Infertility is defined as the inability to
conceive after one year of sexual life without contraception. It is
also known as Sterility. There are many hormonal causes of
infertility that could be in the male or female. These causes may
be due to lifestyle, food and diet. In 10% of the cases of
infertility, no obvious abnormality can be found to explain its
occurrence. Infertility tends to be very traumatic on the couple in
general, and the affected individual, in particular. He / she often
experiences a deep sense of inadequacy.
Allopathic treatments for
female Infertility include Clomiphine citrate, Human menopausal
gonadotrophin (HMG), Gonadotrophin releasing hormone (GnRH),
Bromocryptine and Corticosteroids and male infertility include
clomiphene. However these Allopathic treatments do not cure
Infertility. They are merely a way of suppressing
symptoms.
Types
of Infertility
Infertility may be
classified as:
a) Primary Infertility where
conception has never occurred.
b) Secondary (acquired)
Infertility where conception has failed to occur after a period of
fertility.
The following factors may
interfere in the process of fertility:
A]
Physiological:
Infertility exists naturally
before puberty, after menopause, during pregnancy and sometimes
during lactation.
B]
Pathological:
- Faulty male factors in
one fourth of the cases
- Faulty female factors in
half of the cases
- Faulty male & female
factors in the remaining one fourth of cases
In 10% of cases, no obvious
abnormality can be found to explain infertility. This is
unexplained infertility.
Causes of
Infertility
Any number of the following
male or female factors may be responsible for
infertility:
1. Male
Factors:
Age above 45yrs, obesity,
fatigue, heavy smoking, alcoholism, nervous tension about sex and
psychiatric illness can affect
fertility.
Some diseases such as
hypothyroidism, diabetes mellitus and hypothalamic pituitary
dysfunction lead to infertility.
Some males produce
antibodies against their own sperm due to conditions such as
orchitis and vas obstruction, leading to
infertility.
Ignorance about sex - no
consummation of marriage, poor frequency of sexual intercourse,
severe phimosis and hydrocele also lead to
infertility.
Defect in sperm production
due to undescended testes, hypospadias, klinefelter syndrome, small
pox, mumps, varicocele (enlarged testicular veins), and huge
hydrocele also lead to infertility.
Impaired sperm function due
to urethritis, vas ligation leads to
infertility.
2. Female
Factors:
Age above 35yrs, obesity,
fear of sex, marital disharmony can lead to
infertility.
Disorders such as thyroid
disorders, hormonal amenorrhea, irregular menstrual bleeding,
polycystic ovarian disease cause infertility through
anovulation.
Narrow vaginal introitus
(opening), spasms of the vagina, vaginitis, and escape of semen
after coitus can also lead to
infertility.
Intracervical obstruction,
cervical scarring, cervicitis and cervical polyp lead to
infertility.
Uterine tumors can lead to
infertility. Tubal occlusions or peritubal adhesions caused by
pyogenic tuberculosis, chlamydia and appendicitis can lead to
infertility.
Hyperprolactinaemia,
oophoritis, cysts, ovarian tumors, premature ovarian failure, and
unruptured follicles can lead to
infertility.
Diagnosis of
Infertility
It is diagnosed by the
gynecologist when:
a) Women below 25 yrs (above
18yrs) are unable to conceive after two years of normal sexual life
without contraception.
b) Women from 25 to 35 yrs
are unable to conceive after one year of sexual life without
contraception.
c) Women above 35 yrs are
unable to conceive after one year of sexual life without
contraception.
Normally, about 90% of women
conceive within 18 months of regular sexual activity, without
contraception.
A patient is investigated
for infertility the following ways:
- For women, the history of menstrual cycles,
previous pregnancies and systemic diseases is noted. A total health
check-up and genital tract check-up is carried out to evaluate any
abnormalities.
- In men, the history of sexual function, coital
frequency, smoking, addiction and systemic disease is noted. A
total health check-up is done to identify any
abnormalities.
- If both are found to be normal, a semen analysis
is advised.
- If the semen analysis report is normal, the
couple's hemoglobin, blood group, VDRL, post-lunch blood glucose
and urine analyses are conducted.
- If the above laboratory investigations are
normal, cervical dilatation & curettage (D&C) may be
performed between the 18th and 21st day of the menstrual cycle and
the endometrial tissue (inner layer of uterus) is sent to the
laboratory for histology.
- If the D&C report is normal,
hysterosalpingography (HSG) (a radiological procedure) is done to
test the patency of the fallopian tubes.
- If the tubes are patent, an ovulation test is
done, by checking the basal body temperature. If ovulation takes
place, the fern test, thread test and post-coital test (PCT) are
done to rule out cervical factors as causes of
infertility.
- If HSG findings are abnormal, laparoscopy dye
test is done.
- If there are menstrual abnormalities, then,
thyroid profile, prolactin and testosterone levels in the blood are
checked.
- For low sperm count, testicular biopsy is done.
The man is carefully evaluated for varicocele in cases of low sperm
count.
- Plasma hormones like FSH, LH, prolactin, TSH and
testosterone are tested in male endocrine studies to rule out
Klinefelter syndrome, Sertoli cell only syndrome, hypothyroidism,
and acromegaly.
- Sperm mucus slide test is done on normal
sperm-count samples, where immunological cervical factors are
suspected.
