Introduction to Infertility
Infertility means you cannot get pregnant (conceive). Primary Infertility refers to couple who have not become pregnant after at least 1 year having sex without using birth control methods.
About
Infertility is a significant social and medical problem affecting couples worldwide.
It is defined as failure to achieve pregnancy after 12 months of unprotected intercourse.
In India, approximately 15-20% of the couple are infertile.
Female factor is responsible for 40% of cases, male factor for 40% and combined for 20% infertility.
Fertility tests are the best way to know about your infertility status and can help you find the cause of it.
Types of Infertility
Primary Infertility: A couple that has never conceived.
Secondary Infertility: Infertility that occurs after previous pregnancy regardless of the outcome.
When to Test?
If under the age of 35 and trying regularly for 12 months.
If above the age of 35 years and trying regularly for 6 months.
When should one see a fertility specialist before?
- Women over age of 35yrs
- History of oligomenorrhea or amenorrhea
- Thyroid problems
- PCOS
- Erectile or ejaculatory dysfunction
- Irregular periods
- Repeated Miscarriage
- Pelvic Inflammatory Disease
- Past Ovarian/Uterine surgery
- Family history of early menopause
Evaluation
Infertility evaluation involves male partner and female partner evaluation.
In males, Semen Analysis is most common test performed.
The male partner is asked to give semen sample which will be assessed by andrologist for volume, count, motility, morphology and other parameters.
In females, detailed history is taken - Age, Marriage duration, Type of infertility, Consanguinity (Marriage amongst 1st degree relative).
Menstrual history - Regularity, flow, pain and duration of bleeding are assessed. A normal ovulating woman would bleed every 28-30 days without any pain and heavy bleeding.
Complaints - Menstrual and other complaints may point towards the cause of infertility.
Past Medical / Surgical History & Past treatment history.
Vitals - Height, Weight, BMI, Pulse, Blood pressure.
Sexual History - Frequency of intercourse, history of any erectile or ejaculatory disturbance.
Family history - History of early menopause, diabetes, hypertension, fibroids.
Tests
Male - Detailed history and Genital examination
- Semen analysis is the primary tests. Others like scrotal ultrasound, sperm DNA Fragmentation may be required case to case.
- Blood test (If required) – CBC, Sugars (FBS / PPBS), urine routine, Viral markers.
- TSH, PRL, FSH, LH, Serum Testosterone.
Female - Genital examination
- Pelvic Ultrasound is performed to assess the uterus and ovaries.
- Uterus is assessed for the endometrial lining, blood flow and any other abnormalities like fibroid, polyp, adenomyosis, etc.
- Ovaries are assessed for the follicle count which gives an estimate of the ovarian reserve and any other abnormality like ovarian cyst, endometriosis.
Blood Test
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Basic – CBC, FBS, PPBS, Urine routine, Viral markers.
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Special – TSH, PRL.
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If Required – FSH, AMH, Estradiol, Endo TB PCR.
Tubal Testing
- For natural conception, tubal patency is very important. It may need evaluation with Sonosalphingography or Hysterolaparoscopy.
Diagnostic and Corrective Surgeries
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As per the case, Diagnostic Hysterolaparoscopy, Endometriosis surgery, Fibroid surgery, Hysteroscopic surgeries may be required.
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After that, the couple is explained about normal fertility and advice given based on the reports.
Remember that your doctor will plan tests based on you and your partners situation and medical history. Thus, you and your partner may not require all of the tests, and they may be done in a different order depending from doctor to doctor.
Treatment Options
Planned Relation
- Natural cycle monitoring followed by planned relationship.
- With Ultrasonography, the growth of the follicle and endometrial response is monitored.
- Ovulation is confirmed.
- Couple is asked to have relationship around the ovulatory period.
Ovulation Induction
- Certain tablets may be given to form a good single follicle and its growth monitored on USG.
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Couple will be asked to have relationship around ovulatory period.
Ovarian Hyperstimulation
- Certain tablets and injections may be given to form more than one follicle and their growth will be monitored with USG.
- When follicles are optimally formed, injection will be given to induce ovulation.
- Couple will then be asked to have relationship around ovulation period or IUI may be done.
Intrauterine Insemination (IUI)
- Intra-uterine insemination (IUI) also known as Artificial Insemination is a process in which the washed/processed semen is placed into the uterine cavity with the help of a catheter in and around the time of ovulation (release of egg from the ovary).
- It is usually accompanied with Ovulation Induction or Hyperstimulation.
ART (Artificial Reproductive Technology)
- In couples who can’tconceive naturally due to blocked or damaged tubes, poor ovarian reserve, low sperm count or motility, one can conceive through Test tube baby treatment.
- Using women’s egg and husband’s sperm, embryo is formed in the specialized laboratory and then transferred back to the uterus at appropriate time.
- ART involves IVF, ICSI, Donation program, Freezing Program.