What is Infertility
If you are struggling to have a baby, you are not alone. Nearly 10-15% of the couples in India and across the world battle against infertility. Infertility is defined as inability to conceive despite regular unprotected intercourse for atleast a year. Age of the woman is of prime importance as far as infertility is concerned. Women whose age is between 35-38 years can try for 6m before they can consult the doctor. Women whose age is more than 38 years should consult a fertility specialist once they start planning for pregnancy. Nearly 95% of the couples conceive within 2 yrs of trying. With each passing year the ability to conceive decreases substantially
When to approach an infertility specialist
Couples who are unable to conceive after an year of unprotected and regular intercourse should consult a doctor. Women whose age is 35-38 years its better to approach an infertility specialist after trying naturally for 6 months. And in women more than 38 years should consult an infertility specialist once they start planning for pregnancy. For women with irregular cycles, tubal or peritoneal disease or advanced endometriosis and in men with suspected subfertility its better to get evaluated earlier.
Causes of infertility
Both the partners contribute to the problem of infertility equally. Women contribute in 30% of the cases, men contribute in 30% and in 30% of the cases both contribute. So its always better for both the partners to get evaluated simultaneously. In women the cause can be tubal, ovarian, uterine, hormonal disorders like hypothyroidism and other unexplained causes. In men it could be due to abnormal semen parameters like low or absent count, low motility, abnormal forms, hormonal discorders like diabetes, hypothyroidism. Obesity, smoking, alcoholism are also contributing factors to infertility in both the partners
Male factor infertility
This accounts for infertility in 25-40 % of couples. Problems with sperm include the abnormal shape of the sperm, the decreased number of sperm, or their inability to move effectively or the abnormal shape of the sperm. Obesity, smoking, alcoholism are also contributing factors to male infertility
Ovulation
Problems related to ovulation or release of womans egg accounts for 25-30 % of infertility cases in couples. This could be due to hormonal causes or abnormalities in the ovaries such as polycystic ovary syndrome. These defects can be overcome using medications that stimulate ovulation.
Tubal defect
Abnormality of the Fallopian tubes accounts for 20-30 % infertility cases among couples. Fallopian tubes connect the ovaries to the uterus. Functional tubal defects can be caused by infection like tuberculosisand pelvic inflammatory disese which cause damage to ciliary structures in the tube which might hamoer with the transportation of embryo. Tubal block can be caused by infections like tuberculosis, scarring from earlier surgery or a previous tubal ligation (tying of the tubes).
Endometriosis
Endometriosis refers to the attachment of the uterine lining to various pelvic organs such as the ovaries, Fallopian tubes and sometimes even the intestines. This can cause scarring, pain, and affects the ability of the eggs to fertilize and create a pregnancy. Endometriotic cysts in the ovaries often called chocolate cysts not only decrease the quantity of eggs but also afect the egg quality as well. This accounts for 5-10 % infertility in couples.
Unexplained infertility
In about 10-20% couples there is no obvious cause of infertility but are still unable to conceive. However, fertility treatments also are successful in these cases.
Investigations
A preliminary infertility evaluation is done to determine the probable causes of infertility. It also helps in the determination of the best possible approach for treatment. Your health specialist will take steps to get a clear understanding of your medical history and recommend various tests.
Female and male partners contribute equally to infertility. Hence for a complete evaluation and diagnosis both male and female partners should undergo testing
The anxiety to start with evaluation and treatment is very common in most patients. Your first step should be to meet up with your infertility specialist and perform a series of preliminary tests at the earliest. Make sure that you carry all the previous reports with you to the infertility specialist at your first appointment.
Male Partner Test
A semen analysis is performed at the beginning of the evaluation. The male partner should provide a sample after refraining from ejaculation for at least 48 hours but should have had an ejaculation within 6 days of providing the sample. A semen culture is also performed too.
Female Partner Tests
Female infertility can be evaluated using these baseline tests
Hormone Testing
On day 2 of the menstrual cycle, blood tests are performed to check for the levels of FSH(Follicle Stimulating Hormone) , LH( Leutinizing hormone), E2 (Estradiol) . AMH (Anti-Mullerian Hormone) is done in those with advanced age, cases with suspected decreased ovarian reserve, endometriosuis and if other hormone tests are abnormal
Progesterone level
During day 20-22 of a 28 day cycle the serum progesterone level are measured
Testing for ovulation
Ovulation occurs between Day 12-Day 18 of a regular menstrual cycle that occurs every 26 to 32 days. USG is one of the best tests to document ovulation. It can also be confirmed by some hormone tests.
Other Tests
Your fertility specialist or gynecologist may recommend additional tests
Pelvic ultrasound
Pelvic ultrasound is done on day 2 of the cycle to give a better idea about uterus and its lining and any other pathologies, to determine the ovarian reserve and other problems like PCO.
Hysterosalpingogram (HSG, or tubogram)
Hysterosalpingography, or HSG, is an X-ray test to outline the internal shape of the uterus and show whether the fallopian tubes are blocked. In HSG, a thin tube is threaded through the vagina and cervix. A substance known as contrast material is injected into the uterus.
Laparoscopy
Performed as an outpatient procedure, it uses a magnifying scope to look inside the abdominal and pelvic cavity. This procedure helps in the detection of adhesions or endometriosis.
Hysteroscopy
This procedure is performed to check for uterine abnormalities or polyps or scar tissues. The procedure involves inserting a small scope into the uterus through the vagina and cervix to get a clear picture of the inside of the uterus.