Infertility and IVF
The number of couples seeking treatment for infertility issues have increased exponentially over the years. Infertility has been on the rise over the past decade due to multiple causes most of which are postulations.Now with increased awareness and better-equipped facilities for infertility treatment across the world,the accessibility and utilisation have dramatically improved making the dream of having a child within reach to many a couple.In this article,I would try to point out the most common risk factors prevelant in our society and to familiarise with the latest options of treatment.
When is the term infertility used?
A couple is said to be infertile if they are unable to conceive even after one year of frequent,unprotected sexual intercourse.
Infertility can be primary or secondary. Secondary infertility is when the couple has a previous child while in primary infertility,as the name suggests,there has been no successful conception ever.
What causes infertility?
Infertility can be due to male factor or female factor or combined factors.Whichever factor is involved has to be confirmed by series of tests before adequate treatment can be initiated.
Abnormal or low testicular function: Testicular atrophy, genetic factors, varicocele(enlargement of veins with loss of function)
Obstruction of sperm passsage: blockage in pathway, damage, premature ejaculation etc
Testicular damage: as in radiation or post-cancer treatment
Environmental risk factors: Radiation, overexposure to heat,exposure to pesticides and chemicals, smoking etc.
Ovulation disorders-this refers to the release of eggs from ovaries.This can happen in conditions like PolyCystic Ovarian Syndromes(PCOD-where there would be multiple cysts in ovary suggestive of improper ovulation and a leading cause of female infertility), thyroid disorders particularly hypothyroidism(low functioning thyroid gland) and hormonal factors.
Uterine abnormalities-as in fibroids or developmental abnormalities.
Fallopian tube disorders-especially when a woman has PID(Pelvic Inflammatory Disease) often due to recurrent infections
Endometriosis : when uterine tissue grows outside it causing functional derangements.
What are the risk factors involved?
There exists a multitude of causes and each of them becomes important.While some of them are specific to gender,others are mutually inclusive.
Age: Fertility decreases with age in both gender because the quality of sperm and eggs decrease over time
Obesity: Significantly associated with infertility in both genders,weight reduction is an important aspect in treatment for infertility.
Smoking: Associated with miscarriages in women and erectile dysfunction(inability to attain or sustain erection enough for sex) and low counts in men.
Alcohol: Similar to effect of smoking.
Overexposure to heat: Particularly of importance in men as it is associated with low sperm count.This happens to people who needs to work in environments with exposure to prolonged heat.
Varicocele: refers to the elongated testicular veins which can significantly contribute to decreased number and quality of sperm.
Recurrent urinary or genital tract infections which can lead to scarring.
Diabetes: another common risk factor which can affect fertility and the treatment in more ways than one.
What should we do if we have difficulty in conceiving?
Always ensure that you have intercourses several times around the time of ovulation where you have the maximum chances of conception.
Intercourse beginning at least five days before and until a day after ovulation improves your chances of getting pregnant.
How do I calculate my fertile period?
Ovulation usually occurs in the middle of the cycle — halfway between menstrual periods — for most women with menstrual cycles about 28 days apart.
You can make use of online calculators to find out your fertile period with fair accuracy.One such link is given below:
Visit a gynaecologist to start with as well as an andrologist(or Urologist) who would evaluate you as a couple and decide what should be the course of action.
Initally after evaluation if there are only minor issues,then your doctor might put you on basic treatment methods such as control of PCOD,hormonal treatments and surgical corrections wherever feasible.These include Laparoscopic drilling procedures for PCOD,Varicocelectomy surgeries for correction of varicocele etc. Follow up is the key top assess response.If all these trials fail,then your infertility specialist might suggest ART as the next course of action.
ART-Assisted Reproductive Technology
In simple words,ART refers to procedures that aid to achieve fertility in infertile couples.I shall discuss the various options very briefly:
1. IVF IVF stands for In-Vitro Fertilisation.IVF refers to the process by which the eggs of the woman are extracted out of the body after hormonal treatment and fusing them with the sperms of the partner in the lab under aseptic conditions.The fused resulting embryo is often transferred into the uterus(ET) afterwards. The Centers for Disease Control and Prevention (CDC) lists the success rates of IVF treatments for single attempt as:
52% for people aged 35 or younger
38.1% for people aged 35–37
23.5% for people aged 38–40
7.6% for those over the age of 40 Remember: It might take multiple cycles of IVF to attain a pregnancy in some couples and in some cases IVF may fail even after repeated attempts.
In IUI-IntraUterine Insemination-sperms that have been washed and concentrated are placed directly inside the uterus around the time of ovulation.
3. IntraFallopian transfers
Here the eggs and sperms are directly deposited into the fallopian tubes laparoscopically.This is more expensive.
4. Frozen Embryo Transfer(FET)
In FET, previously frozen and kept IVF embryos are thawed and inserted into the uterus at a later date and is found to have comparatively better pregnancy rates compared to the routine IVF and ET.
5. IntraCytoplasmic Sperm Injection (ICSI)
It is often done as an add-on procedure to IVF where,as the name implies,a sperm is directky injected into the egg to achieve maximum chances of fertility.It is more expensive however.
6.Third party ART
Here an individual donates eggs,sperms or embryos to the ART couple.Includes surrogate and gestational carriers.Another person is either inseminated with sperm or implanted with an embryo.
Some common queries in relation to infertility
Is there any method by which I can know if I am ovulating other than the calculation method,since I have irregular periods? Yes.There are certain symptoms and signs that you are ovulating.These include:
Rise in basal body temperature, typically 1/2 to 1 degree, measured by a thermometer
Higher levels of luteinizing hormone (LH), measured on a home ovulation kit
Cervical mucus, or vaginal discharge, may appear clearer, thinner, and stretchy, like raw egg whites
Slight pain or cramping on your side
Is varicocele always associated with infertiliy? No! About 25-30% of normal men can have varicoceles.Varicocele is said to be contributing to infertility only if there is evidence of infertility in semen parameters and when the testes starts becoming smaller.In such cases,varicocelectomy can offer better success rates.
Are mobile phone usages linked to infertility?
Recent evidence from several studies imply that prolonged usage and direct exposure to the radiation can have a detrimental effect on the semen parameters but the risk is more with prolonged duration of use.
Infertility is a vexing problem to many couples.Often simple measures can help in conception but if serious impairments are present,treatment should be taken if the couple is desirous of pregnancy.The success rates of ART depends on the type of ART and multiple other couple related and environmental factors.
An infertility specialist would be your best option to discuss with you the appropriate treatment course taking into account the benefits,risks and long-term outcomes.
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