Infertility - What Are The Reasons?

Hello,

 I am Dr. Saloni Chopra, Gynaecologist. I have worked in govt. sector for 3 years and in the private sector for a few years. I have done my ultrasound laparoscopy as well as infertility courses. Today we will talk about a very highlighted topic i.e. infertility. Infertility is seen in every 3rd couple who enters to our OPD and the reason is because of late marriages of the couple. They are giving more importance to their career as compared to family life. It is seen in the woman of reproductive age group. When we call a couple infertile when they are not able to conceive after 1 year of unprotected sexual intercourse. If the woman age is more than 35 years then we call them infertile even after 6 months of unprotected intercourse. Infertility can be of 2 types: Primarily and secondary. Primary means when they are not able to have one child after marriage and secondary means they had a previous child but after trying for 2nd child, they are not able to conceive.

So, the most common factors for infertility are female infertility as well as combining both of them. The female factors account for 40-50% and malefactors 25-40% of the cases and the rest of them are the combine factors. So, the most common cause in the female infertility is the ovulation problem i.e. menstrual irregularity and because of hormonal imbalance happening in the body. The second common cause is the uterine or the cervical factor. Uterine factor means that there is some fibroid, some swelling, some polyp inside the uterus which is causing infertility. And the cervical factors means is the problem when the cervix which is the mouth of the uterus which is causing some abnormality. 3rd is the tube. The tubal factor is also very important because our pregnancy is formed inside the tubes and then it comes in the uterus. If the tubes are blocked or damaged because of any reason then there will be difficulty in conceiving.

 The third can be because of unexplained infertility. We don't know the exact cause of it. And sometimes there is some pelvic adhesion. There can be some endometriosis and sometimes if the female is having any cancer then the treatment of that also cause infertility. The medical condition like thyroid, hypertension, diabetes is also one of the factors which can cause infertility in the female. If we talk about male, so the most common cause is semen analysis. Sperm can be low and the mortality also can be low, there can be abnormal morphology in the semen. There can be some pus cells and the infection in the semen analysis. All of these factors can cause infertility. Along with this, there can be some other medical factors that they are taking drugs, smoking, alcohol or they are in a very heated environment. All these can also have some abnormality in the semen analysis. If they are also going for some cancer treatment can also give this problem. Along with this if they have PE then also they can have male infertility. And there can be a combined factor. So, there can be some male problems or female problems. So, in this condition, we have to treat both of them. What is basically the risk factor for infertility? It can because of the increasing age of the mother and father, smoking, tobacco chewing, alcohol, stress, being overweight, all these can take you towards infertility.

How do we diagnose infertility? We have to diagnose male as well as female. For male, we have to go for semen analysis which is the first and foremost investigation to be done. If required, we can go for hormonal analysis. We can take the treatment with a urologist to figure out what can be the treatment for any of the factor which has gone wrong out of all these 3. For female infertility, we have to do the basic ultrasound, pelvic ultrasound in which we see how is the uterus, how is the endometrial line. How are the tubes and the ovaries? If there is an ovary problem which we can see in the uterus along with this, how are the follicles are forming in the ovaries because of this help in the formation of pregnancy as well as the menstrual problem? 2nd is we need to go for the hormonal tests to see the ovulation problem.

If there is any hormonal abnormality, the problem with the thyroid, this means they will be having ovulatory dysfunction. Next, we have to go for the blood test. 3rd is we have to look for the tubes. We can o the laparoscopy as well as hysteroscopy in which we see the whole uterus from outside and inside whether any of them has any problem. And sometimes, if anything is wrong then we have to go for genetic testing of the couple. How do we treat them? So, the treatment part first includes counselling. Because of the infertility treatment impacts on physical and mental health also.

So, this should be very well prepared. 2nd we have to start the medications for the patient. Like for the females, we can give drugs for ovulation induction and we can see how their ovaries are reacting, how the eggs are forming, we can go for follicular monitoring along with this. 2nd is we can go for surgeries. In the investigation, if we see any of the fibroid, blocked tube or polyp or endometriosis or any pelvic adhesion, we can go for the surgery to remove. So that the chances for them to conceive gets improved. 3rd is if the female is not able to conceive then there are other modalities like intra-uterine insemination, IVF, surrogacy, adoption, they can go for the donor. For males also, we can give the medications to improve the fertility and if required, we can go for the surgery of varicocele. So, I think this brief will help you.

Thank You.