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Maternityis the perfect concoction of love, care , nervousness; a completely different yet precious experience for any woman. A woman gets her rebirth with her child. For some women living this moment turn impossible due to infertility. Infertility refers to a condition when the female cannot conceive even after frequent and regular intercourse for an year or more due to any phys2iological or pathological conditions. It is a condition that disturbs the physical, mental and social state of a woman. The cause of infertility may lie in males too, but here we will mention about the infertility in females.
Most of the infertility causes are treatable and can be treated with medications or surgeries and in severe cases where the conservative and surgical approaches don’t work there comes the technology and assistive reproductive techniques. To land to the treatment approach detection of infertility and is cause is most important.
Here Are The Symptoms That Would Alarm You About Infertility:
Absent Menstrual Cycle
Too early (<21 days) or too late (>35 days) menstrual cycle or the excessive painful menstrual cycle
Multiple miscarriage
What Can Cause Infertility In females?
Hormonal Imbalances: Pregnancy in humans is a hormone mediated process. Starting from ova maturation to ovulation and preparing the uterus for conceiving and even the abortion is mediated by hormones. Any imbalance in the gonadal hormones involving the oestrogen, progesterone, follicle stimulating hormone, oxytocin may lead to infertility.
Ovulation Disorders: Ovulation isthe process of release of mature ova from female ovary. The ovulation disorders are most common cause of infertility:
Polycystic Ovary Syndrome
Hypothalamic Dysfunction
Premature Ovarian Failure
Hyperprolactinemia
Tubal Involvement: Damage to fallopian tubes or it’s blockagecan cause infertility , as it is the passage where ova and sperm fuse to form zygote
Fallopian tube may be too narrow to allow entry of sperm or egg.
Any infection in fallopian tube
Any surgical trauma or previous ectopic pregnancy leading to rupture of membrane.
Pelvic Inflammatory Diseases
Pelvic Tuberculosis
Uterus Involvement : Uterus is the major reproductive organ that provides the growing environment to the foetus. Any structural or pathological condition of uterus may lead to infertility.
Fibroids and uterine tumour
Endometriosis
Congenital conditions
Cervical Involvement: Block in cervix or vagina or any infection that lead to sperm death. The quality of mucous in cervix would affect the entry of sperm. Cervical cancer is a leading cause of infertility in female. Cervical stenosis is another such cause of infertility in female.
What adds the risk ?
Any abusive substance be it alcohol or any other drugs.
Smoking or environmental hazards.
Overweight can lead to hormonal imbalance.
Sexually transmitted diseases like HIV, chlamydial infection and gonorrhoea due to previous unprotected sex.
Overage women , after mid 30’s face more issues due to decrease in follicle maturation rate and improper maturation.
Infertility is a condition that affect the family along with the parents emotionally and mentally, thus with improved technology and secured guidance, live the moments of parenthood.
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Most women with PCOS grow a number of small cysts, or fluid-filled sacs, on their ovaries. The cysts are not harmful, but they can lead to an imbalance in hormone levels.
Women with PCOS may also experience menstrual cycle abnormalities, increased androgen (sex hormone) levels, excess hair growth, acne, and obesity.
In addition to the many health conditions associated with PCOS, which will be discussed in this article, PCOS is the most common cause of infertility in women – because it can prevent ovulation.
Women who can conceive with PCOS have a higher incidence of miscarriage, gestational diabetes, pregnancy-induced high blood pressure, preeclampsia, and premature delivery.
Causes
Currently, there is no known cause of PCOS. However, there are associations with excess insulin, low-grade inflammation, and genetics.
Symptoms
Apart from cysts on the ovaries, symptoms of PCOS include:
irregular menses
excess androgen levels
sleep apnea
high stress levels
high blood pressure
skin tags
infertility
acne, oily skin, and dandruff
high cholesterol and triglycerides
acanthosis nigricans, or dark patches of skin
fatigue
female pattern balding
insulin resistance
type 2 diabetes
pelvic pain
depression and anxiety
weight management difficulties including weight gain or difficulty losing weight
excessive facial and body hair growth, known as hirsutism
decreased libido
Tests and diagnosis
No single test can determine the presence of PCOS, but a doctor can diagnose the condition through medical history, a physical exam that includes a pelvic exam, and blood tests to measure hormone, cholesterol, and glucose levels.
An ultrasound may be used to look at the uterus and ovaries.
Treatment
There is no cure for PCOS, but treatment aims to manage the symptoms that affect an individual.
This will depend on whether the individual wants to become pregnant and aims to reduce the risk of secondary medical conditions, such as heart disease and diabetes.
There are several recommended treatment options, including:
Birth control pills: These can help regulate hormones and menstruation.
Diabetes medications: These help manage diabetes, if necessary.
Fertility medications: If pregnancy is desired, these include the use of clomiphene (Clomid), a combination of clomiphene and metformin, or injectable gonadotropins, such as follicle-stimulating hormone (FSH) and luteinizing hormone (LH) medications. In certain situations, letrozole (Femara) may be recommended.
Excessive hair growth may be reduced with the drug spironolactone (Aldactone) or eflornithine (Vaniqa). Finasteride (Propecia) may also be recommended, but it should not be handled by women who may become pregnant.
Anyone using spironolactone should use birth control, due to the risk of birth defects if taken while pregnant. Breast-feeding on this medication is not recommended.
Other possible options to manage hair growth is laser hair removal, electrolysis, hormonal treatments, or vitamin and mineral use.
Surgical options include:
Ovarian drilling: Tiny holes made in the ovaries can reduce the levels of androgens being produced. Oophorectomy: Surgery removes one or both ovaries. Hysterectomy: This involves removal of all or part of the uterus. Cyst aspiration: Fluid is removed from the cyst.
Pregnancy and menopause
Women who are affected by PCOS may experience the effects throughout their lifetime.
There may be an increased risk of miscarriage, gestational diabetes, preeclampsia, and preterm births.
After delivery, there is an increased risk of the newborn being placed in the neonatal intensive care unit or death before, during, or soon after birth. These complications are more common in multiple births, for example, twins or triplets.
Symptoms such as excessive hair growth and male pattern baldness can last beyond menopause and may become worse.
With aging also comes the risk of the secondary health complications related to PCOS, including heart disease.
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The spontaneous loss of a woman’s pregnancy before the 20th week that can be both physically and emotionally painful.
Miscarriage is the most common type of pregnancy loss and often occurs because the foetus isn’t developing normally. Miscarriage can also be genetically.
Symptoms of miscarriage include:-
Miscarriage are both physically and mentally painful. In some cases female can’t have next pregnancy. Some of the symptoms include:
cramps
Abdominal pain
Bleeding which turn from low to high level
Weakness which some time cause faint
Back pain
Fever
Abdominal infection
Urinal problems
Can I get pregnant after miscarriage :
Yes. At least 85% of women who have miscarriages have subsequent normal pregnancies and births. Having a miscarriage does not necessarily mean you have a fertility problem. If you’ve had two miscarriages in a row, you should stop trying to conceive, use a form of birth control , and ask your health care .
Can a Miscarriage Be Prevented?
Usually a miscarriage cannot be prevented and often occurs because the pregnancy is not normal. If a specific problem is identified with testing, then treatment options may be available. Sometimes,treatment of a mother’s illness can improve the chances for a successful pregnancy. Basically to prevent miscarriage a female should take some basic medicine that helps in building up the baby Or foetus. sure to take at least 400 mg of folic acid every day, beginning at least one to two months before conception, if possible.
Exercise regularly.
Eat healthy, well-balanced meals.
Manage stress.
Keep your weight within normal limits.
Don’t smoke and stay away from smoke.
Don’t drink alcohol
Avoid illicit drugs.
Take proper rest
Make sure you are up to date on immunizations.
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In order to extract and fertilize the eggs during IVF, doctors generally follow the same process everytime. Once fertilization has occurred, there are a few different options available for embryo transfer:
Fresh embryo transfer: Once eggs have been fertilized, they are cultured for 1-2 days. The best embryos are chosen to transfer directly to the woman’s uterus.
Frozen embryo transfer: Any healthy embryos that were not used in the first transfer can be frozen and stored for future use. These can be thawed and transferred to the uterus.
Blastocyst embryo transfer: If many healthy embryos develop after the fertilization, it is common to wait to see if the embryos develop into blastocysts. According to a study in the Indian Journal of Clinical Practice, blastocyst embryo transfer has a higher success rate than the standard embryo transfer on day 3. However, another recent study suggests that it may pose risks later in pregnancy and should not always be recommended.
Assisted hatching (AH): A study in the Reproductive Biomedicine Online found that the process of assisted hatching – weakening the outer layer of the embryo before it is transferred to the uterus – does not improve pregnancy and implantation rates in women who are having fresh embryos transferred. The researchers noted, however, that women having frozen embryos implanted do benefit from having their embryos treated in this way.
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There’s no cure for endometriosis. Treatments usually include surgery or medication. You might need to try different treatments to find what helps you feel better.
Pain medicine. Your doctor may recommend an over-the-counter pain reliever. Non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen (Advil, Motrin) or naproxen (Aleve) work for many people. If these don’t relieve your pain, ask about other options.
Some other things you can do at home may help with pain:
Take warm baths.
Put a hot water bottle or heating pad on your belly.
Exercise regularly.
Some women find that alternative therapies like acupuncture, diet changes, or homeopathy work for them. Before starting one, talk to your doctor to be sure it won’t interfere with another treatment.
Hormones. Hormonal therapy lowers the amount of estrogen your body creates and can stop your period. This helps lesions bleed less so you don’t have as much inflammation, scarring, and cyst formation. Common hormones include:
Birth control pills, patches, and vaginal rings
Gonadotropin-releasing hormone (Gn-RH) agonists and antagonists such as elagolix sodium (Orilissa) or leuprolide (Lupron)
Progestin-only contraceptives
Danazol (Danocrine)
Surgery. Your doctor might recommend surgery to take out as much of the affected tissue as possible. In some cases, surgery helps symptoms and can make you more likely to get pregnant. Your doctor might use a laparoscope or do a standard surgery that uses larger cuts. Pain sometimes comes back after surgery.
In the most severe cases, you may need a surgery called a hysterectomy to take out your ovaries, uterus, and cervix. But without them, you can’t get pregnant later.
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Endometriosis happens when the endometrium, the tissue that usually lines the inside of a woman’s uterus, grows outside it.
This tissue acts like regular uterine tissue does during your period: It will break apart and bleed at the end of the cycle. But this blood has nowhere to go. Surrounding areas may become inflamed or swollen. You might have scar tissue and lesions.
Endometriosis is most common on your ovaries.
Types of Endometriosis
There are three main types of endometriosis, based on where it is:
Superficial peritoneal lesion. This is the most common kind. You have lesions on your peritoneum, a thin film that lines your pelvic cavity.
Endometrioma (ovarian lesion). These dark, fluid-filled cysts, also called chocolate cysts, form deep in your ovaries. They don’t respond well to treatment and can damage healthy tissue.
Deeply infiltrating endometriosis. This type grows under your peritoneum and can involve organs near your uterus, such as your bowels or bladder. About 1% to 5% of women with endometriosis have it.
Endometriosis Symptoms
You might not notice any symptoms. When you have them, they can include:
Back pain during your period
Severe menstrual cramps
Pain when pooping or peeing, especially during your period
Unusual or heavy bleeding during periods
Blood in your stool or urine
Diarrhea or constipation
Painful sex
Fatigue that won’t go away
Trouble getting pregnant
Endometriosis Causes
Doctors don’t know exactly what causes endometriosis. Some experts think menstrual blood that contains endometrial cells may pass back through your fallopian tubes and into your pelvic cavity, where the cells stick to your organs. This is called retrograde menstruation.
Your genes could also play a role. If your mom or sister has endometriosis, you’re more likely to get it. Research shows that it tends to get worse from one generation to the next.
Some women with endometriosis also have immune system disorders. But doctors aren’t sure whether there’s a link.
Endometriosis Complications
Severe endometriosis pain can affect your quality of life. Some women struggle with anxiety or depression. Medical treatments and mental health care can help.
About 40% of women who have trouble getting pregnant have endometriosis. Researchers suspect that inflammation damages the sperm or egg or makes it harder for them to move. Or scar tissue might block your fallopian tubes. Surgery may boost your fertility.
Endometriosis may raise your risk of ovarian cancer or another cancer called endometriosis-associated adenocarcinoma.
Endometriosis Diagnosis
Your doctor might suspect endometriosis based on your symptoms. To confirm it, they can do tests including:
Pelvic exam . Your doctor might be able to feel cysts or scars behind your uterus.
Imaging tests. An ultrasound, a CT scan, or an MRI can make detailed pictures of your organs.
Laparoscopy. Your doctor makes a small cut in your belly and inserts a thin tube with a camera on the end (called a laparoscope). They can see where and how big lesions are. This is usually the only way to be totally certain that you have endometriosis.
Biopsy. Your doctor takes a sample of tissue, often during a laparoscopy, and a specialist looks at it under a microscope to confirm the diagnosis.
Endometriosis Stages
Doctors use the American Society of Reproductive Medicine’s four stages of endometriosis:
Stage I (minimal). You have a few small lesions but no scar tissue.
Stage II (mild). There are more lesions but no scar tissue. Less than 2 inches of your abdomen are involved.
Stage II (moderate). The lesions may be deep. You may have endometriomas and scar tissue around your ovaries or fallopian tubes.
Stage IV (severe). There are many lesions and maybe large cysts in your ovaries. You may have scar tissue around your ovaries and fallopian tubes or between your uterus and the lower part of your intestines.
The stages don’t take pain or symptoms into account. For example, stage I endometriosis can cause severe pain, but a woman who has stage IV could have no symptoms at all.
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In vitro fertilization (IVF) is a type of assistive reproductive technology (ART). It involves retrieving eggs from a woman’s ovaries and fertilizing them with sperm. This fertilized egg is known as an embryo. The embryo can then be frozen for storage or transferred to a woman’s uterus.
How Is In Vitro Fertilization Performed?
There are five steps involved in IVF:
stimulation
egg retrieval
insemination
embryo culture
transfer
Stimulation- A woman normally produces one egg during each menstrual cycle. However, IVF requires multiple eggs. Using multiple eggs increases the chances of developing a viable embryo. You’ll receive fertility drugs to increase the number of eggs your body produces. During this time, your doctor will perform regular blood tests and ultrasounds to monitor the production of eggs and to let your doctor know when to retrieve them.
Egg Retrieval- Egg retrieval is known as follicular aspiration. It’s a surgical procedure performed with anaesthesia. Your doctor will use an ultrasound wand to guide a needle through your vagina, into your ovary, and into an egg-containing follicle. The needle will suction eggs and fluid out of each follicle.
Insemination- The male partner will now need to give a semen sample. A technician will mix the sperm with the eggs in a petri dish. If that doesn’t produce embryos, your doctor may decide to use ICSI.
Embryo Culture- Your doctor will monitor the fertilized eggs to ensure that they’re dividing and developing. The embryos may undergo testing for genetic conditions at this time.
Transfer- When the embryos are big enough, they can be implanted. This normally occurs three to five days after fertilization. Implantation involves inserting a thin tube called a catheter inserted into your vagina, past your cervix, and into your uterus. Your doctor then releases the embryo into your uterus.
However ivf involves these five most important procedure and this should be done under a best doctor. If you face any problem after and before ivf you must concern to your doctor. Ignore taking the medicine without recommendations.
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Infertility refers to the condition in which a female not getting pregnant, although by having carefully timed, unprotected sex for one year.
The cause of infertility may be difficult to determine but may include inadequate levels of certain hormones in both men and women, and trouble with ovulation in women. Smoking, alcohol and drug are the major problem of infertility in both male and female. The effects of smoking on male reproductive part (sperm) and female reproductive part (ovum) are affected.
Effect of smoking on MALE :
Sperm concentration: Sperm concentration refers to the number of sperm found in a measured quantity of semen. Studies have shown a 23 percent decrease in sperm concentration in men who smoke.
Sperm motility: Sperm motility refers to the swimming capabilities of the sperm. If sperm cannot swim properly, they may have trouble reaching the egg and fertilizing it.
Sperm morphology: Sperm morphology refers to the shape of sperm. Oddly shaped sperm may not swim well enough to get to the egg and may not be able to fertilize an egg. Male smokers have fewer healthy shaped sperm than non-smokers.
Harmful toxins are found in cigarettes are frequently to blame for bad health effects. Smoking exposes men to high levels of cadmium that have been linked to decreased fertility. Heavy smoker were found to have higher levels of cadmium in their semen.
But these toxins may not be the only factor. Zinc levels may play a role. Male smokers who had lower zinc levels in their semen also had poor sperm concentration, movement, and shape.
On the other hand, in smokers who had normal semen zinc levels, there were still issues with sperm concentration, motility, and morphology, but the degree of abnormality was less.
Effect of smoking on FEMALE :-
Women who smoke do not conceive as efficiently as non-smokers. The risk for fertility problems increases with the number of cigarettes smoked daily.
Even fertility treatments such as IVF may not be able to fully overcome smoking’s effects on fertility. Female smokers need more ovary-stimulating medications during IVF
Smoking damages the genetic material in eggs and sperm, miscarriage and offspring birth- defect rates are higher among patients who smoke. Smokeless tobacco ,drugs, drinks, alcohol and other harmful products also leads to increased miscarriage rates. Women who smoke are more likely to conceive a chromosomally unhealthy pregnancy than non-smoking mothers. Ectopic pregnancies also occur more often among female smokers.
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This includes a number of special technique which assist infertile couples to have children. Some prominent technique are :-
Test tube baby programme
Gamete intra fallopian tube (GIFT)
Intra cytoplasmic sperm injection (ICSI)
Artificial insemination technique (AIT)
Test tube baby programme :- this method involves in vitro fertilization (IVF) , fertilization of male gamete and female gamete outside the body in almost similar conditions as that in the body followed by zygote Or embryo transfer.
In some women normal conception is not possible because of blocked oviducts Or spermicidal secretions in the vagina pr low sperm count of the males. These are also cases wherein women cannot produce ova or men can’t produce sperm. In such cases, ovum from females is remove surgically after hormonal stimulation of the follicle. It is then fertilized by her donor male sperm in am laboratory dish containing a nutrient broth. The zygote up to eight blastomers is then transferred into fallopian tube or embryo with more than eight blastomers is transferred into the uterus.
The entire operations is carried out under the sterilised conditions.
The baby produced by conceiving in culture dish and nursing in the uterus is called a test tube baby. A scientific term for this procedure is In vitro fertilization.
Success rate of test tube babies :- The success rate of the technique of producing test tube baby is less than 20% . To increase the chance of success, the prospective mother given fertility drug which cause many ovarian follicle to mature at same time. This release many eggs simultaneously, there by increasing the chance of success. The additional embryo are transferred to surrogate mother for competition of development. They can also be frozen for later use.
Surrogate mother : a developing embryo can be inserted in the uterus of another female, provided her hormone are in the proper phases of reproductive cycle for implantation to occur. A woman who substitute or take place of the real mother to nurse the embryo is called as surrogate mother.
Problem in producing test tube baby : the production of test tube baby involving the surrogate mother raises some ethical and legal problem such as right over child.
U. S. Government has proposed the following guidelines :-
No embryo should be left outside the mother.
Only married person should contribute egg and sperm for producing test tube baby.
Cost of embryo transplants in surrogate mother will not be funded by the Federal Government
Gamete Intra Fallopian Transfer (GIFT) :- this method is used in female who can’t produce ova but can provide suitable environment for fertilization and further development of embryo in the oviduct. In such case, ovum from the donor female is surgically removed and is them introduced into the Fallopian tube of such female. Such women then accept sperm from male during copulation.
Intra Cytoplasmic Sperm Injection (ICSI) :- it is another specialized technique to form an embryo in the laboratory in which a sperm is directly injected into the ovum placed in a nutrient broth.
Artificial insemination technique (AIT) :- this technique is used in those female where the husband either is unable to insemination the female or has very low sperm count in the ejaculates. In such case, the semen of the husband is first collected and then is artificial introduced either into the vagina or into the uterus of the female.
All the above mentioned technique require extremely high precision handling by specialized professional and expensive instrumentation.
Such facilities are presently available in all IVF centre.. This may lead to complications such as pelvic inflammatory disease PID, abortion, still birth, ectopic pregnancy, infertility or even cancer of the reproductive tract. Sexually transmitted diseases STD are a major threat to a healthy society Under such programmes., Adolescence are specially targeted to follow some principles given below :
Avoid sex with unknown partner or multiple partner
Always use condoms during coitus
If you doubt for an reproductive infection.., go to doctor immediately.
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Mohak Infertility Centre 