Generally it is thought that infertility is primarily a female problem. However, that is not true and in couples suffering from subfertility/infertility in 30% of couples the problem is in the female, in another 30% in the male (low sperm count) and in the rest 40% there are combined problems in both male and female contributing to the infertility. (Read More)
The common treatment options in the female are ovulation induction, laparoscopic surgery for mild tubal disease and endometriosis and Assisted reproductive technologies such as IUI (Intra Uterine Insemination) and IVF (In Vitro Fertilization- test tube baby). The main treatment options for male infertility are assisted reproductive treatment in the form of IUI, IVF and ICSI (Intra Cytoplasmic Sperm Injection) depending on the severity of the problem.
For the female partner
- Complete Blood Profile
- Blood group and RH type
- Rubella IgG
- Vitamin D
- HIV 1&2
- Anti Mullerian Hormone
- Transvginal Ultrasound
For the male partner
- Semen Analysis
- HIV 1&2
Post laparoscopy, the treatment options are if it is a relatively short period of subfertility and female partner age is young they can try naturally for 6 months before active treatment. If there is longer period of subfertility or female age is more, IUI-Intra Uterine Insemination or IVF-In Vitro Fertilisation is the way forward. It is better to see fertility specialist who can guide you based on your individual situation.
However, most of the subfertility issues are treatable and we are able to help more than 9 out of 10 couples who seek help for fertility issues. So the advice is to see a good fertility specialist so that the issues are sorted out.
However, endometrial biopsy is just a blind biopsy -a small piece of tissue-endometrium is taken for pathological diagnosis.
Polycystic Ovary Syndrome or PCOS is a very common issue seen in India, which usually leads to hormonal disturbances, which in turn leads to problems with egg growth and release leading to anovulation. Women with PCOS produce higher-than-normal amounts of male hormones. This hormone imbalance causes them to skip menstrual periods and makes it harder for them to get pregnant.
Age and subfertility: The fertility in women begins to drop as they grow older. Women are most fertile in their 20’s and once they are in the age range of 32-35, their fertility begins to drop. And as they grow older it becomes more difficult with the quantity and quality of fertile eggs being impacted. It is thus advisable that if you are someone in that age range seeking to start a family, you should seek out a fertility expert sooner.
Problems in the uterus or fallopian tubes can prevent the egg from traveling from the ovary to the tube where the process of fertilisation takes place and the fertilised egg reaches the womb in a few days time to develop in the womb. If the egg does not travel, it can be harder to conceive naturally.
Scarring or damage to the fallopian tubes secondary to infection and in India tuberculosis is a common cause of tubal block.
Fibroids, benign or non-cancerous tumors occur in the muscular wall of the uterus can also impair fertility.
Endometriosis is a disorder in which tissue/cells that normally lines the inside of your uterus — the endometrium — grows outside your uterus. It most commonly involves ovaries, fallopian tubes and the tissue lining the pelvis.
Unexplained Another reason could be that eggs and sperms do not mix and hence the process of fertilisation does not take place. This can be a cause of subfertility in some couples.There are some other reasons as well which present as unexplained subfertility-which is the diagnosis given when the sperm count is ok, ovulation is happening and tubes are working fine but still, the couple can’t conceive. This could be because the quality of eggs can be poor or there are issues with fertilisation process. The risk is higher in older women.
While the above-cited reasons are the most common causes of female infertility, all of these causes can be worked around if you decide to confer with a specialist sooner.
In women having ovulation problems, simple medication to facilitate egg growth and release is suggested as first step.
In women with tubal block, either laparoscopic surgery or IVF based on the sevrity of the disease is suggestd.
In women with endometriosis, in mild stages post laparoscopic surgery, trying naturally or simple treatment like IUI (Intra Uterine Insemination) is suggested as first step.In moderate to severe stages IVF-In Vitro Fertilisation is the way forward.
In women with age related fertility problems, IUI or IVF based on the age and duration of trying is suggested.
In unexplained infertility, IUI or IVF is suggested.
Though generally, it is safe to use them sometimes secondary infection can set in leading to tubal block or tubal disease which can cause secondary subfertility/infertility-medical term used when a couple can’t conceive a second child.If tubal block has set in then ART-IVF or if tubal block is mild tubal surgery can be considered.
Use of birth control pills only temporarily block the hormones leading to ovulation. After stopping pill use the hormone levels come back to normal and ovulation occurs and hence there is no long term effect of the pill to cause infertility.
Here are some of the most common causes that could be related directly to infertility in men:
Lifestyle issues such as smoking, alcohol, stress, and obesity can all have a negative influence on the sperm count.
Hormonal imbalances too can be a cause of infertility in men.
Tubal blockage – spermatic cord is a tube-like structure which carries sperm from the testis and their blockage could cause infertility. These blockages could be a result of – an infection-either a sexually transmitted infection or tuberculosis, surgery or a genetic/inherited condition.
Some infections can interfere with sperm production or sperm health or can cause scarring that blocks the passage of sperm. These include inflammation of the epididymis or some sexually transmitted infections, including gonorrhea or HIV.
Congenital or genetic causes such as Klinefelter’s syndrome (chromosomal abnormality) or genetic conditions related to deletion of genes from Y chromosome (male chromosome) may also give rise to male infertility.
Long-term use of steroids or treatments for cancer can cause impairment of sperm production leading to subfertility.
However about 40% of men with infertility present with abnormal semen analysis for idiopathic reasons and for these men no specific treatment is available and Assisted Reproductive Technologies such as IUI/IVF are the way forward.
There is no specific treatment designed to bring a low sperm count up to normal, except in the case of some hormonal abnormalities which can respond to medication such as clomiphene citrate or injections called gonadotrophins. Improving lifestyle measures may help to a certain extent only.
There are several treatment options available and how this issue is dealt with is based on circumstances and your consultations with your specialists. Intrauterine insemination or IUI is often a go-to treatment for conception, this has especially resorted when some good quality sperm is available, so highest quality sperms are selected, prepared and injected into the uterus where they are left to fertilise the eggs naturally.
Another treatment option is In Vitro Fertilisation. IVF involves creating fertilised embryos in the lab, and later being transferred into the uterus of the female partner.
Treatment with Intracytoplasmic Sperm Injection or ICSI. As a procedure, it is performed when the sperm count is very low. ICSI is a technique by which a single sperm is injected into the egg to aid the fertilisation process to make the embryo (fertilised egg). This form of treatment is suggested when the sperm count is extremely low or sperm has to be retrieved from the testes where there is no sperm in the ejaculate (azoospermia).
- In cases where there are problems related to sexual intercourse like premature ejaculation or erectile dysfunction, medication combined with counseling will be recommended.
- In case the patient has a varicocele (dilated veins in the scrotum)-in severe grade associated with pain the way forward is to get it corrected or repaired surgically. However the vast majority have only mild varicocele and in these men correction of varicocele does not increase the sperm count.
- Sometimes it is possible that a bacterial infection may be affecting the sperm count or fertility, for which antibiotics may be prescribed.
- In cases where there is influence of low hormone levels, there are hormone treatments and medications.
- In some cases, lifestyle choices can also play a role and the following actions can improve the sperm count in addition to overall health.
- Obesity or being overweight can affect the sperm count and it would help if the patient maintains a healthy lifestyle through diet and exercise.
- Sometimes it is possible that there are certain deficiencies, which can be revealed through a blood test. The solution would require the patient to include new foods or taking supplements to help restore vitamin and mineral levels.
- It is a well known fact that substance abuse needs to be avoided at all costs if you are serious about conceiving which includes heavy drinking and drug or tobacco use.
- Lifestyle choices and underlying medical conditions can affect your sperm count. Patients with low sperm count, need to see a fertility specialist, so that the couple is assessed and depending on the case, treatment options discussed.
- At Mother-To-Be fertility clinic we offer various treatment options for patients with low sperm count:
World Health Organization (WHO) results below show how a normal semen analysis result look. Since results can vary from person to person, the below results show a range which is considered normal.
|Total sperm count in ejaculate||39–928 million|
|Ejaculate volume||1.5–7.6 mL|
|Sperm concentration||15–259 million per mL|
|Total motility (progressive and non-progressive)||40–81 percent|
|Sperm morphology||4–48 percent|
|Progressive motility||32–75 percent|
However, IUI’s work when there are no blockages in the fallopian tubes with healthy sperm and eggs. And in case of irregular ovulation, experts may administer IUI with aid of some fertility drugs.
IVF is advised to bypass all the medical issues that cause infertility and in cases where there has been a blockage or damage to the fallopian tubes, with male infertility such as decreased sperm or motility and in case of genetic disorders and unexplained infertility.
Some of the factors which affect success rates of IVF is as follows
- Female age is the most important factor which influences the success rates of IVF. Success rates with IVF is high in women less than 35 years of age, however, even as the woman age, the maximum chance of conception is only after following IVF treatment compared to other treatments.
- Indications for IVF – Certain indications such as male factor, anovulation (PCOS), tubal disease and endometriosis have better rates of success with IVF compared to couples undergoing IVF due to poor ovarian reserve, unexplained subfertility, problems in both partners such as low sperm count and poor egg reserve, a prolonged period of subfertility and genital tuberculosis.
- Women with a history of previous pregnancies, either a miscarriage or ectopic or a live birth in the past seem to have better chances than others indicating successful implantation.
- Women with a good number of eggs indicating good ovarian reserve have a better chance of pregnancy compared to others.
- One of the most important factor determining the success rate of IVF is the choice of the IVF center where you choose to have treatment. Proper research with regards to the expertise of the doctor performing IVF and their credentials and training matter most. In addition, the IVF lab has to be state-of-the-art and the expertise of the scientists who perform the procedure is also equally important. Evidence-based treatments along with quality control and witnessing procedures go a long way in making the difference in pregnancy rates between an average clinic and the best one.
How long should a person diagnosed for unexplained infertility continue with the IUI and IVF cycles?
Usually 6 cycles of IUI can be tried though the success is higher in the first 3 cycles and most of the pregnancies which happen with IUI do happen in the first 3 cycles. Hence it would be advisable to discuss with your fertility doctor regarding the next step at the end of 3 cycles of IUI as to what the next step would be.
- If female is young with good egg number, laparoscopy followed by 3 more cycles can be tried prior to proceeding with IVF.
- If the female partner age is more better for IVF.
- If laparoscopy has already been performed, then the maximum is 3 cycles post laparoscopy and if doesn’t work then way forward is IVF.
With IVF in good clinics, vast majority -9 out of 10 conceive by 3 cycles of IVF.
What is the next step after clomid? I ovulated on clomid, took 200mg for 6 months but failed to get pregnant. What is next? IUI or IVF?
There are several steps in the process of IVF.
In vitro fertilization (IVF) is one of the commonly used methods of fertility treatment, which can be captured in 5 stages:
Step 1: Ovulation Induction: Egg production is stimulated with medication, tests such as ultrasound are conducted to examine the ovaries to assess the response to medication and blood test might be suggested in some patients to check hormone levels.
Step 2: Egg Retrieval: Minor surgical procedure is used to retrieve the eggs. The procedure uses ultrasound imaging to guide a hollow needle through the vaginal probe of the scanner to remove the eggs. This process is done under short anaesthesia.
Step 3: Collection of Sperms: The sperm sample is collected from the husband, required for the fertilization.
Step 4: Fertilisation Process: After securing a sperm sample, most active sperm is mixed with the egg in a special chamber and stored in an incubator to encourage fertilization. The eggs are monitored to confirm that fertilization and cell division are taking place. Once this occurs, the fertilized eggs are considered as embryos.
Step 5: Embryo Examination, Transfer and Implantation: The Last step in the process, this entails embryo examination and transference to woman’s uterus.
From Egg retrieval to fertilization, it takes three to five days. A small plastic tube placed through the cervix into the uterine cavity to transfer embryos. Once the embryo transfer process is complete one can go home and continue normal life, too much rest is not normally recommended. Most clinics and specialists have 50% success rates for IVF for one cycle, this also means that more than one cycle could be needed for successful conception.