Infertility refers to a couple that has failed to conceive after 12 months of regular unprotected sex. Primary infertility is when a couple who has never had a child. Secondary infertility is failure to conceive following a previous pregnancy. Infertility may be caused by infection in the man or woman, but often there is no obvious underlying cause. It represents a reduced potential for pregnancy which is different from sterility which means there is no chance for a pregnancy. Most childless couples with a female aged under about 43 that are having problems getting pregnant are considered to be infertile but not sterile.

Common causes:

  • Ovulation problems: Absence of ovulation from Ovary commonly due to polycystic ovarian syndrome (PCOS)
  • Tubal Problem: Blockage, damage or scarring in fallopian tube which creates difficulty for ovum to travel from ovary to uterus commonly due to pelvic inflammatory disease (PID), endometriosis or scar tissues.
  • Sperm problems: Low motility or low sperm count can be the reason. Around 25% of total infertility cases are due to sperm problems.
  • Idiopathic infertility: All tests are normal and the cause is unexplained.
  • Female age: Successful pregnancy outcome is very much related to female age as age is directly proportional to quality and quantity of eggs.
  • Uterine disorders: Normal uterine cavity and endometrial lining are necessary to conceive and maintain a pregnancy. Uterine polyps, uterine fibroids, bicornuate uterus or thin endometrial lining does not allow to rest the embryo in epithelium and lead to recurrent miscarriage.
  • Endometriosis: Endometrial tissues grow outside the endometrial lining. This is a one of the major cause.
  • Tubal ligation surgery: Female sterilization surgery will not allow to fertile the ovum.
  • Vasectomy surgery: Male sterilization surgery will stop chances of pregnancy in a couple.

Treatment advised for a couple

  • Induction of ovulation: Use of medication to stimulate development of mature follicles in the ovaries of women who have anovulation. These women often have irregular menstrual cycles, increased body hair, and PCOS. Female having PCOS, who do not ovulate on their own regularly, and want to get pregnant should go for induction of ovulation medication.
  • Insemination – IUI: Intrauterine insemination (IUI) is a fertility treatment where sperm is placed inside a woman's uterus to facilitate fertilization. The goal of IUI is to increase the number of sperm that reach the fallopian tubes and subsequently increase the chance of fertilization. In this procedure semen is "washed" in the laboratory and sperm is separated from the other components of the semen and concentrated in a small volume. The IUI procedure can be an effective treatment for women where there is severe tubal damage, ovarian failure, severe male factor which keep them infertile or severe endometriosis.
  • In vitro fertilization – IVF: In vitro fertilization (IVF) is a complex series of procedures used to treat fertility or genetic problems and assist with the conception of a child. In IVF, mature eggs are collected from ovaries and fertilized by sperm in a lab. Then the fertilized egg (embryo) are implanted in the uterus. IVF can be used as an effective treatment for infertility of all causes except for women with an anatomic problem with the uterus, such as severe intrauterine adhesions. Main reasons for IVF are blocked fallopian tubes, male sperm problem, failure of IUI, female age is more than 38, low quantity and quality of eggs, severe endometriosis or idiopathic infertility.
  • Egg donation - IVF using donor eggs: Egg donation is an effective treatment except in women with a severe uterine problem, such as extensive intrauterine adhesions.
  • Surgery: Laparoscopy is a surgical procedure that involves insertion of a narrow telescope-like instrument through a small incision in the belly button. This allows visualization of the abdominal and pelvic organs including the area of the uterus, fallopian tubes and ovaries. Semen analysis, hysterosalpingogram, assessment of ovarian reserve and documentation of ovulation should be assessed prior to consideration of laparoscopy.

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