Infertility

The inability of women to conceive after a year of having unprotected sex either primarily or secondarily, i.e. after previous pregnancies.

When to get help?

You may have reason to be concerned if you have been trying to get pregnant for at least one year and:

  • You are in your late 30s and have been trying to get pregnant for six months or longer
  • Your menstrual cycles are either irregular or absent
  • You have painful periods and pain at intercourse
  • You have a known history of fertility problems
  • You have a history of pelvic inflammatory disease or endometriosis
  • You have had multiple miscarriages
  • You have been treated for cancer with drugs and radiation

What are the causes?

Some of the causes may include:

  • Problems with ovulation: Certain conditions, like polycystic ovarian syndrome (ovaries secrete excessive amounts of male hormone testosterone) and hyperprolactinemia (produce high amounts of prolactin, a hormone that induces the production of breast milk), can prevent your ovaries from releasing eggs.
  • Damaged fallopian tubes: Fallopian tubes carry the eggs from the ovaries to the uterus. Any damage to them can affect the fertilization of the egg by the sperm. Pelvic surgeries and infections can cause formation of scar tissue that can damage your fallopian tubes.
  • Abnormalities of the cervix and uterus: Abnormal mucus production in the cervix, problems with the cervical opening, abnormal shape and presence of benign growths in the uterus can all contribute to infertility.
  • Premature menopause: Mostly caused by a condition known as primary ovarian insufficiency, premature menopause occurs when menstruation stops before the age of 40. The exact cause of this condition is unknown, though various treatments for cancer and abnormalities with the immune system have been known to contribute to it.
  • Adhesions: Bands of scar tissue can form in the pelvis after an infection or surgery.
  • Other medical conditions: Diabetes, endometriosis, thyroid disorders, sickle cell disease or kidney diseases can affect the fertility of a woman.
  • Medications: Certain medications have been known to cause temporary infertility. Stoppage of those medications can restore fertility in most of the cases.

Who is at risk?

Your fertility decreases with age. You are at a greater risk if you smoke, consume excess alcohol, or are overweight, obese, or underweight.

Diagnosis

Female infertility can be confirmed with the following tests:

  • Blood tests measure your hormone levels and determine if you are ovulating.
  • Biopsies may be obtained to evaluate the inner lining of your uterus.
  • Ovarian reserve testing may be performed in order to determine the number and quality of eggs ready for ovulation.
  • Imaging studies such as a pelvic ultrasound or hysterosonography may be performed to obtain a detailed view of your fallopian tubes and uterus.
  • Hysterosalpingography involves obtaining an x-ray image after injecting a contrast material into your cervix which travels up to your fallopian tubes. This can help identify any blockages in your fallopian tubes.
  • Laparoscopic evaluation involves inserting a thin tube fitted with a camera through an incision in your abdomen, in order to detect any abnormalities in your reproductive organs, such as the ovaries, uterus, and fallopian tubes.

How is infertility treated?

Your doctor will suggest a treatment suitable for your problem. Fertility drugs may be recommended to stimulate and regulate ovulation, in women who are infertile due to ovarian disorders. You could also be chosen for assisted insemination, where your husband’s sperm is collected, concentrated, and placed directly into your uterus, when your ovary releases eggs to be fertilised. This procedure is also known as intrauterine insemination (IUI), and can be in tandem with your normal menstrual cycle or fertility drugs. Apart from these, problems with your uterus, such as intrauterine polyps or scar tissue, can be treated with surgery.

In vitro fertilisation (IVF) is a type of assisted reproductive technique, which involves collecting multiple mature eggs from a woman and fertilising them with sperm outside the body, in the lab. Once fertilised, the embryos are implanted into the uterus within three to five days.

Some of the other techniques used in IVF include intracytoplasmic sperm injection (a single healthy sperm cell is directly injected into a mature egg), assisted hatching (the outer covering of the embryo is removed to facilitate embryo implantation into the uterus), and using donor eggs or sperm. Gestational surrogates may also be considered for women for whom pregnancy poses high health risks, or for those who have a non-functional or absent uterus.

Conclusion

Infertility can be of a variety of causes, and the treatment may differ accordingly. Dealing with infertility can be difficult and can be stressful and emotional, but there is hope – about two-thirds of the couples treated for infertility conceive successfully. Your doctor will be the best person to address your concerns.

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