|Gynaecologic Problems: Infertility|
Infertility is defined as the inability
to conceive a child despite trying for one year. The condition affects
about 5.3 million Americans, or 9 percent of the reproductive age population,
according to the American Society for Reproductive Medicine. Of the 80%
of cases with a diagnosed cause, about half are based at least partially
on male problems (referred to as male factors ),
usually that the man produces no sperm, a condition called azoospermia ,
or that he produces too few sperm, called oligospermia .
The causes of infertility are various and depend on whether the infertility
is male or female:
- Male . Lifestyle can influence the number
and quality of a man's sperm. Alcohol and
drugs , including marijuana, nicotine, and
certain medications, can temporarily reduce sperm quality. Also, environmental
toxins , including pesticides and lead, may be to blame for some
cases of infertility.
The causes of sperm production problems can exist from birth or develop
later as a result of severe medical illnesses, including
and some sexually transmitted diseases ,
or from a severe testicle injury , tumour ,
or other problem. Inability to ejaculate normally can prevent conception,
too, and can be caused by many factors, including diabetes ,
surgery of the prostate gland or urethra,
blood pressure medication , or impotence .
- Female . Female factors in infertility are
most commonly ovulation disorders. Without ovulation, eggs are not available
for fertilisation. Problems with ovulation are signalled by or a lack of periods altogether (called amenorrhoea ).
Simple lifestyle factors, including stress, diet, or athletic training,
can also affect a . Much less often, a hormonal imbalance can result
from a serious medical problem such as a tumour.
A blockage of the may prevent the
from travelling through the tubes into the .
Such a blockage may result from , surgery for an , or other problems, including .
A medical evaluation may determine whether a couple's infertility is
due to the factors mentioned above, or if another factor is the root of
For the woman, the first step in testing is to determine if she is ovulating
each month. This can be done by charting changes in morning body temperature,
by using a home ovulation test kit (an FDA-approved one in the U.S.),
or by examining cervical mucus, which undergoes a series of hormone-induced
changes throughout the .
Checks of ovulation can also be done in the doctor's office with simple
blood tests for hormone levels or
tests of the ovaries. If the woman is ovulating, further testing will
need to be done.
Common female tests include an ,
Treatment depends on the identified cause of the infertility. 80 - 90%
of infertility cases are treated with drugs or surgery. Treatment options
- The fertility drug Clomid or with another
more potent hormone stimulator, such as Pergonal ,
Metrodin , Humegon ,
or Fertinex , is often recommended for women
with ovulation problems. The benefits of each drug and the side effects,
which can be minor or serious but rare, should be discussed with the
doctor. Multiple births occur in 10 to 20 percent of births resulting
from fertility drug use.
- Other drugs, used under very limited circumstances, include Parlodel
(bromocriptine mesylate), for women with elevated levels of prolactin,
and a hormone pump that releases the
necessary for ovulation.
- If drugs aren't the answer, surgery may
be. Because major surgery is involved, operations to repair damage to
the woman's ovaries, fallopian tubes, or uterus are recommended only
if there is a good chance of restoring fertility.
- In vitro fertilisation (IVF). IVF makes
it possible to combine sperm and eggs in a laboratory for a baby that
is genetically related to one or both partners. IVF is often used when
a woman's fallopian tubes are blocked. First, medication is given to
stimulate the ovaries to produce multiple eggs. Once mature, the eggs
are suctioned from the ovaries and placed in a laboratory culture dish
with the sperm for fertilisation. The dish is then placed in an incubator.
About two days later, 3 to 5 embryos are transferred to the woman's
uterus. If the woman does not become pregnant, she may try again in
the next cycle.
- Other assisted reproductive technologies .
These include Gamete intrafallopian transfer
(GIFT). Similar to IVF, but used when the woman has at least one normal
fallopian tube. 3 to 5 eggs are placed in the fallopian tube, along
with the man's sperm, for fertilisation inside the woman's body. Zygote
intrafallopian transfer , (ZIFT; or tubal embryo transfer) is
a mixture of both IVF and GIFT. The eggs retrieved from the woman's
ovaries are fertilised in the laboratory and replaced in the fallopian
tubes rather than the uterus. Donor egg IVF .
For women who, for example, have impaired ovaries or carry a genetic
disease that can be transferred to the offspring. Eggs are donated by
another healthy woman and fertilised in the lab with the male partner's
sperm before being transferred to the female partner's uterus. Frozen
embryos . Here embryos are frozen, to be used in the future if
the woman doesn't get pregnant on the first cycle or wants another baby
in the future.
The information in this page is presented in summarised form and has been taken
from the following source(s):
The National Women's Health Information Center (NWHIC) FAQs:
(def;articles & more)