Infertility means not being able to get pregnant after one year of trying. Or, six months, if a woman is 35 years of age or older. It affects perhaps one couple in six in the reproductive age group. About one-third of infertility cases are caused by women’s problems and one third are due to the man. The other cases are caused by a mixture of male and female problems or by unknown problems(unexplained infertility).
Evaluation of infertile couples usually starts after 12 months of having unprotected sex life. The most common causes of infertility are male factor such as sperm abnormalities, female factor such as ovulation dysfunction and tubal pathology, combined male and female factors and unexplained infertility. Diagnosis of infertility covers the four critical areas which are needed to make a baby - eggs, sperm, fallopian tubes and the uterus.
Around 85% of couples conceive naturally within one year of having regular unprotected sexual intercourse. It is a matter of concern if after 12 months of unprotected sexual life if a woman is not able to conceive. It is a time to visit the physician and seek their help. The process of trying to conceive is emotional one and hence both partners need each others support. It is highly recommended that both the partners make visit to the doctor together.
The physician will initially discuss your full medical, sexual and social history. This will help them identify what may be causing fertility problems. This includes age of the female partner, children through previous pregnancy, length of time of trying to conceive, sexual habits, Medical history and symptoms, whether on any medication and lifestyle habits like smoking, taking alcohol, caffeine consumption, obesity, habit of illicit drugs and most importantly stress level.
After taking a medical, sexual and social history, the physician may carry out a physical examination of both the partners or refer you for further tests. During physical examination the doctor will check you weight for healthy body mass index (BMI),examine your pelvic area, to check for infection, lumps or tenderness, which could be an indication of fibroids, ovarian tumours, endometriosis, or pelvic inflammatory disease. In men the physical examination will include checking of testicles(to look for any lumps or deformities) and of penis(to look at its shape and structure, and for any obvious abnormalities).
After medical history and physical examination have been considered, and no conclusion has been derived at the physician may refer you to an infertility specialist for further test and investigations. In any fertility treatment commitment is required because the the procedure of investigation may take month also or longer then that also. Infertility specialist will recommend following test for both the partners.
The female partner:
To determine if the female partner has problems concerning ovulation, egg transport, fertilization or implantation, various tests may be administered based on the physician's examination and analysis. Infertility specialist or infertility clinic will recommend following test.
1. Ovulation testing. A blood test is sometimes performed to measure hormone levels to determine whether you are ovulating.
2. Hysterosalpingogram (HSG) - an x-ray of the uterine cavity and fallopian tubes using a radio graphic dye to detect structural abnormalities of the uterine cavity, fallopian tubes, as well as tubal patency.
3. Diagnostic laparoscopy - a minimally invasive surgical procedure typically performed in an outpatient day surgery setting. It permits direct visual assessment of the uterus, fallopian tubes, ovaries, and lower pelvis. It is particularly useful in diagnosing endometriosis, tubal disorders or pelvic adhesions.
4. Hysteroscopy - often done in conjunction with a laparoscopy to examine visually the interior of the uterine cavity for scar tissue, adhesions, polyps, tumors, and other abnormalities and to eliminate endometriosis.
5. Ultrasound - performed seven to nine days after ovulation to reveal the thickness of the uterine lining (the endometrium) and its response to hormonal stimulation and as well as growth of the ovarian follicles can be monitored.
6. Endometrial biopsy - used to determine if the endometrium, the lining of the uterus, has responded appropriately for implantation of the embryo. This is obtained as a tiny tissue sample from the endometrium.
7. Bad obstetric history profile – This includes the list of all tests require to find the cause in a women with multiple miscarriages.
8. Polycystic ovarian disease ( Anovulation ) profile – Women with polycystic ovaries often need help concieving. This profile includes all the tests to be done in women with anovulation.
9. Hormone testing. Hormone tests may be done to check levels of ovulatory hormones as well as thyroid and pituitary hormones.
10. Ovarian reserve testing. Testing may be done to determine the potential effectiveness of the eggs after ovulation. This approach often begins with hormone testing early in a woman's menstrual cycle.
11. Genetic testing. Genetic testing may be done to determine whether there's a genetic defect causing infertility.
The Male Partner:
Male factor problems may be related to inadequate or abnormal sperm production and delivery, anatomical problems, previous testicular injuries or hormonal imbalances. The test for male includes
1. General: Full blood count, Hepatitis B and C, HIV serology, and Chlamydia trachomatis serology
2. Semen analysis (after 72 hours of sexual abstinence): interpreted for its volume, sperm count, motility, and morphology according to the WHO reference values (Two analyses with 3 months apart at the same lab)
3. In addition to the routine analysis of morphology, motility, and concentration, some of the additional testing performed on the semen includes:
• routine semen cultures to detect infections
• pre- and post-processing to determine what to expect for IUI or IVF procedures
• testing for antisperm antibodies and for IgA, IgM, and IgG antibodies
• long-term survival studies
• detection of biochemical markers in the semen, e.g.fructose testing and also additional diagnostic testing for patients with severe male problems e.g. Hos Test.
In cases where the semen analysis is normal, treatment will focus on the work-up of the female partner only.
4. Abnormal semen analysis: An abnormal sperm analysis is repeated first for verification. This test is done to decide the treatment option for IUI or ICSI.
5. Anti Sperm antibodies: Anti-sperm antibodies are substances that attach to the surface of the sperm and may interfere with the ability of the sperm to move & penetrate the cervical mucus, or to fertilize an egg. They must be done when infertility is either unexplained, following an abnormal post coital test, or when significant sperm coagulation is noted in the initial semen analysis. If sperm antibodies are detected, sperm washing in conjunction with IUI or IVF is considered.
After all the tests and investigations are done the fertility expert will be able to diagnose the particular treatment. It may so happen that after so much of work up and sessions with the infertility clinic is done no solution is arrived at. It is a case of unexplained infertility. In that case the only option left is to go for surrogacy treatment.
With today's advanced reproductive technology, we can always find a solution to the fertility problems. Come and meet the expert in the infertility field at Rotunda - The Center For Human Reproduction. Rotunda offers the entire range of diagnostic services, all under one roof. At Rotunda, we work hand-in-hand with you to make every phase of the process -- from diagnosis to treatment-- as predictable and comfortable as possible. Together we will map out a plan to determine the cause of your infertility and an appropriate course of action. Many problems can easily be corrected with medication or surgical procedures. For couples facing more difficult challenges, our ART program ranks amongst the best in the nation. You can contact us at http://www.rotunda.co.in or at http://www.iwannagetpregnant.com/dignosticservices.shtml or http://www.rotundaivf.com or at firstname.lastname@example.org or at +91 22 2655 2000