Q1: What is Infertility?

A: 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.  

Q2: What Causes Infertility?

A: No one can be blamed for infertility any more than anyone is to blame for diabetes or leukemia.
Infertility affects approximately 15% of couples at some time in their reproductive lives and this percentage rises as the female ages The incidence is rising in recent past because couples delay childbearing until they are secure in their careers and economically stable. This is a socially responsible choice, however, most women reach their biological peak fertility much earlier in life.

Infertility can be due to problem in female partner in about 40% of cases, problem in male partner in about 40% of cases, 10% of cases problem can be   both partners and in remaining 10% of the cases the cause is unknown (unexplained infertility)

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. Other causes of male infertility including genetic abnormalities such as cystic fibrosis or a chromosomal abnormality, trauma to the testicles, infection, certain medications, exposure to radiation etc. Sometimes a man's occupation can reduce sperm quality eg. truck drivers who are exposed to heat for a long period. Excessive consumption of alcohol or smoking can reduce the count and motility. The scrotum naturally expands to reduce the temperature of the testicles and prolonged sitting can impair this process.

The most common female infertility factor is an 1. ovulation disorder see more (Ovulatory Dysfunction:

Ovulatory dysfunction is a common cause of infertility, which is often treated by the OB/GYN. The female must produce eggs that fertilize and develop into healthy embryos. The term "ovulatory dysfunction' means that quality ovulation is not occurring regularly.
Ovulation can be predicted by several methods, which is useful for timing intercourse. Body temperature rises immediately prior to ovulation and a basal body temperature measurement (BBT Chart) can be used to signal when ovulation will occur. A BBT chart is created by measuring the resting morning (prior to getting out of bed) body temperature daily and graphing the temperatures on a chart. The charts provide an "ovulation pattern" and indicate the most likely days of ovulation.
The simplest, non-invasive, accurate and cheapest way used in India to detect ovulation is serial USG.
Ovulatory dysfunction has many causes including polycystic ovarian disease, and diseases of the pituitary, adrenal, or thyroid glands. Irregular ovulation can also be caused by excessive exercise, obesity or very low body weight, stress, breast-feeding, and other conditions.).

Other causes of female infertility include
2. blocked fallopian tubes see more (Tubal disease is a common cause of infertility. The tubes must be open in order to transport eggs from the ovaries to the uterus and sperm in the reverse way. Tubal blockage can occur because of infection (pelvic inflammatory disease), scarring from previous surgery, congenital defects, endometriosis, or many other conditions.

In many, if not most, cases In Vitro Fertilization is the "therapy of first choice" for tubal disease because success rates are higher),

3. Cervical Factors:

Antibodies in the female (and rarely in the male) can destroy sperm. The immune system "mistakes" the sperm for foreign invaders (allergens) and destroys them. IUI (details given further) avoids the problem of female antibody production by bypassing the cervical mucous.

4. Hormonal Abnormalities:

Hormones like Thyroid, Hypothalamo-Pitutary, Adrenal, Ovarian, either in excess or less form can interfere with ovulation or implantation.

5. Congenital anomalies (birth defects) involving the structure of the uterus and uterine fibroids are associated with repeated miscarriages.

(A normal uterus is necessary for the successful implantation of the embryo and development of the fetus. The embryo attaches to the endometrial lining (inner lining) which is rich in blood supply in order to supply nutrients to the developing fetus. Rarely, the lining may be too thin to support the embryo.

During a normal menstrual cycle, levels of estrogen increase stimulating development of the endometrial lining. If pregnancy does not occur, this lining is "shed" through menstruation. When an implanted embryo is present, progesterone is produced by the corpus luteum (structure that forms on the ovarian follicle after ovulation) to further support the endometrium. Later in the pregnancy, the placenta produces progesterone. The uterus is evaluated by ultrasound, hysteroscopy (direct visualization through a "telescope"), hysterosalpingogram (dye is injected into the uterus and its progress through the uterus to the tube is evaluated by X-ray), or by a hydro sonogram (the uterus is filled with sterile water and examined by ultrasound).

Fibroids can interfere with implantation and development if they are large and located inside the uterine cavity. Polyps are caused by excess tissue growth on the lining of the endometrium and can interfere with pregnancy. Both of these conditions can often be treated successfully with surgery.

Some women have congenital abnormalities of the uterus such as a bicornuate uterus, a uterine septum, or rarely a T- shaped uterus. In many cases, these women can successfully carry a pregnancy to term but the miscarriage rate is higher.

Endometrial cavity can be damaged due to infection or surgery like curettage where because of intrauterine adhesions implantation of the embryo is not possible. Such cavities may be repaired at times but permanent damage may be possible.)

Q3: How is Infertility Diagnosed?

A: 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 an analysis of body temperature and ovulation, x-ray of the fallopian tubes and uterus, and laparoscopy. For men, initial tests focus on semen analysis.