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Infertility - The present day situation

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18 Aug, 2018

Infertility is defined as not being able to conceive despite indulging in frequent, unprotected sexual intercourse for a period of at least one year. The Indian Society of Assisted Reproduction stated that, currently, infertility affects about 10 to 14% of the Indian population. Around 27.5 million Indian couples actively trying to conceive have been found to be infertile. Urban areas have a higher rate with everyone one in six couples affected.

Either you or your partner could be infertile (rarely both the partners). Fortunately, with advances in scientific research and technology, today many safe and effective therapies are available that significantly improve your chances of getting pregnant.

Causes

Male infertility:

  • Abnormal sperm production or function
  • Problems with the delivery of sperm
  • Overexposure to certain environmental factors
  • Damage related to cancer and its treatment

Female infertility:

  • Ovulation disorders
  • Uterine or cervical abnormalities
  • Fallopian tube damage or blockage
  • Endometriosis
  • Primary ovarian insufficiency (early menopause)
  • Pelvic adhesions
  • Cancer and its treatment

 

Signs and symptoms: There may be no other obvious symptoms apart from not being able to get pregnant.  

 

Diagnosis

Tests for men:

  • Semen analysis
  • Hormone testing, such as testosterone levels
  • Genetic testing
  • Testicular biopsy
  • Imaging techniques such as vasography (X-ray of the vas deferens), scrotal or transrectal ultrasound, CT or MRI to detect calcifications (stones) in the reproductive tract, etc.

Tests for women:

  • Ovulation testing: Blood tests to measure hormone levels to determine whether you're ovulating.
  • Hysterosalpingography and/or hysterosonography evaluates the condition of your uterus and fallopian tubes and looks for blockages or other problems
  • Ovarian reserve testing helps determine the quality and quantity of the eggs available for ovulation
  • Hysteroscopy inserts a thin, lighted device through your cervix into your uterus to view any potential abnormalities
  • Laparoscopy: Here, a small incision is made beneath the navel and a thin viewing device is inserted to examine your fallopian tubes, ovaries, and uterus
  • Genetic testing

 

Treatment

For men:

  • Altering lifestyle factors
  • Certain medications may improve sperm production and quality
  • Surgery may be able to reverse a sperm blockage and restore fertility
  • Sperm retrieval, a technique to obtain sperm when ejaculation is a problem or when no sperm are present in the ejaculated fluid

For women:

  • Stimulating ovulation with fertility drugs
  • Intrauterine insemination (IUI), wherein healthy sperm are placed directly in the uterus around the time of ovulation
  • Surgery to restore fertility
  • In vitro fertilization: Multiple mature eggs are retrieved from a woman. These are fertilized with a man's sperm in a petri dish in a lab, and the embryos are implanted in the uterus
  • Intracytoplasmic sperm injection (ICSI), where a single healthy sperm is injected directly into a mature egg
  • Assisted hatching, where the embryo is assisted to attach on the uterine wall
  • Donor eggs or sperm
  • Surrogacy, where another woman acts as a gestational carrier of the embryo from a couple