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General information about infertility

What is infertility?

Infertility is inability to conceive despite frequent unprotected intercourse. The couple should consult a doctor if they have been trying for pregnancy for one year without success. 10-15% couples may need to seek help after trying for one year

How much time is taken for testing/diagnosis before treatment of infertility can begin?

It will depend on the problem/problems and whether man, woman or both are infertile. Treatment will also be affected by the conditions repaired to be treated. To facilitate the treatment both husband and wife should consult the doctors together. Couples can hasten the process by timing their first visit with a fertility expert to coincide with the woman's cycle. The first round of hormone tests should be done on day two or three of her cycle. If that first appointment is on day 10 of her cycle, she'll have to wait until the next cycle to complete the testing process.

 

Are there any symptoms a woman/ couple may have which indicate an inability to conceive?

Women who have extreme pain associated with ovulation or menstruation may be at risk for endometriosis and should seek expert care. Women who do not have very irregular cycles may be at risk for polycystic ovarian disease and should consult a docto

 

How does age affect a woman's ability to have children?

Humans are actually one of the least fertile species on the earth. As a result, even the healthiest, most fertile couple only has about a 20% chance of conception taking place in any given month. As woman‘s age increases fertility begins to decline. This is most notable in women after the age of 35 years; although both men and women experience a reduction in their fertility as they age. Aging decreases a woman's chances of having a baby in the following ways:

  1. The ability of a woman's ovaries to release eggs for fertilization declines with ag
  2. As a woman ages she is more likely to have health problems that can interfere with fertility
  3. Her risk of having a miscarriage increases

 

How long should women try to get pregnant before calling their doctors?

Most healthy women under the age of 30 shouldn't worry about infertility unless they've been trying to get pregnant for at least a year. Women in their 30s who've been trying to get pregnant for six months should speak to their doctors as soon as possible. A woman's chances of having a baby decrease rapidly every year after the age of 30. So getting a complete and timely fertility evaluation is especially important.

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.

 

Does having one child ensure subsequent fertility?

While many people assume that having one child automatically ensures fertility, It may not be always so. Some women may never conceive while others may become infertile after having conceived earlier.

 

Reasons of infertility

What are the most common causes of infertility?

Fertility decreases with age. Other reasons include blocked tubes, other pelvic pathology, low sperm count and motility etc.

What causes infertility in women?

Infertility in women may be due to problems in:

  1. Reproductive System
  2. Other Factors. Reproductive System problems include
  3. Problems in ovulation
  4. blocked fallopian tu
  5. blocked fallopian tubes
  6. physical problems with the uterus
  7. lumps in the uterus referred to as uterine fibroids.

 

What things increase a woman's risk of infertility?

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

  1. Increasing age.
  2. Stress.
  3. poor diet
  4. Being overweight or underweight.
  5. smoking.
  6. alcohal
  7. Health problems that cause hormonal changes
  8. sexually transmitted diseases
  9. Health problems that cause hormonal changes

 

What causes infertility in men?

Infertility in men is most often caused by:

  1. Problems making sperm -- producing too few sperm or none at all
  2. Problems with the sperm's ability to reach the egg and fertilize it -- abnormal sperm shape or structure prevent it from moving correctly
  3. Sometimes a man is born with the problems that affect his sperm.
  4. Other times problems start later in life due to illness or injury.

 

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:

  1. Alcohol/drugs.
  2. Environmental toxins such as pesticide
  3. Smoking cigarettes.
  4. A history of mumps.
  5. Certain medications
  6. Radiation treatment due to cancer.

How do General health and lifestyle affect male fertility?

Some common causes of infertility related to health and lifestyle include

  • Alcohol and drugs. Alcohol or drug dependency can cause reduced fertility. Anabolic steroids, for example, which are taken to stimulate muscle strength and growth, can cause the testicles to shrink and sperm production to decrease. Use of cocaine or marijuana may temporarily reduce the number and quality of sperm.
  • Tobacco smoking. Men who smoke may have a lower sperm count than those who do not smoke. Second hand smoke also may affect male fertility
  • Emotional stress. Stress may interfere with certain hormones needed to produce sperm. Sperm count may be affected if one/man experience excessive or prolonged emotional stress. A problem with fertility itself can sometimes become long term and discouraging, producing more stress. Infertility can affect social relationships and sex life
  • Other medical conditions. A severe injury, major surgery or cancer can affect male fertility. Certain diseases or conditions, such as kidney disease, cirrhosis, sickle cell anaemia and celiac disease can interfere with normal sperm production.
  • Age. A gradual decline in fertility is common in men older than 35.
  • Malnutrition. Deficiencies in nutrients such as vitamin C, selenium, zinc and folate may contribute to infertility.
  • Obesity. Being overweight can cause hormone changes that reduce male fertility.

 

Which Environmental exposure contributes to male infertility?

Overexposure to certain environmental elements such as heat, toxins and chemicals can reduce sperm production or function. Specific causes include:

  • Pesticides and other chemicals. Herbicides and insecticides may cause female hormone-like effects in the male body and may be associated with reduced sperm production and testicular cancer. Lead exposure also may cause infertility.
  • Overheating the testicles. Frequent use of saunas or hot tubs can temporarily impair sperm production and lower sperm count. Sitting for long periods or wearing tight clothing also may increase the temperature in the scrotum and reduce sperm production. Person working in industries like coal mines, near furnace are at increased risk.
  • Exposure to radiation or X-rays. Exposure to radiation can impair sperm production. It can take several years for sperm production to return to normal. With high doses of radiation, sperm production can be permanently impaired.
  • Cancer and its treatment. Both radiation and chemotherapy treatment for cancer can impair sperm production. The closer radiation treatment is to the testicles, the higher the risk of infertility.

 

Tests for infertility

How do doctors treat infertility?

Infertility can be treated with medicine, surgery, artificial insemination or assisted reproductive technology. Many times these treatments are combined. Doctors recommend specific treatments for infertility based on:

  1. Test results.
  2. How long the couple has been trying to get pregnan
  3. Age of both the man and woman.
  4. The overall health of the partners
  5. Preference of the partners.

How do doctors often treat infertility in women?

Doctors often treat infertility in women in the following ways:

 

What does a doctor look for in General physical examination in a man?

This includes examination of one/man‘s genitals and questions about illnesses, disabilities and surgeries that could affect fertility. Doctor will want to know what medications one/man takes and his sexual habits. Doctor may also ask about sexual development as a boy has had any signs of low testosterone, such as decreased body or facial hair.

 

How is semen examination done?

This is the most important test for the male partner. Semen is generally obtained by masturbating or by interrupting intercourse and ejaculating semen into a clean container. A laboratory analyzes the physical characteristics of semen, the number of sperm present and looks for any abnormalities in the shape and structure (morphology) and movement (motility) of the sperm. The lab will also check semen for signs of problems, such as infections or blood. Often sperm counts fluctuate from one specimen to the next, so doctor may want to evaluate a few different samples. If sperm analysis is normal, doctor will likely recommend thorough testing of female partner before conducting further male infertility tests.

 

What are the additional tests done for infertility?

Depending on initial findings, doctor may recommend additional, more specialized tests that can help identify the cause of infertility. These can include:

  • Scrotal ultrasound. Ultrasound, which uses high-frequency sound waves to produce images of structures within the body, can help doctor look for evidence of a varicocele or obstruction of the epididymis
  • Hormone testing. Doctor may recommend a blood test to determine the level of testosterone and other male hormones that affect fertility.
  • Genetic tests. These tests are used if doctor suspects fertility problems could be caused by an inherited sex chromosome abnormality
  • Testicular biopsy. This test involves removing samples from the testicle with a needle. It may be used if semen analysis shows no sperm at all. The results of the testicular biopsy will tell if sperm production is normal. If it is, problem is likely caused by blockage or another problem with sperm transport.
  • There are also other advanced tests which may be applicable for specific situations.

How is a woman tested for an infertility problem?

As a part of evaluating infertility in a woman, doctors may perform the following tests:

  1. Check for ovulation by means of blood tests and ultrasound of the ovaries
  2. Hysterosalpingography: This is an X –ray technique to check for functioning of the fallopian tubes
  3. Laparoscopy: This is a surgical technique by means of which doctors use a tool known as laparoscope to see inside the abdomen. Using the laparoscope, doctors check the ovaries, fallopian tubes, and uterus for disease and physical problems

 

Tests for infertility

What is the normal sperm count to make pregnancy happen?

Account of 20 million or more sperms per millilitre of semen is considered normal. A normal sperm concentration is greater than or equal to 20 million sperm per millilitre of semen. A count of 10 million or fewer sperm per millilitre of semen indicates low sperm concentration (sub-fertility). Rarely, a man may not produce any sperm at all.

How is a man tested for an infertility problem?

Some infertile couples have more than one cause of their infertility. Doctor will usually begin a comprehensive infertility examination on both partners. For a man, doctors usually begin by general clinical examination, testing his semen. They look at the number, shape, and movement of the sperm. Sometimes doctors also suggest testing the level of a man's hormones. In some cases, the cause of infertility may be unclear, or it may take a number of tests to determine the cause.

 

What does a doctor look for in General physical examination in a man?

This includes examination of one/man‘s genitals and questions about illnesses, disabilities and surgeries that could affect fertility. Doctor will want to know what medications one/man takes and his sexual habits. Doctor may also ask about sexual development as a boy has had any signs of low testosterone, such as decreased body or facial hair.

 

How is semen examination done?

This is the most important test for the male partner. Semen is generally obtained by masturbating or by interrupting intercourse and ejaculating semen into a clean container. A laboratory analyzes the physical characteristics of semen, the number of sperm present and looks for any abnormalities in the shape and structure (morphology) and movement (motility) of the sperm. The lab will also check semen for signs of problems, such as infections or blood. Often sperm counts fluctuate from one specimen to the next, so doctor may want to evaluate a few different samples. If sperm analysis is normal, doctor will likely recommend thorough testing of female partner before conducting further male infertility tests.

 

What are the additional tests done for infertility?

Depending on initial findings, doctor may recommend additional, more specialized tests that can help identify the cause of infertility. These can include:

  • Scrotal ultrasound. Ultrasound, which uses high-frequency sound waves to produce images of structures within the body, can help doctor look for evidence of a varicocele or obstruction of the epididymis
  • Hormone testing. Doctor may recommend a blood test to determine the level of testosterone and other male hormones that affect fertility.
  • Genetic tests. These tests are used if doctor suspects fertility problems could be caused by an inherited sex chromosome abnormality
  • Testicular biopsy. This test involves removing samples from the testicle with a needle. It may be used if semen analysis shows no sperm at all. The results of the testicular biopsy will tell if sperm production is normal. If it is, problem is likely caused by blockage or another problem with sperm transport.
  • There are also other advanced tests which may be applicable for specific situations.

How is a woman tested for an infertility problem?

As a part of evaluating infertility in a woman, doctors may perform the following tests:

  1. Check for ovulation by means of blood tests and ultrasound of the ovaries
  2. Hysterosalpingography: This is an X –ray technique to check for functioning of the fallopian tubes
  3. Laparoscopy: This is a surgical technique by means of which doctors use a tool known as laparoscope to see inside the abdomen. Using the laparoscope, doctors check the ovaries, fallopian tubes, and uterus for disease and physical problems

 

Treatment of infertility

How do doctors treat infertility?

Infertility can be treated with medicine, surgery, artificial insemination or assisted reproductive technology. Many times these treatments are combined. Doctors recommend specific treatments for infertility based on:

  1. Test results.
  2. How long the couple has been trying to get pregnant.
  3. Age of both the man and woman.
  4. The overall health of the partners.
  5. Preference of the partners.

How do doctors often treat infertility in women?

Doctors often treat infertility in women in the following ways:

  • Various fertility medicines are often used to treat women with ovulation problems
  • 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.
  •  

    How successful are these infertility treatment modalities?

    About two-thirds of couples who are treated for infertility are able to have a baby.

     

    How do doctors often treat infertility in men?Normal" style="margin-top: 0; margin-bottom: 0"> Treatment of male infertility depends on the cause, how long he has been infertile, his age, and personal preferences. Sometimes an exact cause for fertility can't be identified. But, even if an exact cause is not clear, doctor may be able to recommend treatments that work. Doctors often treat infertility in men in the following ways:

    1. For example, a varicocele can often be surgically corrected, increasing fertility, or an obstructed vas deferens can be repaired
    2. Treatments for sexual problems. Treating conditions such as erectile dysfunction or premature ejaculation can improve fertility. Approaches can include medication or counseling.
    3. Hormone issues. In cases where infertility can be caused by too much or too little of certain hormones, doctor may recommend treatment with hormones or medications that change hormone levels
    4. Assisted reproductive technology (ART) may be required in some cases

     

    Are there foods that can help increase sperm count?

    Roughly half of all couples who struggle with infertility do so because of a problem with the man's fertility. The most common cause of male infertility is a low sperm count. There are several dietary measures that a man who has a low sperm count can take to attempt to increase his sperm count, including:

    • Eat a diet that includes whole, unprocessed foods. The best foods for health in general and also for sperm count problems, are whole grains, legumes, vegetables, fruits, nuts, and seeds.
    • Eliminate alcohol intake. In addition to the general nutritional benefits of avoiding alcohol, avoiding alcohol may also assist with sexual performance issues
    • Identify and avoid food allergies.
    • Raw sunflower seeds and pumpkin seeds have been shown to help with male fertility. It is recommended that a man with a low sperm count eat 1/4 cup of raw sunflower or pumpkin seeds each
    • Some nutrients and vitamin supplements like vitamin C, E, B12, Selenium, zinc, arginine,carnitinecan help in increasing the sperm count.
    • Drink plenty of water
    • Refrain from smoking.

    What is Artificial Insemination?

    In this procedure, the woman is injected with specially prepared sperm. Artificial insemination is often used to treat:

    1. In case the male partner is infertile.
    2. Women who have problems with their cervical mucus.
    3. Couples with unexplained infertility

     

    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. 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.

     

    How often is assisted reproductive technology (ART) successful?

    The average success rate has been seen to be 37 % for women less than 35 years of age. With rising age, the success rate tends to decline. Apart from age, success rates vary and depend on many factors. Some things that affect the success rate of ART include:

    1. Reason for infertility.
    2. Type of ART.
    3. If the egg is fresh or frozen.
    4. If the embryo is fresh or frozen

     

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

    Common methods of ART include

    1. In vitro fertilization (IVF).
    2. Zygote intrafallopian transfer (ZIFT).
    3. Gamete intrafallopian transfer (GIFT).
    4. Intracytoplasmic sperm injection (ICSI)

     

    What is In vitro fertilization (IVF)?

    IVF means fertilization outside of the body. 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.

     

    What is Zygote intrafallopian transfer (ZIFT)?

    Here fertilization occurs in the laboratory. Then, the very young embryo is transferred to the fallopian tube instead of the uterus

     

    What is Gamete intrafallopian transfer (GIFT)??

    Gamete intrafallopian transfer (GIFT) involves transferring eggs and sperm into the woman's fallopian tube where fertilization occurs.

     

    What is Intracytoplasmic sperm injection (ICSI)?

    In ICSI, a single sperm is injected into a mature egg. Then the embryo is transferred to the uterus or fallopian tube. 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.

     

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