Understand Fertility Problems

For most of people having a normal family life is a blessing; one has education, grow up, get married, have children, spend years rearing them, retire and watch their grandchildren grow up. The loss of this is a devastating experience. Most of us fulfill this dream. But there are many people around us who are surrounded by images of children and families- a painful reminder of what they don’t have. Their friends and family have children at just the time when they are struggling with realization that they cannot.

Now a days the decision to get pregnant is usually a calculated and thoughtful choice and is made after consideration of completion of education, career building, financial security and acceptance of responsibilities of a parent. So when there’s finally consensus of having a child, expectation for getting pregnant are usually high. In fact, the average chance of conceiving each cycle is only 15% and chance of spontaneous abortion is also 15%. The good news is that 85% of the couples are successful in during conceiving the first year.

People who are experiencing infertility sometimes find it difficult to talk about. This article is intended to help you understand causes of infertility, investigations, treatment options emotional issues and suggest some ways you might be able to help any one around you with this problem.

Q:        What is infertility?

A:        A couple is regarded as having a fertility problem when they have not conceived after 12 months of marriage. It is called primary infertility when pregnancy was never conceived and secondary infertility when couples have previously been pregnant at least once, but have not able to achieve another pregnancy.

Q:        How a normal pregnancy is achieved? 

A:        Normally during each menstrual cycle the follicles containing egg, start growing in ovaries. About mid cycle by LH hormone surge follicles reach their full maturity and burst releasing the egg which is then picked up, by the fallopian tubes and if sperms are present pregnancy starts. Eventually, it is embedded in the uterus and new life begins. It is important to realize that life span of an egg is 24 hours whereas that of sperm is 72 hours, so for pregnancy to occur only first 24 hours in which egg is released are important because after it, it disintegrates.

Q:        What are the causes of infertility?

A:        In about 40% of infertile couples, the problem is a male factor, in about 40% it is a female one. For the remaining 20% it is joint problem or the cause is unknown.

Q:        What are the causes of infertility in female? 

A:        Among females causes are ovarian problems like (ovulation dysfunction) problem in egg formation for e.g. overall small size or poor quality or inability to rupture follicles, ovarian cysts, hormone imbalance, pelvic infections causing tubal damage as well as damaging transport system from cervix to tubes, scarring from endometriosis or sexually transmitted disease, structural abnormalities and defects of uterus (fibroids) cervical factors, chronic illness and eating disorder also affect fertility.

Q:        What are the causes of infertility in male? 

A:        Some common causes in males are problem with production of sperm, poor sperm quality, infection like epididymitis, orchitis, varicocele, hormonal and autoimmune disorders.

Q:        How age affects chances of conceiving?

A:        Age of men and women is the most sensitive factor affecting fertility. After 35 years the likelihood of getting pregnant drops.

Q:        How weight affects fertility? 

A:        New research from various medical centres have proved that overweight woman with regular cycles, and otherwise no obvious fertility problem, still have less chances of conceiving.

Q:        How a couple trying to conceive is evaluated? 

A:        Receiving a diagnosis of infertility can be heart breaking but may also open the doors of hope. Once you know something is wrong a solution can be found. A complete history and examination of both partners is essential which is followed by tests. Semen analysis is the basic investigation for males. It determines the sperm count, motility, shape and any other problem. Among females pelvic ultrasound is performed for any structural problems and monitoring ovulation. Tubal potency can be checked either radiologically by (HSG) hysterosalpingography or by laproscope. Blood hormone profile is done for either or both partners. The other tests are performed on individual cases. A definite cause can be determined for about 70-80% of cases.

Q:        What treatment options are available? 

A:        Treatments for infertility are many depending on the cause, also depends whether the problem is from the woman’s side, the man side, both sides, or remains unexplained. It may involve counseling and education of couple, medication to improve the production of eggs, or to improve numbers or quality of sperm, surgery of the fallopian tubes to fix blockages, IUI insemination of the woman with her husband’s sperm sample and IVF invitro fertilization and its related treatments such as GIFT.

The good news is that 50-60% couples can be treated with medication or surgery and for rest assisted reproduction technologies like IVF can be done.

Q:        What is artificial insemination (IUI)?

 A:        Artificial insemination

IUI is a latest treatment option for cases of male factor infertility, problems with women’s cervical mucus or in cases of unexplained infertility. It is affordable procedure that involves placing specially prepared sperm sample directly into the uterus. It has a success rate of 30-40%.

Assisted reproductive technologies refer to infertility treatment that involve the handling of embryos. This includes IVF, GIFT and ZIFT. After baseline investigation of both partners they are selected for a certain treatment.

Q:        What is In-Vitro Fertilization (IVF)

A:        IVF (In- Vitro Fertilization)

In this procedure fertility days are used to stimulate the ovaries to produce eggs then the ultrasound and blood hormone level confirm good number, and quality of eggs. The eggs are retrieved from the woman’s ovaries by ultrasound guided needles. Next, the eggs are placed together with sperm, in special media in incubators under strict control. After fertilization on day 5 the embryos are placed inside the uterus.

Q:        What is Intracytoplasm Sperm Insemination (ICSI)

A:        ICSI (Intracytoplasm Sperm Insemination)

The whole procedure is same as that IVF but in it after ovum pick up, the sperm tails are cut and then they are injected in the egg and are again put in the incubators for embryos to form.

There is no easy way to endure the inability to conceive. Anger and frustration, the pressure of time, feeling of loneliness, loss and grief, and the insidious nature of stress all contribute to lowered levels of happiness and contentment. However, there are ways to cope individually, and as a couple.

• Become educated about fertility and infertility 

• See helpline

Right treatment taken at right time not only improves the success rates but also minimizes the long term complications.

• Be patient

Conceiving can take a long time, some time its best to lower your expectation, but to still keep trying. Others find if helpful to take a break and to start trying again in a couple of months.

• Listen and talk to each other

Respect your partners feeling, sharing can boost up strength and courage of your relationship.

• Pray and meditate

It can be calming and give you a sense of peace. 

• Find diversion

Although one should not avoid the problem, it can often be helpful to take a break from it. If possible seek out also help of infertility counselor.

Dr. Ayesha Azam Khan