Infertility

What is Infertility and How is it Treated? 

Infertility refers to the inability of couples to conceive despite regular unprotected sexual intercourse. There are two types of infertility:

• Primary infertility: Inability to achieve pregnancy for at least one year of unprotected intercourse.
• Secondary infertility: Inability to conceive again after a previous pregnancy.

What are the Rates of Infertility in Women and Men? 

These issues can occur in women only (40-50%), men only (30-40%), or in both partners (10-20%).

What are the Causes of Infertility in Women? 

The following problems can interfere with the natural process of pregnancy, where the egg cells travel from the fallopian tubes to the uterus and meet with male sperm for fertilization, leading to the implantation of the embryo and the continuation of pregnancy:

• Tubal blockage
• Menstrual irregularities
• Decreased ovarian reserve
• Past infections or abdominal surgeries
• Endometriosis
• Ovulation problems
• High prolactin levels
• Polycystic ovary syndrome (PCOS)
• Early menopause
• Uterine fibroids
• Pelvic adhesions
• Thyroid problems
• History of cancer and cancer treatments
• Liver and kidney diseases
• Diabetes
• Obesity
• Excessive smoking and alcohol consumption

What are the Diagnostic Methods for Female Infertility? 

In healthy couples under the age of 30 with regular sexual activity, the chance of achieving pregnancy each month is approximately 25-30%. After the age of 35, especially after 40, the likelihood of getting pregnant decreases, and the risk of miscarriage increases. Specific tests can be conducted to evaluate the causes of infertility, including:

• Ovulation tests: Hormone analysis to determine whether ovulation is occurring.
• Hysterosalpingography (HSG): Radiographic imaging of the uterus and fallopian tubes with contrast dye to assess for blockages or other abnormalities.
• Ovarian reserve testing: Hormonal tests to assess the quality and quantity of eggs, typically performed at the beginning of the menstrual cycle.
• Other hormone tests: Evaluation of pituitary and thyroid hormones, androgens, and other hormone levels.
• Pelvic ultrasound and saline-infusion sonohysterography
• Hysteroscopy: Visual examination of the uterine cavity and cervix using an illuminated endoscopic system.
• Laparoscopy: Minimally invasive surgical procedure to assess the uterus, ovaries, and fallopian tubes, and investigate the presence of endometriosis and other adhesions.

What are the Causes of Infertility in Men? 

Causes of male infertility include:

• Decreased sperm count and motility
• Structural abnormalities of sperm
• Azoospermia (absence of sperm in the semen)
• Blocked reproductive tract
• Inability of sperm to exit the body
• Hormonal causes
• Undescended testicles
• Childhood illnesses such as mumps
• Genetic disorders
• Varicocele
• Sexually transmitted infections like syphilis and gonorrhea
• Sexual dysfunction (erectile and premature ejaculation problems)
• Diabetes
• Previous cancer treatments
• Infections
• Testosterone deficiency
• Excessive smoking or alcohol consumption
• Stress

What are the Diagnostic Methods for Male Infertility?

• Semen analysis: It is performed after 3-4 days of sexual abstinence. It evaluates semen volume, sperm count, motility, and structural characteristics. In some cases, urine analysis for sperm may be conducted to assess retrograde ejaculation.
• Genetic tests
• Testicular biopsy
• Imaging techniques: Transrectal or scrotal ultrasonography, vasography, brain magnetic resonance imaging (MRI)
• Other specialized tests: Investigation of DNA abnormalities in semen.

What are the Treatment Approaches for Female Infertility? 

Many women can achieve pregnancy through treatment, but in some cases, more complex and prolonged therapies may be necessary. Some treatment methods include:

• Ovulation induction: Stimulation of egg development and release using infertility medications.
• Intrauterine insemination (IUI): Placement of healthy sperm directly into the uterus after ovulation to facilitate fertilization.
• Fertility surgery: Surgical correction of uterine polyps, intrauterine adhesions, and certain fibroids.
• Assisted reproductive techniques (ART): The most commonly used method is in vitro fertilization (IVF). Mature egg cells retrieved from the woman are fertilized with sperm in a laboratory, and the resulting embryo is transferred into the uterus."