Know More About Infertility

Hello friends, myself Dr Purnima Jain, I am practising obstetrics and gynaecology for last 15 years. Today in this video we are going to discuss about infertility its causes and the basic investigation which are required to investigate an infertile couple. First of all, what is infertility? In India whenever two person decides to continue as a life partner then the whole family starts expecting that after some time the new family member will be added to our family. But in about 15% of patients, this dream is never fulfilled, this is called infertility and technically if we want to define infertility, infertility is when a couple is unable to conceive even after one year of regular and unprotected intercourse. Infertility can be of 2 types primary infertility and secondary infertility, primary infertility is when a couple has never complete irrespective of the duration of their pregnancy and secondary infertility is when a couple has a prior history of conception, whatever the outcome may be but after that there they are unable to conceive this is called secondary infertility. So what can be the causes of infertility in a couple, infertility is not a problem of only female or male it can be a problem of both so causes of infertility can be due to a female cause or male cause due to both. In about 30 to 35% cases it can be due to female factors in about 35% it can be due to male factors and in another 10 to 15% it can be due to problem in both male and female and in 10 to 15% there can be no reason, that is a and explaining infertility. Among causes of infertility in females it can be due to broadly they can be divided into three categories one there is a failure of ovulation or tubal blockage or failure of implantation. Failure of ovulation can be due to some hormonal imbalance or improper development of gonads and tubal blockage, the tubal blockage can be due to some infection like a pelvic inflammatory disease, genital tuberculosis and sexually transmitted diseases. Thirdly, the failure of implantation, failure of implantation can be due to the thin endometrium and some blockage in the endometrium cavity due to a fibroid, polyp, asherman syndrome due to which the zygote is not able to implant in the endometrium. So these are the main three categories of female infertility, about male infertility again male infertility can be due to hypogonadism which leads to failure of production of sperm and it can be due to some genetic factors or due to maldevelopment of gonads or it can be due to hormonal imbalance or decrease hormones. Secondly, it can be due to obstruction in the outflow of sperm that is epididymis, vas deferens etc. If you want to investigate a couple about what can be the cause of infertility in this couple, then there are some basic investigation and some invasive investigation. Basic investigations can be some blood test like haemoglobin, blood group hormonal profile, serum TSH, serum follicular stimulating hormones, serum utilising hormone, serum prolactin and serum AMH and some viral markers like HIV, hepatitis B, anti-HCV and investigation for syphilis and then there are some tests for whether there is ovulation occurring or not, for it we are doing an ultrasound for follicular monitoring first or second day and then for eight and ninth day of cycle on alternate day to see whether the follicle is being developed or not. Then there can be investigations to see whether there is any tubal blockage or not for which there are three investigations available, first is HSG or Hysterosalpingography, in which a dye injected by a cervix into the uterus and fallopian tubes and then an X-ray is done to see that whether the tubes are patent or not and second is saline sonography in which a saline is injected by a cervix into the uterus and fallopian tubes and then ultrasound is done to see whether the tubes are patent or not. But if it is not clear by that, we can do laparoscopy which is an operative procedure and sometimes hysteroscopy is also done. For male infertility, we have to do a basic investigation which is Semen analysis, in which we see counts, morphology and motility of the sperms and if it is normal then it is ok but if it is abnormal then we have to further investigate. So these are the basic investigations which are required to investigate the infertile couple. Thank You.