Let’s Talk about it in detail.
Infertility can be stressful situation for any couple. Around 15% of Indian population of reproductive age group is facing infertility problems. There are various factors that can lead to infertility. However, in today’s scenario, late marriages, carrier related goals, financial instability has led to rise in age related fertility problems.
What is Infertility?
According to WHO, if a couple of reproductive age group, who is not using any contraceptive, is not able to conceive after one year of regular intercourse, comes under the category of subfertility. Such couple should undergo certain fertility tests to narrow down the cause of infertility.
Infertility is divided into primary and secondary Infertility.
Primary Infertility: when a pregnancy has never been achieved by a person.
Secondary Infertility: is defined when atleast one prior pregnancy has been achieved.
If a couple’s age exceed 35 years, they should seek medical advice, if not able to conceive after 6 months of regular unprotected intercourse.
What are the causes of infertility?
Infertility can be due to female causes (45-50%), Male causes (35-40%), combined causes (20-30%) or idiopathic/unexplained causes (10-15%).
Most common Female causes of infertility:
- Ovulatory disorders: PCOS, Poor ovarian reserve, advanced age
- Fallopian tube related causes: Salpingitis, Genital TB, Hydrosalpinx, tubectomy, endometriosis, adhesion leading to kinking of tubes, etc.
- Uterine factors: Polpy, fibroid, septum, uterine malformations, synechiae, thin endometrium, adenomyosis, etc.
- Peritoneal Factors: Endometriosis, chronic pelvic inflammatory diseases
- Hormonal Disorders: Hypothyroidism, Hyperprolactinemia, Hypothalamic disorders, strenuous exercise, eating disorders, etc.
Most Common Male causes of infertility:
- Unexplained
- Varicocele
- Hypogonadism/testicular failure
- Undescended testis
- Immunological disorder
- Erectile dysfunction
- Urogenital infections
- Pituitary/ Hypothalamus related disorders
What are the various infertility treatments?
- Ovulation Induction method
- Intra-uterine insemination (IUI)
- In-Vitro fertilisation (IVF)
Ovulation Induction Method
Ovulation inducing medicines are prescribed from day 2 to day 5 of the menses. Serial trans-vaginal ultrasound is done to monitor the growth of the ovarian follicles. Alternate day intercourse is advised to the couple. Ovulation can be determined with LH kits or HCG trigger injection. Luteal support is given following ovulation for pregnancy support. The success rate of this method is around 25-30%. Usually, it is prescribed for 6 consecutive months. Therefore, time to pregnancy is delayed in this method, therefore it is advised in age, recently married couples.
Intrauterine Insemination (IUI)
In this method, the semen of the male pattern is washed and processed, and directly inseminated inside the uterine cavity. This method is done for couples with mild male factor, i.e. the semen quality is mildly reduced, cervical stenosis, unexplained infertility, PCOS patients, presence of antisperm antibody, and failed ovulation induction method. Tubal patency test showing atleast one patent tube is must before attempting IUI. The success rate of IUI is only 15-20% worldwide and it is usually recommended to undergo 3-4 consecutive cycles of IUIs. Time to pregnancy is delayed in this method also. Therefore, this method is advised in young couples.
In-vitro Fertilization (IVF)
IVF involves controlled ovarian stimulation. The woman is called on day-2 of her periods. Certain hormonal tests like Serum FSH, LH, Estradiol, Progesterone, etc., and transvaginal ultrasound (TVS) are done. The ovaries are stimulated with hormone injections for 9-12 days. Once the ovarian follicles become mature, trigger injection is given. Trigger injection is very important as it helps in detachment of oocyte (egg) from the follicular wall, and triggers the maturation of oocyte from stage 1 to stage 2 of meioses. Oocyte retrieval procedure is usually planned after 35-37 hours under anaesthesia, and the aspirated fluid is checked for oocytes inside the IVF laboratory. IVF or IVF-ICSI is done after 3-4 hours thereafter.
IVF or test tube baby has high success rate i.e. 50-60% (average), if done at right time. Thus, the couple may achieve the dream of parenthood in short period of time.
Read more: Not getting Pregnant ?
Dr Anadeep Chandi 
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