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What is infertility?

Infertility is the inability to get pregnant after a year of regular sexual intercourse without contraception. Approximately 15% of couples worldwide experience infertility. Contrary to popular belief, infertility is not only a women's problem. Men also have infertility problems. Most cases of infertility can be treated with medical intervention. There are 2 types of infertility:

  • Primary infertility defines the failure of achieving pregnancy after 1 year of regular unprotected sex
  • Secondary infertility defines the case where a couple becomes pregnant once but is unable to get pregnant again.

What are the Causes & Risk Factors?

Both men and women are affected by infertility. In order to get pregnant, all steps starting from ovulation to fertilization of egg should happen correctly.

Male Infertility

Semen analysis in men explains about the sperm counts, movement, and shape that determine the ability to fertilise women. The following are the common causes of male infertility:

• Disruption of Ejaculatory function

Overheat in the testicles occurs because a varicose vein in the scrotum become enlarged. It may affect the sperm concentration and shape. The sperm produced in the testicles, ejaculates a low number of sperms and sometimes seminal fluid is not enough for sperm to swim. The abnormal shape also makes it impossible to travel fast and reach the egg.

• Medical conditions

Medical conditions such as diabetes, cystic fibrosis, testicular infection, cancer, and certain types of autoimmune disorders may cause testicular failure.

• Damaged sperm Production

Cancer treatment involving the use of chemotherapy, radiation, or surgery can impair sperm production. Radiation therapy has a risk to remove one or both testicles.

• Hormonal disorders such as, improper function of the hypothalamus or pituitary glands impair the functioning of the production of testosterone hormones that maintain normal testicular function.

• The problem in the delivery of sperm occurs due to blockage in the testicle or damage or injury to the reproductive organs. It can create sexual problems.

• Hypospadias creates abnormality in the urethral opening and makes it harder for sperm to reach to female's cervix.

• Overexposure to certain environmental toxins, pesticides, herbicides, certain chemicals, radiation, and overheat raise body temperature and impact fertility.

• The use of certain medications and supplements such as anti-inflammatory drugs, long-term use of anabolic steroids, marijuana, cocaine, smoking, and illicit drugs reduces sperm counts and mobility.

Female Fertility

Conditions affecting the functioning of ovaries, fallopian tubes, and uterus contribute to female infertility. Causes of female fertility included:

• Hormonal disorders such as more production of prolactin may disrupt the release of eggs monthly. Overproduction/underproduction of thyroid hormone affects the menstrual cycle and creates a hormonal imbalance.

• Polycystic ovary syndrome creates irregularity in ovaries functioning. PCOS is the most common cause of ovulation disorders.

• Women with a diminished ovarian reserve may be able to conceive naturally after a certain age even the production of eggs is declined due to ovaries inefficiency. So, diminished ovarian reserve might be a problem for women above 35 years of age.

• Fallopian tube obstruction and blockage often occur by inflammation of the fallopian tube (salpingitis). It prevents the egg from traveling from the ovary to the uterus. Benign or non-cancerous tumors in the muscular wall of the uterus, interfere and block the fallopian tube and prevent sperm to fertilize an egg.

• Functional hypothalamic amenorrhea (FHA) causes the women not to ovulate normally. Excessive exercise, weight loss, stress, and eating disorders cerate FHA conditions.

• Premature ovarian inefficiency may occur due to chemotherapy, pelvic radiation therapy, or certain medical treatment.

• Early menopause, before the age of 40 years, also stops the functioning of ovaries. Immune system diseases or certain genetic conditions may contribute to early menopause.

• Pelvic surgery and ruptured appendicitis can create scarring and damaged tissue to block the fallopian tube.

• Chemotherapy, radiation therapy, illegal drugs, steroids, marijuana, or cocaine can result in ovarian failure and affect fertility.

What are the risk factors for male and female fertility?

  • Increased age of men and women above 40 years
  • Smoking tobacco or marijuana
  • Excessive alcohol use
  • Being overweight or underweight
  • Excessive physical and emotional stress
  • Sexually transmitted infection or pelvic inflammatory disease

What are the Symptoms?

The main symptom is, if pregnancy does not happen after regular intercourse with unprotected sex. Irregular or absent menstrual periods also cause a lack of ovulation. Some health problem also risks the increase of fertility. A woman age 35 years or older and didn't conceive should see a health care provider.

How is it diagnosed?

A doctor starts with a preliminary assessment of medical and sexual history from both partners.

In Women

  • Ultrasound is done to evaluate the structure and ovarian disease of the uterus, tubes, ovaries, and pelvic. It also detects uterine abnormalities, fibroids, polyps, cysts, fallopian tube obstruction, and ovarian abnormalities.
  • Blood test assess the proper hormone levels
  • X-ray contrast is injected with dye into your uterus to evaluate the condition of the uterus and fallopian tube and look for blockages or other problems.
  • Laparoscopy examines fallopian tubes, ovaries, and uterus and identifies endometriosis, scarring, blockages, or irregularities of the fallopian tubes, ovaries, and uterus.
  • Laboratory testing is done to determine a woman's potential for conceiving. It tests FSH levels and thyroid function to check hormonal imbalance.

In Men

  • Semen analysis is done to check sperm concentration, quality, mobility, or any infection.
  • A biopsy is done for testicles to identify abnormalities contributing to infertility.
  • Blood tests are done to test the levels of testosterone and other hormones.
  • Ultrasound tests give the clear picture of any ejaculatory duct obstruction or retrograde ejaculation.
  • Genetic testing is done to determine any genetic defects.

How is it treated?

Infertility can be treated with medicines, surgery, or artificial reproductive methods.

Infertility treatment in Men

  • When sperm ejaculation is a problem or sperm counts are low, semen is ejaculated in the laboratory and then it is washed with a safe solution and placed into the uterine cavity of a woman by inserting a catheter.
  • Surgery fixes obstructions and allows ejaculation. If there is any complication, sperms are retrieved directly from the testicles by using ART (assisted reproductive technology) treatments.
  • Medications are used to treat hormonal imbalances, erectile dysfunction or any infection.
  • Vitro fertilization (IVF) is a process where egg and sperm are fertilized outside the body and then transfer the embryo directly into the uterus.

Infertility treatment for women

  • Intrauterine insemination (IUI) is used to insert the sperm directly into the uterus at the same time when the ovaries release eggs.
  • IVF treatment to fertilize the egg in the laboratory and then place the embryo into the uterus.
  • Surgery is least recommended option & is used to restore fertility by correcting abnormally shaped uterus, unblocking the fallopian tube, treating the uterine septum, or removing fibroids.
  • Intracytoplasmic sperm injection (ICSI) is used when the prior IVF cycles are failed. When the semen quality is poor, a single healthy sperm is injected directly into the mature egg.
  • Fertility drugs regulate and stimulate ovulation.

Kokilaben Dhirubhai Ambani Hospital

Address: Rao Saheb, Achutrao Patwardhan Marg, Four Bungalows, Andheri West, Mumbai, Maharashtra 400053

Phone: +91-98 88 66 22 00

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