Gynaecologic Problems: Infertility

Description

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 .

Causes

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 mumps 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 irregular menstrual periods or a lack of periods altogether (called amenorrhoea ). Simple lifestyle factors, including stress, diet, or athletic training, can also affect a woman's hormonal balance . Much less often, a hormonal imbalance can result from a serious medical problem such as a pituitary gland tumour.

A blockage of the fallopian tubes may prevent the ovum from travelling through the tubes into the uterus . Such a blockage may result from pelvic inflammatory disease , surgery for an ectopic pregnancy , or other problems, including endometriosis .

Diagnosis

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 the problem.
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 menstrual cycle .
Checks of ovulation can also be done in the doctor's office with simple blood tests for hormone levels or ultrasound tests of the ovaries. If the woman is ovulating, further testing will need to be done.

Common female tests include an hysterosalpingogram , laparoscopy and an endometrial biopsy .

Treatment

Treatment depends on the identified cause of the infertility. 80 - 90% of infertility cases are treated with drugs or surgery. Treatment options include:

• 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 gonadotropins 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):
1. The National Women's Health Information Center (NWHIC) FAQs: http://www.4woman.gov/faq/