ABOUT THE DISEASE

Infertility can be broadly clubbed under two categories-

Primary Infertility: When the female is not able to conceive even after one year of unprotected sex.

Secondary Infertility: Where the female has been able to get pregnant once, but is not able to do so now.

For Pregnancy to happen - First a woman must release an egg from one of her ovaries (ovulation) and then that egg must be fertilized by the male sperm. It then travels through a fallopian tube into the uterus i.e the womb, where it attaches to the wall of the uterus and grows. As for the man, he must produce enough sperm, and the sperm must be motile enough to fertilize the egg along the way, at the proper time. Finally the fertilized egg must then be able to attach to the inside of the uterus. If any of these fail to happen, it leads to infertility.

CAUSES

About 30% of infertility cases are due to male related factors and 30% are due to problems with the female factors. Other cases are due to a combination of male and female factors (10%) or due to unknown causes (25-30%).

Some of the reasons for males are as follows:
- Low sperm count (oligospermia)
- No sperms (azoospermia)
- Decreased motility/ abnormal sperms
- Sexual dysfunction.
- Hormonal or endocrine problems.
- Birth defect, such as absence of the tubes that carry the sperm (Vas deferens).
- Antisperm antibody
- Varicoceles, spematoceles, or tumors of the testicles.

Causes for infertility in women could be:
- Problems with ovulation, as evidenced in- females with irregular menstrual periods or no periods at all; hormonal imbalance, eg.pituitary gland tumor, thyroid disorder; Polycystic ovary syndrome.
- Pelvic infections.
- Blocked fallopian tubes
- Congenital abnormalities of the uterus.

DIAGNOSIS

Other than the physical examination of the penis and testis, some of the blood and imaging tests suggested for males are:
- Sperm/Semen Testing
- Blood hormone level testing
- Testicular biopsy

For females, tests include:
- Checking for ovulation
- Hormone levels, eg. FSH, LH, Testosterone, Thyroid
- Hysterosalpingogram
- Pelvic ultrasound
- Laparoscopy
- Endometrial biopsy
- Hysteroscopy

TREATMENT METHODS

Treatment plan completely depends upon the problem identified and might just require a lifestyle modification (stopping drinks, drugs and smoking) or counselling or medications, however in other cases a surgical intervention might be required.

- Fertility enhancing drugs may be used for women with ovulation problems.

- Surgery may be needed to repair damage to a woman`s ovaries, fallopian tubes, cervix, or uterus, as in endometriosis, blocked fallopian tubes or polycystic ovary syndrome.

- Surgery may be needed in a man, as in Varicocele, obstruction.

- Intrauterine insemination (IUI) of sperm, timed with ovulation.

- IVF - In Vitro Fertilization

Last but not the least, ovulation occurs about 2 weeks before the next menstrual cycle (period) starts. If a woman gets her period every 28 days, the couple should have sex between the 10th and 18th day after the period starts, to maximize chances of pregnancy.

You may also like to learn about:

Blocked Fallopian tubes
Polycystic ovarian disease
Azoospermia
Varicocele
Pelvic inflammatory disease
Endometriosis