What Is infertility?
Inability to conceive (get pregnant) after one year of unprotected intercourse is clinically defined as infertility. It warrants evaluation of the couple by the fertility specialist on priority basis.
Here age is an important consideration. If age of the wife is >35 years or age of the husband is >40 years, then early evaluation and treatment is warranted, even after 6 months of trying for a pregnancy.
Who is Responsible for infertility ?
- Male (husband) – 30 %
- Female (wife) – 40 %
- Both (Husband & Wife)– 20%
- Unexplained (All tests are normal) – 10%
What are the common causes of infertility ?
- Ovulatory Dysfunction
- Fallopian Tubes blockage
- Polycystic ovarian disease
- Endometriosis
- Sperm defects – counts and motility
What are the prognostic markers in infertility?
Age – Increased age of wife or husband is associated with poor prognosis. Therefore, such couples should seek treatment early to get maximum benefit.
Duration of infertility – Longer the duration of infertility, poorer is the prognosis. So, these couples should not waste much of their time with conservative management. They can opt for assisted reproduction techniques early (IVF/ ICSI)
Obesity – Patients with higher BMI (Body mass index) have been associated with poor fertility potential. It is therefore advisable to optimize body weight, this can improve the egg and sperm quality.
Medical disorders – Underlying medical disorders like Diabetes, Hypertension, Thyroid dysfunction, Hormonal disorders, Chronic infections, and Deficiencies of vitamins etc. should be well under control before starting with fertility treatment.
What tests are done to evaluate Infertility?
Couple must undergo different kinds of tests and diagnostic procedures to evaluate their case and find the reason for infertility. This is often time consuming and requires
multiple visits at different phases of your menstrual cycle. The couple should be patient and cooperative in this entire process.
Routine screening blood tests – Blood group, Complete blood count, HIV & Hepatitis screening, Liver & kidney function test, Hemoglobinopathies screening, Rubella immunity status, Vitamin D3 and B12 levels etc.
Hormonal blood tests – Doing blood levels of certain reproductive hormones is an important part of fertility evaluation. Some of the common blood tests are – FSH, LH, Prolactin, TSH, Testosterone, Estradiol, Progesterone. They may be recommended at different phases of your menstrual cycle. AMH (Anti Mullerian Hormone) is an important marker of ovarian reserve in females.
Semen Analysis of the husband– provides information about sperms in detail like counts, motility, and morphology. The male factor infertility can be easily diagnosed by this simple test.
Ultrasound pelvis (TVS) – By doing a trans-vaginal sonography, one can diagnose abnormalities in uterus and ovaries like ovarian cysts, PCOD, endometriomas, fibroid and polyps. TVS is used for follicular monitoring in ovulation study. It is also an essential tool during treatment cycles in assisted reproduction.
Hysterosalpingography (HSG) – It is a procedure to check for patency of both fallopian tubes. It is done by your Gynaecologist where she will instill a radio-opaque dye with the help of a special cannula into the uterus. By taking X Ray films, the course of dye through both fallopian tubes followed by its spill into pelvis can be visualised. It is a painful procedure so you can ask for pain relief options from your doctor.
Laparoscopy – In few of the infertility cases, one needs to undergo a major surgical procedure called Laparoscopy (ie. putting endoscope into your abdomen to directly visualize the pelvis). The common indications for doing it are-
- Diagnostic purpose in unexplained infertility
- To remove fibroids and ovarian cysts
- To confirm that tubes are healthy and patent
- To clip the dilated unhealthy tubes before IVF
- For surgical management of endometriosis, PCOD, Adhesions.
Hysteroscopy – It is an operative procedure to visualize the uterine cavity by a special endoscope. It can be used for various purposes – For evaluating uterine cavity before IVF cycle, to diagnose and correct the septum inside uterus, to diagnose and clear the adhesions inside uterine cavity, to see signs of genital tuberculosis, to diagnose and remove polyps and fibroids inside the uterus
>Endometrial sampling – for genital tuberculosis and biopsy
Culture and sensitivity- semen, urine and endometrium Karyotyping of couple
Analysis of all the tests done will help in making the treatment plan for the infertile couple.
