Infertility – the whys and the way out

Pregnancy - evidence of fertility in a couple

Pregnancy – evidence of fertility in a couple

Infertility means inability to get pregnant after one year of unprotected (without condom or family planning) sexual intercourse. Infertility is common. About 10 -15% of couples are affected by infertility.
Infertility is not always a woman’s problem. Both men and women can have problems that can result in infertility. About 1/3rd of infertility is caused my male problems, another 1/3rd by female problems and the remaining 1/3rd by both male and female problems or no identifiable cause.

The whys of infertility
Male causes of infertility include;
1. Abnormal sperm production or function due to undescended testicle varicocele (enlarged veins in the testes), infections such as chlamydia, gonorrhea, mumps or HIV.
2. Problems with the delivery of sperm; premature ejaculation, blockage of the testicles, damage or injury to the reproductive organ.
3. Genetic diseases such as cystic fibrosis
4. Medical conditions such as diabetes
5. Overexposure to certain environmental factors such as pesticides, heat and radiation.
4. Cancers and their treatment; Radiotherapy and chemotherapy.
Female causes of infertility include;
1. Problems with release of eggs from the ovaries; polycystic ovarian syndrome, increased production of prolactin, increased or decreased production of thyroid hormones.
2. Problems with the uterus (womb); abnormal shape of the uterus, growth e.g uterine fibroid, polyps.
3. Problems with the fallopian tube; infections like salpingitis, pelvic inflammatory disease.
4. Early menopause
5. Endometriosis; abnormal presence of endometrium of the womb in locations outside the womb.
6. Medical conditions such as diabetes
7. Cancers like brain(pituitary gland) cancer, and its treatment such as radiotherapy and chemotherapy.
Other factors that contribute to infertility in both male and female are;
1. Age. A woman’s fertility gradually declines with age, especially in her mid-30s, and drops rapidly after age 37.
2. Cigarette smoking; Miscarriages are more frequent in women who smoke. Smoking can increase the risk of erectile dysfunction and low sperm count in men.
3. Alcohol intake; Alcohol use increases the risk of birth defects, decreases sperm count and motility in men.
4. Being overweight.
5.Being underweight
6. Lack of exercise or excessive exercise.

The way out of infertility?
Male fertility tests
Male fertility requires that the testicles produce enough healthy sperm, and that the sperm is ejaculated effectively into the woman’s vagina and travels to the egg. Tests for male infertility attempt to determine whether any of these processes are impaired. They include;
1. Semen analysis; Semen is generally obtained by masturbating or by interrupting intercourse and ejaculating your semen into a clean container.
2. Hormone testing; You may have a blood test to determine the level of testosterone and other male hormones.
3. Genetic testing; Genetic testing may be done to determine whether there’s a genetic defect causing infertility.
4. Testicular biopsy; This is done to identify problems related to the testes and to retrieve sperm for use in assisted reproductive techniques such as IVF (Invitro fertilisation).
5. Imaging tests; which include brain MRI, bone mineral density scan, transrectal or scrotal ultrasound, vasography.
6. Other tests; post coital tests, sperm function tests
Female fertility tests
Fertility for women relies on the ovaries releasing healthy eggs. Then the egg passes into the fallopian tubes and join with sperm for fertilization. The fertilized egg must travel to the uterus and implant in the lining. Tests for female infertility attempt to determine if there are problems with these processes. They include;
1. Ovulation testing; can be by checking the change in body temperature, urinary ovulation prediction kits.
2. Ovarian reserve testing. This testing helps determine the quality and quantity of the eggs available for ovulation.
3. Hormonal tests; to check the level of female hormones in the body, hormones of the thyroid and pituitary gland which can affect fertility.
4. Ultrasound; to check if there is problem with the uterus such as fibroids, polyps or ovaries like cysts.
5. Hysterosalpingography; evaluates the condition of your uterus and fallopian tubes and looks for blockages or other problems.
6. Hysteroscopy; Your doctor inserts a thin, lighted device through your cervix into your uterus to view any potential abnormalities.
7. Laparoscopy; This minimally invasive surgery involves making a small incision beneath your navel and inserting a thin viewing device to examine your fallopian tubes, ovaries and uterus.
8. Genetic testing; This helps determine whether there’s a genetic defect causing infertility.

Infertility treatment depends on:
1. What’s causing the infertility
2. How long you’ve been infertile
3. Your age and your partner’s age
4. Personal preferences
Some causes of infertility can’t be corrected.

Treatment for men
1. Lifestyle modification; Regular exercise, discontinuation of smoking, alcohol use or intake of harmful substances.
2. Diet; Foods rich in antioxidants such as vitamin C and E can improve the quality of sperm.
3. Drugs; Testosterone replacement, antioestrogens, gonadotropins, anti-prolactins. Antibiotics to treat infection.
4. Surgery; Is done to reverse sperm blockage or repair varicocele.
5. Sperm retrieval; Is done to obtain sperm when ejaculation is a problem or when there is little or no sperm the ejaculated fluid. It may also be used in cases where assisted reproductive techniques are planned.

Treatment for women
1. Lifestyle modification; Exercise, discontinuation of tobacco, alcohol, harmful drugs.
2. Antibiotics to treat infection (PID)
3. Drugs; Clomiphene citrate is used to induce ovulation. Oral contraceptives, progestins, androgen, gonadotropins can be used to treat endometriosis.
4. Surgery; Cervical cerclage is done for women with cervical incompetence. Myomectomy and polypectomy to remove uterine fibroids and polyps respectively. Excision, laser, laparoscopy for endometriosis.
5. Intrauterine insemination (IUI); During IUI, healthy sperm are placed directly in the uterus around the time the woman’s ovary releases one or more eggs to be fertilized. Depending on the reasons for infertility, the timing of IUI can be coordinated with your normal cycle or with fertility medications.
6. Assisted reproductive technology (ART); ART works by removing eggs from a woman’s body. The eggs are then mixed with sperm to make embryos. The embryos are then put back in the woman’s body. These methods include;
A) In vitro fertilization: is the most common ART technique. It involves stimulating and retrieving multiple mature eggs from a woman, fertilizing them with a man’s sperm in a dish in a lab, and implanting the embryos in the uterus three to five days after fertilization.
B) Zygote intrafallopian transfer (ZIFT) or Tubal Embryo Transfer: Just like in IVF, fertilization occurs in the laboratory, however the young embryo is transferred to the fallopian tube instead of the uterus.
C) Gamete intrafallopian transfer (GIFT): involves transferring eggs and sperm into the woman’s fallopian tube for fertilization to occur in the woman’s body. This method is fading out.
D) Intracytoplasmic sperm injection (ICSI) is often used for couples in which there are serious problems with the sperm. Sometimes it is also used for older couples or for those with failed IVF attempts. In ICSI, a single sperm is injected into a mature egg. Then the embryo is transferred to the uterus or fallopian tube.
E) Assisted hatching: This technique assists the implantation of the embryo into the lining of the uterus by opening the outer covering of the embryo (hatching).
F) Donor eggs or sperm: Most ART is done using the woman’s own eggs and her partner’s sperm. However, if there are severe problems with either the eggs or sperm, you may choose to use eggs, sperm or embryos from a known or anonymous donor.
G) Gestational carrier: Women who don’t have a functional uterus or for whom pregnancy poses a serious health risk might choose IVF using a gestational carrier. In this case, the couple’s embryo is placed in the uterus of another woman for pregnancy.

Dr.Lala .A.
Lagos State, Nigeria

Author: temitope

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