INFERTILITY

Probe Obstetrics & Gynecology

A Specialty Bulletin for the Specialist

INFERTILITY

Dr. Neena Singh Kumar
Gynecologic Endoscopic Surgeon

What is Infertility?

Infertility is defined as the inability to conceive after 12 months of unprotected intercourse i.e. without using any form of contraception. Infertility is termed primary, if conception has never occurred and secondary, if the patient fails to conceive after having achieved a previous conception.

What are the causes of infertility?

In one-third of all cases of infertility, the male is directly responsible; in one-third both partners are at fault and in the remaining third the causes of failure can be attributed entirely to the female. No cause may be found in 5% to 10% of cases.

In Females, it can be due to:

  • Irregular egg production of irregular ovulation
  • Tubal block
  • Problems of the uterus like fibroid uterus, congenital abnormalities, polyp and tuberculosis.
  • Diseases like:
    • Hypothyroidism
    • Diabetes Mellitus
    • Cervical factors like abnormal cervical mucus, pinhole OS, etc.

In males, it can be due to:

  • Low count of sperms
  • Low mobility of sperms with normal or low count
  • Varicocele or testicular agencies
  • Congenital absence of VAS deference or Tuberculosis of epidydimis

What is the purpose of infertility investigation?

It is important to investigate for infertility because it helps:

  • To offer an explanation for a couple’s problem
  • To furnish a basis for therapy
  • To provide a prognosis that enables the couple to make a realistic decision
  • To provide an emotional foundation for maintaining psychological well-being

What is the first step in the investigation of infertility?

The first step is to contact your doctor. Your doctor would take detailed history of male partner, your menstrual history, history of previous pregnancy, or abortion, contraceptive history and any problem of diabetes, tuberculosis or thyroid will be inquired into.

What will be the next step after taking the history?

The clinical examination of pelvis and breast will be done and investigation will be carried out, like detailed examination of husband semen, your blood and urine tests, ultrasound examination of pelvis, hormonal assarys, post coital test & tests for detection of ovulation or egg production, Hysteroscopy and Laparoscopy.

How do Hysteroscopy and Laparoscopy help?

Laparoscopy

Is a procedure of “looking inside the abdomen” with a telescope. The size, shape and surface of uterus is seen, the fallopian tubes are examined, ovaries are examined, chromoperturbation (passage of dye through the tubes) is then performed and spill is looked for,  from the fallopian tubes to ascertain that the tubes are patent.

Hysteroscopy

Is looking inside the uterus with a telescope. Four walls of the uterus are seen for any growth (fibroid/polyp), any anatomic deformities like septum, bicornuate uterus, and for tubal ostia.

If irregular ovulation is my problem, how will I be treated?

Medical treatment or treatment with drugs is the method of choice. Various drugs like clomiphene, gonadotrophins (FSH and LH or FSH alone) GnRh analogues, bromocryptine are available. If medical treatment fails, then laparoscopic ovarian drilling is opted for.

What is the role of endoscopic surgery in infertility?

Endoscopic surgery or keyhole surgery has revolutionized the treatment of infertility. Procedures like: breaking down pelvic adhesions, opening up blocked tubes, tubal repairs, draining out pus from tube or tubo-ovarian masses, ovarian drilling, removal of endometriotic cysts, removal of fibroids, incising uterine septa, division of endometrial adhesions, removal of tubal poyps, etc has been universally accepted as methods to enhance fertility and can now be managed laparoscopically or hysteroscopically without the use of laparotomy (opening the abdomen). Thus majority of patients can be managed by day care surgery with the advantage of reduced hospitalization, faster recovery, minimal postoperative pain and early return to work.

What are the other treatment modalities?

  • Intra-uterine Insemination-a method in which sperms are deposited into the uterus via a cannula.
  • In Vitro Fertilization (Test-Tube Baby) – a technology where several eggs are retrieved from a woman’s ovaries and then fertilized by the husband’s sperm outside the body in a controlled environment of the laboratory. The fertilized eggs then develop into embryos, which are redeposited into the women’s uterus.
  • GIFT (Gamete Intra – Fallopian Transfer)
  • ZIFT (Zygote Intra – Fallopian Transfer)
  • ICSI (Intra Cytoplasmic Sperm Injection)
  • Adoption

Advances in the management of an infertile couple have been tremendous and phenomenal. In today’s date therapy is available for the management of every type of infertility.