INFERTILITY
Trying to Get Pregnant
• It’s actually a process that happens over a period that is very dependenton fertility health. First, the egg must successfully mature and release (ovulate) from the ovary into the fallopian tube, where it will meet sperm.
• The sperm will have had to successfully negotiate the vagina, uterus and finally the fallopian tube. If the sperm succeeds in fertilizing the egg, the newly-formed pre-embryo will travel into the uterus where it must successfully attach to the lining. The uterine lining must be just the right thickness and free from abnormalities suchas fibroids or polyps , in order for implantation to occur.
• As you can see, getting pregnant is a sophisticated process where many things must go right in order for a pregnancy to occur.
Ovulation Tracking
• This will improve the chances of natural conception.
• Before jumping into fertility treatment, we encourage couples to consider ovulation tracking as a first step-1 cycle. It is a simple option that involve the monitoring of ovulation by USG.
• Women with regular menstrual cycle, occurring at intervals of 21-35 days, is usually indicative of normal ovulation. USG play a role in confirming ovulation.
• Knowing when you or your partner ovulates will help you time intercourse to increase your chance of conception. As sperm can live at their healthiest inside a woman for 48-72 hours, you’re more likely to conceive when you have intercourse on, or around, one to two days before ovulation.
When Should you? Visit Earlier!
• Women age more than 35 years.
• History of irregular menses or absence of menses.
• Any male factor infertility.
• Endometriosis
• Uterine pathology.
• Tubal pathology.
When do I Need to See the Fertility Specialist?
If you find that falling pregnant hasn’t happened as quickly or easily as you first thought, you’re not alone. Across the world, 1 in 7 couples will struggle to fall pregnant.
When would be the right time to seek help, it depends on age.
1) Women age under 35 years- When the couple is unable to conceive after 1 year of regular unprotected intercourse in the women less than or equal to 35 years of age.
2) Women age > 35 years- Couple should visit within 6 months of regular unprotected intercourse.
Fertility Assessment
A Fertility Assessment is the first step towards getting a clear understanding of what tests may need to be undertaken, whether you can keep trying to conceive naturally or if you need further assistance.
Female Infertility
According to the American Society for Reproductive Medicine (ASRM), women under age 35, who have been trying to get pregnant for twelve months or more without success, are strongly encouraged to see a reproductive specialist. ASRM recommends women over 35 see a specialists after 6-months of trying without success.
Various factors related to female infertility are mentioning below
1)Age
When it comes to overcoming infertility, age is the biggest barrier at oursuccess path. With advance age the first challenge would be eggcount. For example , at birth if she will have nearly one millioneggs, by the time she’s in her early thirties, her pool of eggs hasdecreased substantially to less than half that.
2)Ovulation Problem
Anovulation is the absence of ovulation. Irregular and unreliable ovulation can lead to irregular cycles. A common cause of irregular ovulation is PCOS. There are range of treatment available for anovulation like ovulation induction drugs and natural intercourse, or IVF.
3)PCOS
PCOS is the most common endocrinopathy affecting reproductive aged women. The incidence varies from 8- 10 %. PCOS accounting for 80-90 percent of women suffering from menstrual order. It is well recognized that PCOS is not necessarily a disease but rather a cluster of features.
4)Fibroid Uterus
Uterine fibroids are the commonest benign growth occurring in women of reproductive age. The incidence of fibroid in reproductive age women is 20-50 percent. Almost 5-10 percent of women with infertility will have fibroids. The impact of fibroids and their management.
5)Poor Ovarian Reserve
Age-related decrease fertility has become an increasing challenge for infertility patients. Chances of natural conception as well as success of any fertility treatment (IUI/IVF) decrease dramatically with increasing age due to exhaustion of pool of ovarian follicle.
6)Endometriosis
Endometriosis affect one in 10 women of reproductive age group worldwide. Endometriosis is a long term, recurrent , and debilitating disease. Endometriosis is a condition in which the same cells as in the endometrium ( lining of womb) grow outside of the womb, most commonly.
7)Tubal Factor
The fallopian tubes are the place for meeting of sperm and egg. If any pathology is there it will impact your chances of getting pregnant. Tubal disease contributes to 25-35 % of female infertility. The main cause for tubal infertility is inflammation of tubes.
Understanding Female Menstrual Cycle
For the couples who are trying for pregnancy, one of the first things you should do is ensure you understand the menstrual cycle.
The menstrual cycle is divided into 3 phases-
1) Follicular phase- maturing the egg. ( day 1-13 )
2) Ovulatory phase- releasing the egg. ( approx. day -14 )
3) Luteal phase- preparing for conception. ( day 15- 28 )
• Ovarian follicles can be thought of as tiny little cases in the ovaries that hold immature eggs. Many of the two million eggs women are born with are reabsorbed by the body during childhood, so by the time of puberty, women are left with around 400,000 to 500,000 eggs.
• Women has taken birth with fixed number of eggs, they need to finish there reproductive cycle with those available eggs only, before they get depleted. At Menopause women is left with around 1000 eggs.
• Hormones trigger follicles to grow during the follicular phase.
• In a natural cycle, normally only one dominant follicle goes on to mature fully and release an egg.
Male Infertility
• Male infertility is real and it is more common than you might think.
• In about 30% to 40% of cases where couples have trouble conceiving, the problem lies with the man – the quality or quantity of sperm.
• A male factor is solely responsible in approximately 20 % of infertile couples.
• At a minimum, the initial screening evaluation of the male partner of infertile couple should include at least one semen analysis.
Evaluation of Male Infertility
Semen analysis is the most important and minimum initial screening test for male infertility. SA will record the most important factors below on the basis of WHO 2010 criteria and determine whether an ejaculation sample is normal or abnormal.
1. Sperm count- minimum 15 million/ ml is normal. If it is below that, chances of conception is significantly reduced.
2. Motility- Total motility should be minimum 40 % , progressive motility should be minimum 32 %.
3. Morphology- minimum 4 %
Tips for Improving Sperm Health
• Stop smoking. In men who smoke, all parameters of sperm quality are reduced.
• Reduce obesity. In men a BMI < 20 or >25 kg/m2 is associated with reduced sperm quality.
• Avoid alcohol
• Warm temperatures might affect the testis ability to make sperm. Avoid prolonged steaming, hot water swimming pool bath or hot water shower for long time and putting a laptop on your lap.
• Avoid tight underwear. Mostly should use cotton underwear.
• Regular ejaculation helps increase the quality of sperm.
Treatment of Male Infertility
Various treatment modalities are there, depends on the severity of disease. Couple may require IUI , IVF , TESA or medical management.
Spectrum of Male Infertility
• Abnormal semen parameter.( Low count/low motility/low morphology )
• Obstruction lead to azoospermia.
• Absent sperm production
• Varicocoele.
• Sexual problems
• Immunological causes
• Endocrine and other causes
