Infertility - Causes And Infertility Treatment

Alternative names :- Barren; Inability to conceive; Unable to get pregnant

Infertility affects approximately 10% to 15% of all couples in the United States. About 30% to 40% of all infertility is attributed to the female, and 30% to 40% to the male; about 20% is due to a combination of male and female factors. Following extensive investigation and treatment, approximately 50% of these infertile couples achieve pregnancy. Of the 50% who
don't, 10% have no pathologic basis for infertility; the prognosis for this group becomes extremely poor if pregnancy isn't achieved within 3 years.

What causes Infertility?

The causes of female infertility may be:

• functional. Complex hormonal interactions determine the normal function of the female reproductive tract and require an intact hypothalamicpituitary-ovarian axis system that stimulates and regulates the production of hormones necessary for normal sexual development and function. Any defect or malfunction of this axis can cause infertility due to insufficient gonadotropin secretions (both luteinizing and follicle-stimulating hormones). The ovary controls, and is controlled by, the hypothalamus through a system of negative and positive feedback mediated by estrogen production. Insufficient gonadotropin levels may result from infections, tumors, or neurologic disease of the hypothalamus or pituitary gland. Hypothyroidism also impairs fertility.
• anatomic. Anatomic causes include: - ovarian factors, which are a major cause of infertility and are related to anovulation and oligoovulation (infrequent ovulation). Pregnancy or direct visualization provides irrefutable evidence of ovulation. Presumptive signs of ovulation include regular menses, cyclic changes reflected in basal body temperature readings, postovulatory progesterone levels, and
  endometrial changes due to the presence of progesterone. Absence of presumptive signs suggests anovulation. Ovarian failure, in which the ovaries produce no ova, may result from ovarian dysgenesis or premature menopause. Amenorrhea is commonly associated with ovarian failure. Oligo-ovulation may be due to a mild hormonal imbalance in gonadotropin production and regulation and may be caused by polycystic disease of the ovary or abnormalities in the adrenal or thyroid gland that adversely affect hypothalamic-pituitary function. - uterine fibroids or uterine abnormalities, which rarely cause infertility but may include a congenitally absent uterus, bicornuate or double uterus, leiomyomas, or Asherman's syndrome, in which the anterior and posterior uterine walls adhere because of scar tissue formation.
• - tubal and peritoneal factors, which are due to faulty tubal transport mechanisms and unfavorable environmental influences affecting the sperm, ova, or recently fertilized ovum. Tubal loss or impairment may occur secondary to ectopic pregnancy. Commonly, tubal and peritoneal factors result from anatomic abnormalities, such as bilateral occlusion of the tubes due to
  salpingitis (resulting from gonorrhea, tuberculosis, or puerperal sepsis), peritubal adhesions (resulting from endometriosis, pelvic inflammatory disease [PID], diverticulosis, or childhood rupture of the appendix), and uterotubal obstruction due to tubal spasm.
• - cervical factors, which may include malfunctioning cervix that produces deficient or excessively viscous mucus and is impervious to sperm, preventing entry into the uterus. In cervical infection, viscous mucus may contain spermicidal macrophages. The possible existence of cervical antibodies that immobilize sperm is also under investigation.
• psychosocial problems. Although relatively few cases of infertility can be attributed to psychosocial problems, occasionally, ovulation may stop under stress due to failure of luteinizing hormone release. The frequency of intercourse may also be related. More often, however, psychosocial problems result from, rather than cause, infertility.

Causes infertility in men

Infertility in men is often caused by problems with making sperm or getting the sperm to reach the egg. Problems with sperm may exist from birth or develop later in life due to illness or injury. Some men produce no sperm, or produce too few sperm. Lifestyle can influence the number and quality of a man's sperm. Alcohol and drugs can temporarily reduce sperm quality. Environmental toxins, including pesticides and lead, may cause some cases of infertility in men.

Signs and symptoms of Infertility

Most men with fertility problems have no signs or symptoms. Some men with hormonal problems may note a change in their voice or pattern of hair growth, enlargement of their breasts, or difficulty with sexual function. Infertility in women may be signaled by irregular menstrual periods or associated with conditions that cause pain during menstruation or intercourse.

Diagnosis information

Inability to achieve pregnancy after having regular intercourse without contraception for at least 1 year suggests infertility. (In women over age 35, many physicians use 6 months rather than 1 year as a cutoff point.)

Diagnosis requires a complete physical examination and health history, including specific questions on the patient's reproductive and sexual function. past diseases, mental state, previous surgery, types of contraception used in the past, and family history. Irregular, painless menses may indicate an ovulation. A history of PID may suggest fallopian tube blockage. Sometimes PID is silent and no history may be known.

These tests assess ovulation:

• Basal body temperature graph shows a sustained elevation in postovulation body temperature until just before onset of menses, indicating the approximate time of ovulation.
• Endometrial biopsy, done on or about day 5 after the basal body temperature rises, provides histologic evidence that ovulation has occurred.
• Progesterone blood levels, measured when they should be highest, can show a luteal phase deficiency or presumptive evidence of ovulation.

These procedures assess structural integrity of the fallopian tubes, the ovaries, and the uterus:

• Urinary ill kits, available without a prescription, can sensitively detect the LH surge about 24 hours preovulation.
• Hysterosalpingography provides radiologic evidence of tubal obstruction and abnormalities of the uterine cavity and cervix by injecting radiopaque contrast fluid through the cervix.
• Endoscopy confirms the results of bysterosalpingograpby and visualizes the endometrial cavity by bysteroscopy or explores the posterior surface of the uterus, fallopian tubes, and ovaries by culdoscopy. Laparoscopy, the final diagnostic tool, allows visualization of the abdominal and pelvic areas
• Ultrasound provides evidence of ovarian cysts and uterine fibroids.

Male-female interaction studies include:

• Postcoital test (Sims-Huhner test) examines the cervical mucus for motile sperm cells following intercourse that takes place at midcycle (as close to ovulation as possible).
• Immunologic or antibody testing detects spermicidal antibodies in the sera of the female. Further research is being conducted in this area.

Treatment of Infertility

Treatment depends on identifying the underlying abnormality or dysfunction within the hypothalamicpituitary-ovarian complex. In hyperactivity or hypoactivity of the adrenal or thyroid gland, hormone therapy is necessary; progesterone deficiency requires progesterone replacement. Anovulation necessitates treatment with clomipbene, human menopausal gonadotropins, or human chorionic gonadotropin; ovulation usually occurs several days after such administration. If mucus production decreases (an adverse effect of clomipbene), small doses of estrogen to improve the quality of cervical mucus may be given concomitantly; however, the success of this intervention remains unproven.

Surgical restoration may correct certain anatomic causes of infertility such as fallopian tube obstruction. Surgery may also be necessary to remove tumors located within or near the by pothalamus or pituitary gland. Endometriosis requires drug therapy (danazol or medroxyprogesterone, or noncyclic administration of oral contraceptives), surgical removal of areas of endometriosis, or a combination of both.

Other infertility treatment options, often controversial and involving emotional stress and financial cost, include surrogate mothering, frozen embryos. or in vitro fertilization (IVF). Due to the success rate of IVF (about 20%), it may be used instead of surgery in many cases.

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Complications

Although infertility itself does not cause physical illness, the psychological impact of infertility upon individuals or couples affected by it may be severe. Couples may encounter marital problems, as well as individual depression and anxiety.

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Special considerations

Management includes providing the infertile couple with emotional support and information about diagnostic and treatment techniques- An infertile couple may suffer loss of self esteem. They may also feel angry, guilty, or inadequate, and the diagnostic procedures for this disorder may intensify their anxiety. You can help by explaining these procedures thoroughly. Above all. encourage the patient and her partner to talk about their feelings, and listen to what they have to say with a non judgmental attitude. If the patient requires surgery, tell her what to expect postoperatively, depending on which procedure is to be performed. Some of the prevention tips includes:-

• Mumps immunization has been well demonstrated to prevent mumps and its male complication, orchitis. Immunization prevents mumps-related sterility.
• Women selecting the IUD must be willing to accept the very slight risk of infertility associated with its use. Careful consideration of this risk, weighed with the potential benefits, should be reviewed and discussed with both partners and the health care provider.
• Because infertility is frequently caused by sexually transmitted diseases, practicing safer sex behaviors may minimize the risk of future infertility. Gonorrhea and chlamydia are the two most frequent causes of STD-related infertility.