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Infertility



Infertility

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Infertility

Infertility is the result of a disease (an interruption, cessation, or disorder of body functions, systems, or organs) of the male or female reproductive tract which prevents the conception of a child or the ability to carry a pregnancy to delivery. The duration of unprotected intercourse with failure to conceive should be about 12 months before an infertility evaluation is undertaken, unless medical history, age, or physical findings dictate earlier evaluation and treatment. What is Infertility? Infertility is a disease of the reproductive system that impairs one of the body's most basic functions: the conception of children. Conception is a complicated process that depends upon many factors: on the production of healthy sperm by the man and healthy eggs by the woman; unblocked fallopian tubes that allow the sperm to reach the egg; the sperm's ability to fertilize the egg when they meet; the ability of the fertilized egg (embryo) to become implanted in the woman's uterus; and sufficient embryo quality. Finally, for the pregnancy to continue to full term, the embryo must be healthy and the woman's hormonal environment adequate for its development. When just one of these factors is impaired, infertility can result.

What Causes Infertility?

In rough terms, about one-third of infertility cases can be attributed to male factors, and about one-third to factors that affect women. For the remaining one-third of infertile couples, infertility is caused by a combination of problems in both partners or, in about 20 percent of cases, is unexplained. The most common male infertility factors include azoospermia (no sperm cells are produced) and oligospermia (few sperm cells are produced). Sometimes, sperm cells are malformed or they die before they can reach the egg. In rare cases, infertility in men is caused by a genetic disease such as cystic fibrosis or a chromosomal abnormality. The most common female infertility factor is an ovulation disorder. Other causes of female infertility include blocked fallopian tubes, which can occur when a woman has had pelvic inflammatory disease or endometriosis (a sometimes painful condition causing adhesions and cysts). Congenital anomalies (birth defects) involving the structure of the uterus and uterine fibroids are associated with repeated miscarriages.

How is Infertility Diagnosed?

Couples are generally advised to seek medical help if they are unable to achieve pregnancy after a year of unprotected intercourse. The doctor will conduct a physical examination of both partners to determine their general state of health and to evaluate physical disorders that may be causing infertility. Usually both partners are interviewed about their sexual habits in order to determine whether intercourse is taking place properly for conception. If no cause can be determined at this point, more specific tests may be recommended. For women, these include hormone tests, Transvaginal sonography , x-ray of the fallopian tubes and uterus, hysteroscopy and laparoscopy.
For men, initial tests focus on semen analysis.

How is Infertility Treated?

Most infertility cases -- 85 to 90 percent -- are treated with conventional therapies, such as drug treatment for ovulation or Fertility Enhancing Endoscopic Surgeries surgical repair of reproductive organs.
Few will need IUI, IVF , ICSI, gamete donation or surrogacy

Intrauterine Insemination

Intrauterine insemination (IUI) is an office procedure in which prepared sperm cells are placed directly into a woman’s cervix or uterus to produce pregnancy, with or without ovarian stimulation to produce multiple oocytes.

What is In Vitro Fertilization?

In infertile couples where women have blocked or absent fallopian tubes in vitro fertilization (IVF) offers a chance at parenthood to couples who until recently would have had no hope of having a "biologically related" child.
In IVF, eggs are surgically removed from the ovary and mixed with sperm outside the body in a Petri dish ("in vitro" is Latin for "in glass"). After about 40 hours, the eggs are examined to see if they have become fertilized by the sperm and are dividing into cells. These fertilized eggs (embryos) are then placed in the women's uterus, thus bypassing the fallopian tubes. IVF has received a great deal of media attention since it was first introduced in 1978.

Do I need intracytoplasmic sperm injection (ICSI)?

The purpose of ICSI is to assist the fertilization process when a man’s sperm count is abnormal. Whether it is because the number of motile sperm is very low or the morphology is excessively poor, the technique involves the delivery of a single sperm into a single egg. Since 1991, when it was first described, it has revolutionized the treatment of male infertility. Most clinics will recommend ICSI if there is a fear that poor fertilization may occur by traditional IVF where sperm are merely added to the egg culture dish. Accordingly, efforts are made to assess sperm by function or morphology to help determine those most likely to require ICSI.

Is In Vitro Fertilization Expensive?

The average cost of an IVF cycle inIndia is 1.5 lacs which also includes cost of Medicines / injections. . Like other extremely delicate medical procedures, IVF involves highly trained professionals with sophisticated laboratories and equipment.
Its essential to know the facilities available at the centre before one proceeds for actual procedureas IVF has maximum success rate in few initial cycles.

Evalutation before IVF

Before starting ART, each patient is evaluated to help maximize her chances for success and a healthy pregnancy. Good preconception health is essential to achieving pregnancy with IVF. Chronic medical conditions such as diabetes, hypertension and asthma should be well controlled before attempting to conceive. In addition, women planning an IVF cycle should optimize their weight. Obesity has been associated with infertility, a reduced chance of success with IVF, and an increase in the risk of miscarriage and preterm birth. Your physician can help you determine your ideal weight and refer you to appropriate resources for weight management.

Blood Tests

General

Prior to starting IVF, the woman's blood type should be verified, and she should be screened for conditions that could affect the health of a pregnancy. Documentation of immunity to rubella (German measles) and varicella (chicken pox) may also require a blood test. The patient and her partner will also be tested for hepatitis B and C, HIV and syphilis. Other genetic tests may be requested depending on the patient’s genetic background, such as cystic fibrosis and sickle cell trait.

Ovarian Reserve Testing

As women age they have a decreased ability to conceive and an increased risk of miscarriage. Ovarian reserve testing tries to measure egg quality, quantity and reproductive potential. The following tests may be used to measure ovarian reserve:

1. Day 3 Levels of FSH, LH, and Estradiol. The determination follicle stimulating hormone (FSH), luteinizing (LH) and estradiol levels on menstrual cycle day 3 has been used to estimate fertility potential. Women with elevated levels of FSH and/or estradiol measurements may have reduced pregnancy rates with IVF or may require more medications during IVF.

2. Clomiphene Citrate Challenge Test. This test requires patient to take 100 mg of clomiphene citrate on menstrual cycle days 5-9. Blood levels of FSH are measured on cycle day 3 and again on cycle day 10. Elevated blood levels of FSH on cycle day 3 or cycle day 10 are associated with reduced pregnancy rates.

3. Anti-Mullerian Hormone Test (AMH). Anti-Mullerian hormone levels are thought to reflect the remaining number of eggs. This test can be performed on any day of the cycle.

Semen

A semen analysis should be reviewed. Changes in sperm quality may occur over time that could affect IVF success.

Uterus

The uterus is usually evaluated prior to an IVF. Three methods can be used: a hysterosalpingogram, a saline infusion sonohysterography or a hysteroscopy.
Prior to IVF, a trial or “mock” transfer may be done. The purpose of this procedure is to determine the length and direction of the uterus. This enables the physician to anticipate any difficulties with the embryo transfer.

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