The inability to achieve or conceive a successful pregnancy in couples, after regular unprotected intercourse for six months for those who are over 35 or for those under the age of 35, is termed as ‘Infertility.’ This emotionally challenging and complex condition impacts the ability of couples to build and grow their families as they desire.
Infertility affects millions of couples and individuals, more than is often realized. It is not limited to a specific demographic or age group. Approximately 17.5% of adults globally face infertility challenges. As of April 4, 2023, the World Health Organization (WHO) reports that 1 in 6 people worldwide is affected by infertility, underscoring the urgent need to improve accessibility to affordable and high-quality fertility care for those requiring assistanc
Infertility can occur in both males and females. Various factors contribute to female infertility, including issues with the fallopian tubes, ovulatory disorders, age-related declines in fertility, and abnormalities in the uterus.
Sperm-related problems, hormonal imbalances, lifestyle factors, environmental influences, and anatomical issues may contribute to male infertility. Thorough evaluation and treatment are essential to effectively address the main causative factors.
Ovulatory disorders mostly cause female infertility. These conditions affect the normal pattern of egg release from the ovaries. Disorders like hypothalamic dysfunction and Polycystic Ovary Syndrome (PCOS) can destroy the ovulation process, ultimately making it problematic to conceive.
Fertilization can be hindered by issues related to fallopian tubes. Scarring or blockages in the fallopian tubes prevent the egg and sperm from meeting, conditions such as endometriosis, and pelvic inflammatory disease (PID) can contribute to these challenges.
Uterine and Cervical Factors
Implantation can be affected by the interference of polyps, uterine fibroids, and abnormalities. The health of the cervix and uterus is considered essential for fertility. Cervical factors, including mucus abnormalities and narrowing of cervix (cervical stenosis), can influence fertility as cervical mucus plays an essential role in sperm transport.
As women age, there is a natural decline in fertility. Conceiving becomes more challenging due to a reduction in the quality and quantity of eggs. Advanced maternal age increases the likelihood of chromosomal abnormalities, raising the risk of birth defects or miscarriage.
A comprehensive medical history and thorough evaluation are crucial steps in diagnosing infertility. Healthcare providers gather information about medical conditions, previous pregnancies, menstrual cycles, and lifestyle factors through a detailed history of both partners. This evaluation helps identify potential causes, paving the way for the next steps in the diagnosis process.
Several tests and procedures are commonly used to diagnose the causes of infertility in females:
The regulation of ovulation and menstrual cycles can be monitored by ovulation predictor kits, basal body temperature charting, and blood tests that determine the levels of hormones like FSH and LH.
Hysterosalpingography (HSG) detects the blockages and abnormalities. This X-ray procedure involves the injection of a particular contrast dye into the fallopian tubes and uterus.
The condition of the follicles, uterus, and ovaries can be assessed by transvaginal ultrasound.
Laparoscopy is a minimally invasive surgical procedure. It involves the use of a laparoscope, a thin, flexible tube equipped with a light and camera. During laparoscopy, the laparoscope is inserted through small incisions in the abdominal wall, allowing surgeons to view and examine the organs in the abdominal and pelvic cavities. It allows the identification of problems, including adhesions, ovarian cysts, and endometriosis.
Hormonal imbalances can be uncovered with the help of blood tests. These tests assess thyroid levels, prolactin, and sex hormones like progesterone and oestrogen.
The quantity of remaining eggs in women can be identified by antral follicle count and anti-Mullerian hormone (AHM) tests.
The lining of the uterus may affect implantation. Evaluation of any potential issues of the lining of the uterus can be made possible by an endometrial biopsy.
Some genetic disorders affect fertility. Genetic testing is recommended if repeated miscarriages are occurring.
Examination of the cervical mucus helps to determine if it is facilitative to sperm transport or not.
These procedures and tests enable the healthcare providers to suggest appropriate recommendations and treatment plans for every individual or couple.
Treatment options are utilized to address the potential and specific causes identified during diagnosis. Some of these treatment options are described as follows
Medications like gonadotrophins and clomiphene are used for ovulation induction. These medications encourage the release of eggs by stimulating the ovaries. Women with ovulatory disorders should opt for these medicines as they increase the chances of conception.
Intrauterine insemination is mainly used in cases where problems in cervical mucus quality or sperm motility are reported. This procedure involves the processing of sperm and its direct placement into the uterus.
IVF is used for several causes of infertility, like endometriosis, blocked fallopian tubes, or unexplained infertility. It is a very effective treatment option, involving the retrieval of women’s eggs, fertilisation with sperm in the laboratory, and implantation of resulting embryos into the uterus.
Some females may benefit from surgical interventions. Laparoscopy is one of the surgical interventions that improves fertility in conditions like blocked fallopian tubes, ovarian cysts, or endometriosis.
To overcome infertility, some advanced procedures like Assisted reproductive technology (ART) are employed. These procedures are primarily used in cases where other treatments have shown no success. Some of the primary ART procedures include:
ICSI is a technique in which a single sperm is injected directly into an egg. This facilitates fertilisation. ICSI is used when previous IVF efforts or in cases of severe male infertility.
GIFT allows fertilisation to occur within the body. It involves the transfer of eggs and sperm into the fallopian tubes. It is not used commonly but may be recommended for special cases.
ZIFT involves the transfer of fertilised embryos into the fallopian tubes. It is considered a variation in GIFT and is used in cases when multiple IVF cycles do not result in pregnancy or when IVF is not suitable.
It is emotionally challenging to deal with infertility. Access to mental health professionals, support groups, and supportive counselling can help to provide emotional support throughout the fertility treatment. It helps couples and individuals navigate the psychological features of infertility, helping to maintain the well-being of the patients.
Infertility affects couples and individuals worldwide, presenting as an emotionally challenging and complex condition. It’s crucial to remember that infertility can result from various factors, ranging from ovulatory problems to age-related issues, impacting both females and males
Seeking proper guidance from healthcare providers and fertility specialists is crucial when facing infertility. They can perform essential tests, offer expert advice, and recommend treatment plans tailored to address specific infertility cases. This ensures that individuals and couples receive appropriate guidance and care on their journey to parenthood.
There is no doubt in the fact that infertility is a challenging journey. Hope and courage are essential throughout the treatment of infertility. Advances in technology, medical science, and proper counselling are essential to remain optimistic. By using and following healthcare providers’ recommendations, many individuals and couples achieve their dream of becoming parents. Always remember that you are not alone in this journey, your healthcare team and many resources are available to support you to achieve parenthood.
Choosing the right pathway to parenthood is often complex. Our fertility experts are dedicated to help you explore all available avenues in a transparent, unbiased, and evidence-based approach to identify the treatment that most suit your needs.
We provide flexible virtual consultations to help patients explore their preferred treatment options, gain a specialist opinion, and offer continious support.