Infertility
A couple who have had regular unprotected intercourse for a period of 12 months without a pregnancy occurring is considered to be infertile. For healthy young couples, the odds are about 20% that a woman will become pregnant during any one menstrual cycle. This percentage starts to decline in a woman?s late 20s and early 30s and decreases even more after age 35. Infertility affects about 10-15% of couples.
Causes of Infertility
Infertility may be caused by a problem with the woman, the man, the couple or their lifestyle. Some of the causes are:
? Male factors (defective sperm production, insemination difficulties 30-60%
? Ovulation factors 5-25%
? Tubal or uterine factor 15-25%
? Cervical / immunological factors 5-10%
? Unexplained after investigations 10-25%
Infertility may be caused by more than one factor.
Investigation of the female
The investigation of the female involves determination of three basic issues:
Does ovulation occur on regular basis?
Is there any impairment of tubal function and of implantation?
Is there a cervical factor preventing sperm invasion?
Ovulation.
The most effective way in determining if the woman is ovulating is to measure the serum progesterone level in the mid luteal phase of the menstrual cycle (D21). The older methods are Basal Body Temperature (BBT) and Endometrial Biopsy to confirm endometrial luteinization had occurred, indicating ovulation. Nowdays, ultrasonography is used to identify follicular growth and development.
Tubal factors.
The patency of the Fallopian Tubes can be evaluated in 2 ways:
a) Hysterosalphingogram
It is performed by inserting a cannula attached to a syringe into the cervix and injecting a radio opaque substance into the uterus under direct imaging. The passage of the dye is observed as its fills the uterine cavity and passes along the Fallopian tubes to spill into the peritoneal cavity.
b) Laparoscopy & Dye Test.
Laparoscopy has to be performed under general anaesthesia and then a water-soluble blue dye is injected into the uterine cavity via the cervix. If the tubes are not blocked, it will spills through the Fimbrial ends of the Fallopian tubes. The advantage of Laparoscopy, pelvic diseases such as endometriosis, peritubal adhesions, can be detected and treated.
Investigation of the male.
Ideally, a man should have a proper physical examination during the visit especially the genital part. Semen analysis is required from him.
The seminal specimen usually collected by masturbation into a clean, dry glass container and taken to the laboratory within 1 hour of the test, and the analysis is made
Normal seminal analysis:
Volume > 20ml
Sperm concentration > 20 million per ml
Motility 60mm after ejaculation > 50% with forward progression
Morphology > 50% normal.
Treatment of Infertility
a) Ovulation Induction
If the woman does not ovulate, she will be given certain medications to increase/stimulate the growth of more eggs and an injection to cause/induce eggs to be released. Ovulation can be induced with antioestrogen such as Clomiphine citrate. If this fails, gonadotrophins( eg: Puregon, Gonal-F) and human chorionic gonadotrophine (eg:Profasi) are used. Sometimes gonadotrophic releasing hormone (GnRH) is used in the assisted reproduction
b) Intra-Uterine Insemination (IUI)
It means by placing a prepared sperm into a woman?s womb during her fertile period. Most of the time it involves control ovulation induction either with Clomiphene or gonadotrophin. By inseminating directly into the womb, the sperm has better chance to fertilize the eggs.
c) In vitro Fertilization
The eggs from the woman and sperm from her husband are fertilized in a laboratory. The fertilized eggs are then placed in the woman?s womb to grow.
d) Intracytoplasmic Sperm Injection(ICSI)
When a man has severe sperm problem, one of his sperm can be directly placed into an egg to fertilize. The fertilized egg is then placed in the woman?s womb.
Finally, whatever method we used to become pregnant, the success rate is still low within 20-30% range. Infertility and treatment require a big commitment from both partner. An advancement in Assisted Reproductive Technologies gives more hope to those who has difficulty to conceive.
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