Infertility Medicine

Introduction

Infertility is the medical term used for couples who have had regular unprotected sexual intercourse for a year or more and are unable to conceive. This condition affects millions of people, including couples, their families, and society, and occurs due to health complications in either or both partners. However, there are many safe and effective treatments available that can increase the chances of pregnancy.

Types of Infertility 

• Primary Infertility: When a couple has never had a baby and is unable to conceive after one year (or six months if 35 or older) of regular, unprotected sexual intercourse.
• Secondary Infertility: When a couple is unable to conceive again after their first child. 
• Unexplained Infertility: Fertility tests reveal no reason for the inability to conceive. 

Causes of Infertility

Infertility may be caused by several factors in both male and female reproductive systems. The following steps are intrinsic to pregnancy, which will not happen if any step is broken:

• Production of reproductive hormones that control ovarian function in the brain
• The release and transfer of an egg from an ovary to the fallopian tube
• The passage of sperm through the vagina and uterus into the fallopian tube
• Fertilization of the egg by the sperm to form an embryo
• The planting of the embryo in the uterus

Causes of Female Infertility:

• Ovulation Disorders: Hormonal imbalances in the body, eating disorders, or tumors affect the release of mature eggs from the ovaries.
• Problems in the Uterus: Abnormal growths, such as uterine polyps, issues with the shape of the uterus or the cervix (lower end of the uterus), or fibroids (tumors) in the wall of the uterus, can block the fallopian tubes.
• Fallopian Tube Damage: Swelling of the fallopian tube (salpingitis) due to infection can also block the tube.
• Endometriosis: Tissue resembling the inner lining of the uterus grows outside of the uterus and affects the functioning of the ovaries, uterus, and fallopian tubes.
• Primary Ovarian Insufficiency: The ovaries stop functioning normally due to immune system diseases, genetic conditions, and chemotherapy, resulting in poor egg quality.
• Pelvic Inflammatory Disease (PID): Infection of the pelvis that forms scar tissues between the organs, leading to appendicitis, endometriosis, or surgery.
• Cancer: Cancers affecting the reproductive organs, along with radiation and chemotherapy, decrease female fertility. 
• Sexually Transmitted Diseases (STDs): STDs affect different parts of the female reproductive system, causing genital ulcer disease, vaginitis, and pelvic inflammatory disease.

Causes of Male Infertility: 

• Low sperm count or quality due to conditions like undescended testicles, genetic defects, hormone imbalances, diabetes, chlamydia, gonorrhea, mumps, HIV, and enlarged veins in the scrotum
• Obstruction in the reproductive tract because of premature ejaculation, cystic fibrosis, blockage in the testicle, or damage/ injury to the reproductive organs, blocking the sperm from reaching the female reproductive tract 
• Exposure to pesticides, chemicals, radiation, certain medicines, and heat (saunas, bathtubs) and certain medicines
• Testicular failure to produce sperm due to cancer treatments such as chemotherapy and radiation
• Poor sperm quality because of poor lifestyle choices, such as smoking, alcohol consumption, obesity, and exposure to environmental pollutants

Diagnosis of Infertility

How is female infertility diagnosed?

The diagnosis begins with the doctor collecting information about the person’s medical and sexual history and detecting issues with any of the stages in the conceiving process.

The fertility tests include:

• Pelvic examination to check for structural problems or signs of disease
• Blood work to check hormone levels
• Transvaginal ultrasound to look for issues with the reproductive system
• Hysteroscopy to examine the uterus by inserting a thin tube (hysteroscope) into the vagina 
• Saline sonohysterogram (SIS) to conduct a transvaginal ultrasound by filling the uterus with saline (sterilized salt water)
• Sono hysterosalpingogram (HSG) to check for tubal blockages by filling fallopian tubes with saline and air bubbles
• X-ray hysterosalpingogram (HSG) to capture fallopian tube blockages through an injectable dye
• Laparoscopy to identify problems like endometriosis, uterine fibroids, and scar tissue through a small tube with a camera

How is Male Infertility Diagnosed?

Diagnosing infertility in men primarily includes checking if there is healthy sperm ejaculation. 

The tests include:

• Semen analysis through needle biopsy to check sperm count and quality 
• Blood tests to check for thyroid and other hormone levels and chromosomal abnormalities
• Scrotal ultrasound to identify varicoceles or other testicular problems

Management and Treatment of Infertility

Infertility treatment depends mostly on the cause of infertility, age, and the duration of trying to get pregnant. The treatment may involve one or both partners.

Infertility Treatment for Women:

• Lifestyle modifications, including weight management, healthy habits (no smoking and alcohol), and improvement in health conditions
• Fertility medicines that lead to increased ovulation 
• Surgery that can unblock fallopian tubes and remove polyps, fibroids, or scar tissue
• Tracking ovulation through basal body temperature using a fertility tracking app
• Using a home ovulation kit to help predict ovulation

Infertility Treatment for Men:

• Medicines to increase testosterone or other hormone levels and improve erectile dysfunction 
• Surgery to eliminate any blockages in the sperm-carrying tubes or to manage any structural issues
• Varicocele surgery for enhanced sperm quality 

Common fertility treatment procedures include Assisted Reproductive Technology (ART), which involves a healthcare provider handling the sperm or egg externally to increase the chances of pregnancy.

• In-Vitro Fertilization (IVF): This process involves taking eggs from the ovary and placing them with the sperm for fertilization. After that, around three eggs are planted in the uterus.
• Intracytoplasmic Sperm Injection (ICSI): An embryologist injects a single sperm directly into each egg. Then, a healthcare provider plants one to three of the embryos into the uterus.
• Intrauterine Insemination (IUI)/Artificial Insemination: A healthcare provider uses a long, slim tube to put the sperm directly into the uterus.
• Assisted Hatching: It is a process of opening the outer layer of an embryo to place it easily in the uterine lining.
• Third-Party ART: Couples may use donor eggs, donor sperm, or donor embryos and may use a surrogate.