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Infertility Therapy

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Infertility is the inability to conceive a child. A couple may be considered infertile if, after two years of regular sexual intercourse, without contraception, the woman has not become pregnant (and there is no other reason, such as breastfeeding or postpartum amenorrhea). Primary infertility is infertility in a couple who have never had a child. Secondary infertility is failure to conceive following a previous pregnancy. Infertility may be caused by infection in the man or woman, but often there is no obvious underlying cause.

Infertility is difficulty in conceiving or getting pregnant. This general term does not identify the cause of the problem or whether it will be permanent. World Health Organization defines infertility as follows:

Often, physicians and researchers consider a couple to have infertility if they have not conceived, despite regular intercourse without using birth control, for at least one year. As per world survey 15 to 20 % of couples do not conceive despite a year of trying.

However, this does not mean that they will not be able conceive later on or even without treatment. Some investigators believe that if a couple is not able to conceive even after 2 years, then they surely require some kind of assistance.

When an individual has no chance to conceive without treatment (for example, a woman does not ovulate nor has two blocked fallopian tubes), it is sometimes called sterility.

Is infertility a male or female problem?

In the past, infertility was commonly considered a female problem. It is now recognized that a couple’s infertility is just as likely to root from problems in the male partner. In infertility testing, about 40 % of the cases are found to stem from female factors and another 40 % from male factors. In 10 % of couples, infertility factors are found in both the man and woman. In the remaining 10 %, the infertility remains unexplained after testing. The statistical data clearly shows that male infertility can also cause failure of conception.

General factors causing female and male infertility both:

  • DNA damage: reduces fertility in female eggs as caused by smoking or radiations and fertility in male sperm as caused by drugs or chemotherapy.

  • Genetic factors

  • General factors

  • Hormonal factors

  • Diabetes mellitus

  • Thyroid disorders

  • Environmental factors

  • Toxins such as glues, volatile organic solvents or silicones, physical agents, chemical dusts, and pesticides Tobacco smokers are 60% more likely to be infertile than non-smoker.

Male infertility causes:

  • low semen quality

  • testicular malformations

  • hormone imbalance

  • blockage of the man's duct system

Female infertility causes:

  • Severe endometriosis

  • Pelvic Inflammatory Disease (PID)

  • Ovulation disorders

  • Elevated prolactin (hormone)

  • Polycystic ovary syndrome (PCOS)

  • Early menopause

  • Benign uterine fibroids

  • Pelvic adhesions

Combined infertility:

In some cases, it is found that both the persons, male and female are infertile and sub-fertile hence the couple infertility arises from both of them.

Infertilty treatment for females

1.     Medicines or fertility drugs are employed to answer the underlying pronlematic issues. Various fertility drugs are classified in order of their mode of actions.

  • Medicines to improve fertility

  • Medicines used in ovulation induction therapy

  • Medicines used in super ovulation therapy along with ART(Assisted Reproductive Technology)

  • Medicines used in to treat specific causes of infertility

The fertility treatment comprises of many medicines that addresses various problems. The fertility drugs for the infertility treatments are mentioned as below:

  • Clomifene is a medicine that has been used to help with fertility for many years. It is taken as a tablet. It works by blocking a feedback mechanism to the pituitary gland. This results in the pituitary making and releasing more gonadotropin hormones than normal. The extra amount of gonadotropin hormones may stimulate the ovaries to ovulate.

  • Metformin may be offered to women with polycystic ovary syndrome (PCOS) who have infertility but have not responded to clomifene. Metformin is a medicine that is commonly used to treat some people with diabetes. Some studies have suggested that metformin may help to improve fertility problems in some women with PCOS, usually in addition to clomifene.

  • Medicines that contain gonadotropin are another type of treatment. These need to be injected. They are used when clomifene does not work, or prior to IUI and IVF, to cause ovulation. Gonadotropin medicines may also improve men fertility with certain types of hormonal problems that can affect sperm count.

  • Medicines that contain gonadotropin-releasing hormone are sometimes used. These stimulate the pituitary to release gonadotropin (which in turn stimulate the ovaries).

2.     Surgical treatments for the infertilty treatment are as follows:

  • Ovarian drilling (surgical method of ovulation induction)

  • Fallopian tube surgery

  • Uterine surgery

  • Surgery for endometriosis

 3.     Assisted Reproductive Technology (ART)

  • Intrauterine Insemination( IUI)

  • In Vitro Fertilization (IVF)

  • Gamete Intra fallopian Transfer (GIFT) & Zygote Intra fallopian Transfer (ZIFT)

  • Intra cytoplasmic Sperm Injection (ICSI)

  • Donor insemination (sperm or egg donation)

  • Pre implantation Genetic Diagnosis and Screening

  • In Vitro Maturation (IVM)

  • Factors affecting outcome of ART

  • Risks and adverse effects associated with ART

  • Egg donation

  • Embryo donation

4.     Other infertilty treatments

Doctors suggest that supplements including zinc, selenium, and vitamin E may be helpful for men who have abnormal sperm counts due to an unknown cause. 

Male infertility Treatment

The male infertility treatment part includes treatment for general sexual problems or lack of healthy sperm. Treatment may include:

  • Medication or behavioral approaches: Addressing impotence or premature ejaculation with one or both approaches may improve fertility.

  • Surgery, hormones or assisted reproductive technology: If the lack of a healthy sperm is suspected as the cause of a man's infertility, surgery or hormones to correct the problem or use of assisted reproductive technology is sometimes very useful.

  • Sperm retrieval: These techniques are used when ejaculation is a problem:

    • Surgical sperm aspiration, which allows retrieval of sperm if the ejaculatory duct is blocked

    • Electric or vibratory stimulation to achieve ejaculation, which can help retrieve sperm in men with spinal cord injury.

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