INFERTILITY

When to get help?

You may have reason to be concerned if:

• You have are less than 35 years of age and have been trying to get pregnant for at least one year
• You are over 35 years of age and have been trying to get pregnant for six months or longer
• Your menstrual cycles are either irregular or absent
• You have painful periods
• You have a known history of fertility problems
• You have a history of pelvic inflammatory disease or endometriosis
• You have had multiple miscarriages
• You have been treated for cancer with drugs and radiation

What are the causes?

The causes of infertility can be present from birth (congenital) or can be acquired as you age. Some of the causes may include:

• Problems with ovulation: Certain conditions, like polycystic ovarian syndrome and hyperprolactinemia (high amounts of prolactin, a hormone that induces the production of breast milk), can prevent your ovaries from releasing eggs.
• Damaged fallopian tubes: Fallopian tubes carry the eggs from the ovaries to the uterus. Any damage to them can affect the fertilization of the egg by the sperm. Pelvic surgeries and infections can cause formation of scar tissue that can damage your fallopian tubes.
• Abnormalities of the cervix and uterus: Abnormal mucus production in the cervix, problems with the cervical opening, abnormal shape and presence of benign tumors in the uterus can all contribute to infertility.
• Premature menopause: Mostly caused by a condition known as primary ovarian insufficiency, premature menopause occurs when menstruation stops before the age of 40. The exact cause of this condition is unknown, though various treatments for cancer and abnormalities with the immune system have been known to contribute to it.
• Adhesions: Bands of scar tissue can form in the pelvis after an infection or surgery.
• Other medical conditions: Diabetes, endometriosis, thyroid disorders, sickle cell disease or kidney diseases can affect the fertility of a woman.
• Medications: Certain medications have been known to cause temporary infertility. Stopping these medications can restore fertility in most of the cases.
• Male factor: Millions of sperm are needed in the vagina, in order for successful fertilisation of the egg in the Fallopian tube.

Who is at risk?

Your risk for infertility increases with age. You are at a greater risk if you smoke, consume excess alcohol, or are overweight, obese, or underweight.

What are infertility tests?

Infertility tests are various tests performed to identify why a pregnancy is not taking place. The tests are performed on both men and women.

When is infertility testing performed?

Before undergoing testing, your doctor will find out whether you are aware of your fertile period and are having intercourse at the opportune times. Couples who have been trying to get pregnant for 12 months and have not succeeded should be evaluated. As a woman grows older, the likelihood of her getting pregnant reduces. Women over 35 or those who suspect they have fertility issues for other reasons should be evaluated after 6 months of trying to conceive without success.

What are the tests performed for infertility?

Your doctor will review the couple’s medical history and perform a physical examination. Examination of the woman includes a pelvic examination and Pap test. A testicular examination is performed in men. Various tests are conducted to check fertility. These include blood and urine tests, sperm studies, special imaging studies and laboratory evaluation of a sample of tissue (biopsy) lining the uterus or cervix.

What are special imaging tests?

Special imaging tests are performed to obtain a detailed view of the reproductive structures, when the initial examination and testing does not reveal a clear cause for infertility. These tests include:

• Pelvic ultrasound: uses sound waves to create images of the pelvic structures such as the uterus and ovaries in women and the prostate gland in men
• Sonohysterogram: an ultrasound study of the uterus while filled with saline (salt solution) for a better image. This also allows examination of the fallopian tubes and ovaries.
• Hysterosalpingogram: An X-ray test to examine the uterus and fallopian tubes with the help of contrast dye
• Laparoscopy: insertion of an illuminated tube with a tiny camera through a small incision near your navel to access and view the reproductive structures. It can help reveal scar tissue, infection, cysts, fibroids or tumours. A sample of tissue (biopsy) may also be obtained during the procedure. Corrective procedures such as unblocking the fallopian tubes and treating endometriosis may also be performed.

How is infertility treated?

Your doctor will suggest a treatment suitable for your problem. Fertility drugs may be recommended to stimulate and regulate ovulation, in women who are infertile due to ovarian disorders. You could also be a candidate for assisted insemination, where healthy sperm is collected, concentrated, and placed directly into your uterus, when your ovary releases eggs to be fertilized. This procedure is also known as intrauterine insemination (IUI), and can be in tandem with your normal menstrual cycle or performed in conjunction with fertility drugs. Apart from these, problems with your uterus, such as intrauterine polyps or scar tissue, can be treated with surgery.

In vitro fertilization (IVF) is a type of assisted reproductive technique, which involves collecting multiple mature eggs from a woman and fertilizing them with sperm outside the body, in the lab. Once fertilized, the embryos are implanted into the uterus within three to five days.

Some of the other techniques used in IVF include intracytoplasmic sperm injection (a single healthy sperm cell is directly injected into a mature egg), assisted hatching (the outer covering of the embryo is removed to facilitate embryo implantation into the uterus), and using donor eggs or sperm. Gestational surrogates may also be considered for women for whom pregnancy poses high health risks, or for those who have a non-functional uterus.

Infertility can be due to a variety of causes, and the treatment may differ accordingly. Dealing with infertility can be difficult and can be stressful and emotional, but there is hope – about two-thirds of the couples treated for infertility conceive successfully. Your CREI Fertility Specialist will be the best person to address your concerns.