnancy, which occurs when an egg is fertilized but, due to the damaged cilia, it is unable to travel to the uterus, growing instead in the wall of the fallopian tube. This condition can result in rupture, internal bleeding and further tubal damage.

The physician reviews the complete history and does a complete pelvic exam to diagnose the tubal disorder. For the confirmatory diagnosis, additional tests such as hysterosalpingogram and laparoscopy are required and the exact course of treatment is decided on the basis of the condition.

Unexplained
In about one –third of the couples despite an extensive battery of tests, we are unable to find the cause. These couples are termed to be suffering from ‘unexplained ‘ infertility. Perhaps there is a problem with sperm –egg interaction. These couples may benefit from superovulation and IUI or IVF.

Infertility in men
In men, infertility generally is caused by a lack of sperm in the semen (azoospermia), deformed or structurally abnormal sperm, sperm that lack the ability to reach and fertilize a female egg (immotile sperm). Genetic, infection, testicular trauma, hormonal imbalance or exposure to radiation and certain medications are all causes of sperm production disorders.

Infertility normally occurs when there is a low sperm count, or problems with the motility (movement) or morphology (appearance or shape) of the sperm. Sperms that have poor motility, are often not able to reach the egg and therefore, fertilization does not occur. Abnormal sperms are sometimes unable to penetrate and fertilize the egg. Sperm DNA damage may interfere with conception as well as lead to a greater risk of miscarriage.

Any structural or anatomical problem that may block the path of sperm can cause infertility, by preventing fertilization to occur. Infertility related to structural and anatomical problems in the male anatomy may be caused by scar tissue, varicose veins or infection or, in some cases, the problems exist from birth.

In few cases, the immune system of the men develop antibodies that may attack the sperm and destroy their ability to fertilize the egg. Antibodies bind to specific parts of the sperm, such as the head or tail and, depending on the site of attachment and interfere with the movement of the sperm.