Infertility-male-female

General information about infertility

1. What is infertility?

Infertility, whether male or female, can be defined as 'the inability of a couple to achieve conception or to bring a pregnancy to term after a year or more of regular, unprotected intercourse'.

2. What is the incidence of infertility worldwide?

The World Health Organization (WHO) estimates that approximately 8-10% of couples experience some form of infertility problems. On a worldwide scale, this means that 50-80 million people suffer from infertility. However, the incidence of infertility may vary from region to region.

3. Is infertility exclusively a female problem?

No. The incidence of infertility in men and women is almost identical. Infertility is exclusively a female problem in 30-40% of the cases and exclusively a male problem in 30-40% of the cases. Problems common to both partners are diagnosed in 10-15% of infertile couples. After thorough medical investigations, the causes of the fertility problem remain unexplained in only a minority of infertile couples (5-10%). This is called unexplained infertility.

4. What are the most common causes of infertility?

The most common causes of female infertility are ovulatory disorders and anatomical abnormalities such as damaged fallopian tubes. Less frequent causes include, for example, endometriosis and hyperprolactinemia, thyroid gland related problems.

In developing countries like India, infections of the womb such as gonorrhoea, chlamydia and tuberculosis significantly, contribute to infertility.

Causes of male infertility can be divided into three main categories: Sperm production disorders affecting the quality and/or the quantity of sperm;Anatomical obstructions; Other factors such immunological disorders. Approximately a third of all cases of male infertility can be attributed to immune or endocrine problems, as well as to a failure of the testes to respond to the hormonal stimulation triggering sperm production. However, in a great number of cases of male infertility due to inadequate spermatogenesis (sperm production) or sperm defects, the origin of the problem still remains unexplained.
5. Ectopic Pregnancy
When a pregnancy is not located in the uterus it is called an Extra Uterine Pregnancy (EUG) or ectopic pregnancy. The most common place for an EUG is the fallopian tube but sometimes the ectopic pregnancy is located elsewhere, such as in the cervix, the ovary or in the abdomen. EUG is a rare disease and occurs in 1% of all pregnancies. With IVF treatment the risk can increase. Risk factors for EUG are a history of infection of the tubes (Salpingitis), Chlamydia infection, Pelvic Inflammatory Disease (PID), genital tuberculosis, former EUG, operation on the tubes or in the lower abdomen, endometrioses and appendicitis. The symptoms of ectopic pregnancy are often similar to those of a normal miscarriage and may include a positive pregnancy test together with or without vaginal bleeding and abdominal pain. Although it is not common, the possibility of EUG has to be considered in patients with the symptoms and one (or more) of the risk factors for EUG. Diagnoses is made by questioning the patient on the risk factors, physical examination, vaginal ultrasound and laboratory findings, especially the serum BHCG levels. Depending on the size and the location of the EUG, different treatments can be given. Nowadays, most of the ectopic pregnancies can be removed surgically by Laparoscope, without opening the abdomen. But occasionally medical treatment in the form of Methotrexate injection or expectant treatment is offered when the pregnancy is very small and thorough control of the patient is possible. Alternatively, one can directly inject drugs into the ectopic pregnancy, making use of a thin needle, under the guidance of Tranvaginal Sonography.
6. PCOS
Polycystic ovary syndrome or shortly PCOS, is an ovulation disorder which affects 4-6% of all women. Several factors contribute to the disease. At this moment researchers think that the cause of the disease is genetic. The major features of this syndrome are irregular or no menstruation, Hirsutism and acne due to high levels of male hormones, obesity (40-50%), high insulin levels with risk for developing diabetes and large polycystic ovaries shown on ultrasound. Women with PCOS usually present at fertility clinics for counseling. To increase fecundity the treatment possibilities are mostly focused on regulation of the menstrual cycle. For this, several drugs are used (Clomiphene Citrate, Bromocriptine, Gonadotrophins) and weight loss is strongly advised. In many cases the cycle will be ovulatory and regulated by these treatments. Newer oral anti diabetic drugs such as Metformin are being more frequently used to treat PCOS, with very good outcome. Alternately, one can Electrocoagulate the ovarian surface using a laparoscope, especially in those women with highly elevated levels of LH hormone. If these women fail to become pregnant, they may be subjected to Gonadotropin injections, to stimulate ovulation. This may be combined with an Intrauterine insemination procedure (IUI) . Resistant cases may be treated by performing ART procedures such as IVF or ICSI.