Infertility

What is infertility?

Infertility is defined as not being able to get pregnant after at least one year of trying. Women who are able to get pregnant but who have repeat miscarriages are also called infertile In order to get pregnant: The following cycles of events are important.

A woman must release an egg from one of her ovaries called ovulation. The egg released from the ovary must pass through the fallopian tube moving towards the uterus.

A male sperm must fertilize the egg to form a zygote. The fertilized egg must then get attached to the inside of the uterus (implantation) for a successful pregnancy.

Infertility can result from problems that interfere with any of these steps.

Is infertility just a woman's problem?

No, infertility is not always a woman's problem. In only about one-third of cases is infertility due to the woman (female factors). In another one third of cases, infertility is due to the man (male factors). The remaining cases are caused by a mixture of male and female factors or by unknown factors.

What causes infertility in men?

Infertility in men is most often caused by:
Problems making sperm -- producing too few sperm or none at all.
Problems with the sperm's ability to reach the egg and fertilize it

What increases a man's risk of infertility?

The number and quality of a man's sperm can be affected by his overall health and lifestyle. Some things that may reduce sperm number and/or quality include:

• Alcohol
• Drugs
• Environmental toxins, including pesticides and lead
• Tobacco abuse
• Medicines
• Age

What causes infertility in women?

Problems with ovulation account for most cases of infertility in women. Without ovulation, there are no eggs to be fertilized. Some signs that a woman is not ovulating normally include irregular or absent menstrual periods.
Less common causes of fertility problems in women include:

Blocked fallopian tubes due to pelvic inflammatory disease, Endometriosis or surgery for an ectopic pregnancy, physical problems with the uterus like fibroids

What things increase a woman's risk of infertility?

Many things can affect a woman's ability to have a baby. These include:

• Age
• Stress
• Poor diet
• Athletic training
• Obesity
• Tobacco abuse
• Alcohol
• STDs health problems that cause hormonal changes

Tests of fertility in women

Hysterosalpingography:

In this test, doctors use x-rays to check for physical problems of the uterus and fallopian tubes. They start by injecting a special dye through the vagina into the uterus. This dye shows up on the x ray. This allows the doctor to see if the dye moves normally through the uterus into the fallopian tubes. With these x-rays doctors can find blockages that may be causing infertility. Blockages can prevent the egg from moving from the fallopian tube to the uterus. Blockages can also keep the sperm from reaching the egg.

Laparoscopy:

During this surgery doctors use a tool called a laparoscope to see inside the abdomen. The doctor makes a small cut in the lower abdomen and inserts the laparoscope. Using the laparoscope, doctors check the ovaries, fallopian tubes, and uterus for disease and physical problems. Doctors can usually find scarring and endometriosis by laparoscopy.

How do doctors treat infertility?

Infertility can be treated with medicine, surgery, artificial insemination or assisted reproductive technology. Many times these treatments are combined. About two-thirds of couples who are treated for infertility are able to have a baby. In most cases infertility is treated with drugs or surgery.

Doctors recommend specific treatments for infertility based on:

• Test results
• How long the couple has been trying to get pregnant the age of both the man and woman
• The overall health of the partners
• Preference of the partners

Doctors often treat infertility in men in the following ways:

Sexual problems : If the man is impotent or has problems with premature ejaculation, doctors can help him address these issues. Behavioral therapy and/or medicines can be used in these cases.

Too few sperm: If the man produces too few sperm, sometimes surgery can correct this problem. In other cases, doctors can surgically remove sperm from the male reproductive tract. Antibiotics can also be used to clear up infections affecting sperm count.

Various fertility medicines are often used to treat women with ovulation problems. It is important to talk with your doctor about the pros and cons of these medicines. You should understand the risks, benefits, and side effects
Doctors also use surgery to treat some causes of infertility. Problems with a woman's ovaries, fallopian tubes, or uterus can sometimes be corrected with surgery.

Intrauterine insemination (IUI) is another type of treatment for infertility. IUI is known by most people as artificial insemination. In this procedure, the woman is injected with specially prepared sperm. Sometimes the woman is also treated with medicines that stimulate ovulation before IUI.

IUI is often used to treat:

• Mild male factor infertility
• Women who have problems with their cervical mucus
• Couples with unexplained infertility

What medicines are used to treat infertility in women?

Some common medicines used to treat infertility in women include:

• Clomiphene citrate
• Human menopausal gonadotropin or hMG
• Follicle-stimulating hormone or FSH
• Gonadotropin-releasing hormone (Gn-RH) analog
• Metformin
• Bromocriptine

However the need and use of these medicines would depend on the individual history and must never be administered without consultation of the doctor.

What is Assisted Reproductive Technology (ART)?

Assisted reproductive technology (ART) is a term that describes several different methods used to help infertile couples. ART involves removing eggs from a woman's body, mixing them with sperm in the laboratory and putting the embryos back into a woman's body.

How often is assisted reproductive technology (ART) successful?
Success rates vary and depend on many factors. Some things that affect the success rate of ART include:

• Age of the partners
• Reason for infertility
• Clinic
• Type of ART
• If the egg is fresh or frozen
• If the embryos fresh or frozen
• The U.S. Centers for Disease Prevention (CDC) collects success rates on ART for some fertility clinics. According to the 2003 CDC report on ART, the average percentage of ART cycles that led to a healthy baby were as follows:
  • 37.3% in women under the age of 35
  • 30.2% in women aged 35-37
  • 20.2% in women aged 37-40
  • 11.0% in women aged 41-42
• ART can be expensive and time-consuming. But it has allowed many couples to have children that otherwise would not have been conceived. The most common complication of ART is multiple fetuses. But this is a problem that can be prevented or minimized in several different ways.

What are the different types of assisted reproductive technology (ART)?

Common methods of ART include:
In Vitro Fertilization (IVF) means fertilization outside of the body. IVF is the most effective ART. It is often used when a woman's fallopian tubes are blocked or when a man produces too few sperm. Doctors treat the woman with a drug that causes the ovaries to produce multiple eggs. Once mature, the eggs are removed from the woman. They are put in a dish in the lab along with the man's sperm for fertilization. After 3 to 5 days, healthy embryos are implanted in the woman's uterus.

Zygote intrafallopian Transfer (ZIFT) or Tubal Embryo Transfer is similar to IVF. Fertilization occurs in the laboratory. Then the very young embryo is transferred to the fallopian tube instead of the uterus. Gamete intrafallopian transfer (GIFT) involves transferring eggs and sperm into the woman's fallopian tube. So fertilization occurs in the woman's body. Few practices offer GIFT as an option.

Intracytoplasmic Sperm Injection (ICSI) is often used for couples in which there are serious problems with the sperm. Sometimes it is also used for older couples or for those with failed IVF attempts. In ICSI, a single sperm is injected into a mature egg. Then the embryo is transferred to the uterus or fallopian tube.

ART procedures sometimes involve the use of donor eggs (eggs from another woman), donor sperm, or previously frozen embryos. Donor eggs are sometimes used for women who can not produce eggs. Also, donor eggs or donor sperm is sometimes used when the woman or man has a genetic disease that can be passed on to the baby.