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| What
is Infertility |
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| Infertility
implies apparent failure of a couple to conceive. To
be issueless is a serious social problem which is a
cause of a great mental stress. A couple is labelled
as infertile when the female fails to conceive even after
one year of unprotected intercourse with her male partner.
The causes of infertility are :- |
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- 10 % in both
male and female
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| The
number of infertile females in the world is approximately
100 millions with an incidence of 10-15 %. |
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| Causes
Of Infertility |
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| There
are innumerable causes which need meticulous and systematic
investigation. |
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| Causes
In Male |
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| 1.
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Semen : The number, morphology and motility of
sperms is not adequate. This can be due to stress,
addiction to tobacco, alcohol and other drugs,
mumps,
hormonal
disturbances, hypothyroidism, diabetes, obesity, advancing
age etc. |
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2. Inability to deposit the semen into vagina due to
defects in penis, premature ejaculation etc. 1 to 2 %
couples are found to have unconsummated marriage. |
| 3. Infrequent coitus or no coitus during fertile phase. |
| 4. Use of lubricants during coitus. |
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| Causes
In Female |
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| 1.
Congenital absence of vagina or uterus and/ or hypo plastic
uterus. |
| 2.
Ovarian insufficiency which means eggs do not form properly.
It is responsible for 30-40 % of female infertility
. This happens due to disturbance of hormones. This
is manifested as disturbed or no menstruation, growth
of hair on face, milk like secretions from breasts etc. |
| 3.
Blocked fallopian tubes. This represents 15-20 % cases.
This can result from T.B., venereal diseases and inflammation
of uterine lining following infection. |
| 4.
Defects in Uterus : Small size, divided uterus with
septa, presence of fibroids in uterus etc. |
| 5.
Defects In Vagina:- Vaginal inflammation, presence of
septa, imperforated hymen and presence of tumors. |
| 6.
Defects in cervix or mouth of uterus : Its position,
presence of growth, hostile mucus etc. |
| 7.
Immunological factors :- Presence of anti sperm antibodies
in semen or in cervical mucus. |
| 8.
Peritoneal Factors. |
| 9.
Genetic and unknown causes. |
| 10.
Other related factors :- Anxiety, Obesity, Addiction
to drugs etc. |
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| EVALUATION
OF INFERTILITY : |
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| It
includes history, examination and certain tests. It
is very important to find the cause of infertility so
that a successful treatment is carried out. Hence both
male and female partners have to be investigated. The
husband and wife should be questioned separately so
as to give any confidential secrets and then together.
They should be asked regarding age, active married life,
previous marriages, frequency and timing of coitus,
sexual dysfunction, menstruation, use of drugs and any
addiction. |
| Both
partners should be thoroughly examined. In the female,
after general physical and abdominal examination, vaginal
examination should be done to assess vagina, cervix,
uterus and any enlargement or fixation of appendages.
Many times only a minor defect is there which can be
easily corrected . Investigation is done on following
lines :- |
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| Tests
for the Male |
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| 1.
Semen analysis : it should be done after 2-3 days of
abstinence of sex. It includes sperm count, morphology,
motility, presence of infection etc. |
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| 2.
Hormonal assays. |
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| Tests
For Female |
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| 1.
Blood tests for hormones. |
| 2.
Testing the lining of uterus prior to/ during menstruation. |
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3. Uterus examination by Ultrasonography/ Hysteroscopy. |
| 4.
Examination of ovaries, fallopian tubes and peritoneum
by laparoscopy. |
| 5.
T.V.S Sonography for ovulation monitoring. |
| 6.
Testing the fallopian tubes - Hystero Salpingography |
| 7.
Evaluation of cervical mucus. |
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| Advice
To Couple |
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| Personal
life of the couple should be full of love and free from
stress and worry. If any one is suffering from high
B.P., diabetes and V.D. etc., it should be treated The
couple should avoid use of all addiction. The
weight should be under control. Aim should be to produce
the baby soon after marriage. The fertility reduces
with advancing age. Couple is explained about fertile
period and advised to achieve pregnancy during that
period. For a pregnancy to occur, the following conditions
are needed :- |
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| 1.
Ovulation - Egg formation. |
| 2.
Sperm count must be adequate. |
| 3.
Intercourse during fertile phase. |
| 4.
Cervical mucus must not be hostile to sperms. |
| 5.
There must not be any obstruction to fertilization. |
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| Rationale
Of Treatment for Female :- |
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| 1.
Hormones and drugs to improve ovulation. |
| 2.
Treatment for blocked fallopian tubes. |
| 3.
Treatment for Polycystic ovaries. |
| 4.
Treatment for uterine fibroids and uterine/ cervical
polyps. |
| 5.
Diagnostic and operative laparoscopy and hysteroscopy. |
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| Treatment
Of Infertility |
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A.
Surgical Treatment :- After evaluation, the doctor
may pin point the effect. Quite often, surgical treatment
alone is enough to remove the cause of infertility and
thus eliminating the need for ART. Operative Laparoscopy
and Hysteroscopy can correct some major causes of infertility
such as endometriosis, polyps, fibroids, congenital
abnormalities, pelvic adhesions and diseases of ovaries.
Blocked fallopian tubes are also opened surgically. |
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B.
Induction of Ovulation :Ovaries are
stimulated with drugs to produce multiple eggs thereby
improving chances of fertilization. Thereafter one can
resort to natural means or artificial insemination. |
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C.
Assisted Reproductive Technologies (ART) : When
other treatments fail, only then we recommend ART whereby
a very meticulous care and highly standardized procedure
is followed. |
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| 1.
Intra Uterine Insemination (I.U.I) :- It is an
effective and first line of treatment in cases of subnormal
semen quality, hostile Cervical mucus, sexual dysfunction,
retrograde ejaculation and unexplained infertility.
In this procedure female partner is given fertility
drugs to stimulate ovaries to produce more eggs so that
chances of pregnancy improve. The IUI is usually performed
between day 12 and 15 after the onset of periods depending
on the ovulation which is determined with the help of
vaginal ultrasound. The male partner provides semen
sample two hours prior to insemination. Active sperms
are then separated by advanced semen preparation and
thereafter suspended in a special culture medium.
About half ml. of this preparation is deposited high
in uterus near the openings of fallopian tubes which
completes the process of IUI. The procedure is painless.
The patient lies down for 30 minutes before going home.
There are no physical restriction after IUI. The IUI-D
also called donor Insemination may be resorted to where
male partner has less or no sperms. |
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| 2.
IVF-ET. This is common type of Artificial Reproductive
Technique (ART). The eggs are aspirated out of the ovaries
under Ultrasonographic guidance. Sperms and eggs are
then placed together in a test tube or a petridish under
a special body like environment. After fertilization
the embryo is placed in the uterus where it grows naturally. |
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| With
the help of hormones and injections, we produce many
eggs which on maturity are taken out with a special
needle under the guidance of a Trans Vaginal Sonography
(TVS) and placed in Co2 incubator. Then good quality
sperms from male's semen are separated and placed in
Co2 incubator. After 3-4 hours a specific quantity of
sperms are placed along each egg and again placed in
Co2 incubator. After 2 or 3 days the fertilized eggs
are deposited in uterus with the help of a special catheter.
Not more than 3 embryos are transferred . If implanted,
the pregnancy will grow like in a normal woman. The
success rate, the world over about 30-35 % |
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| Other
Option Like IVF-ET |
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| a)
Gamete Intra fallopian transfer (GIFT). Here eggs and
sperms are directly placed in the fallopian tubes. |
| b)
Tubal Embryo Transfer : (ZIFT) Here fertilized eggs
are placed in the fallopian tubes. |
| c)
Donor Oocyte (eggs) and Donor Sperm :- Some women
and some men are not able to produce healthy eggs
and sperms respectively. In such case IVF-ET can be
donation of Oocyte and sperms from known or unknown
donors. Donor Insemination is also possible. |
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d)
Intra Cytoplasmic Sperm Injection. (ICSI) This method
is used where sperm count is very less. In this procedure
a single sperm is injected into the egg with the help
of a sophisticated machine called micro manipulator
which aids in fertilization. |
| e)
Assisted Hatching :- In some cases the Zona pellucida
i.e. the shell surrounding the eggs is hard and sperms
are not able to penetrate it. A hole is drilled with
laser into the shell of the egg thereby helping the
sperm to fertilize the egg. |
| f)
Micro Epididymis Sperm Aspiration (MESA) and Testicular
sperm Aspiration (TESA) are resorted to where
sperms are formed but do not find their way out in the
ejaculate |
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