No, infertility is not always a woman’s problem. Both women and men can have problems that cause infertility. About one-third of infertility cases are caused by women’s problems. Another one third of fertility problems are due to the man. The other cases are caused by a mixture of male and female problems or by unknown problems.
Most cases of female infertility are caused by problems with ovulation. Without ovulation, there are no eggs to be fertilized. Some signs that a woman is not ovulating normally include irregular or absent menstrual periods.
Ovulation problems are often caused by polycystic ovarian syndrome (PCOS). PCOS is a hormone imbalance problem which can interfere with normal ovulation. PCOS is the most common cause of female infertility. Primary ovarian insufficiency (POI) is another cause of ovulation problems. POI occurs when a woman’s ovaries stop working normally before she is 40. POI is not the same as early menopause.
Less common causes of fertility problems in women include:
Many things can change a woman’s ability to have a baby. These include:
Many women are waiting until their 30s and 40s to have children. Age is a growing cause of fertility problems. About one-third of couples in which the woman is over 35 have fertility problems.
Aging decreases a woman’s chances of having a baby in the following ways:
Most experts suggest at least one year. Women 35 or older should see their doctors after six months of trying. A woman’s chances of having a baby decrease rapidly every year after the age of 30.
Some health problems also increase the risk of infertility. So, women should talk to their doctors if they have:
It is a good idea for any woman to talk to a doctor before trying to get pregnant. Doctors can help you get your body ready for a healthy baby. They can also answer questions on fertility and give tips on conceiving.
Painful periods do not necessarily mean infertility. Regular painful periods are an indication of ovulatory cycles. However progressive pain before the menses or during the sexual act may signify endometriosis. Irregular menses should be investigated especially if you are obese.
Day 1 is the first day you see a red flow, not just intermittent spotting.
As long as the periods are regular, this means ovulation is occurring. Some women have menstrual cycle lengths of as long as 40 days. Of course, since they have fewer cycles every year, the number of times they are “fertile” in a year is decreased. Also, they need to monitor their fertile period more closely, since this is delayed (as compared to women with a 30 day cycle).
Polycystic ovary syndrome (PCOS) is one of the most common causes of infrequent ovulation and irregular cycles in women. The exact cause is as yet unknown and in some cases may be genetic. In this syndrome, the ovaries produce an excess of androgens (male-type hormones) that prevent the egg from maturing normally, and the ovaries often have a multicystic appearance on ultrasound (hence the term polycystic ovaries) as a result of this arrest in maturation. Higher androgen production may also be associated with excess hair growth (hirsutism) on the face, chest, and abdomen. Because of fewer normal ovulations, women with PCOS often have difficulty conceiving. In addition, many patients with PCOS are resistant to the action of insulin and thus should be screened for diabetes.
Because ovulation is infrequent when PCOS is present, the uterine lining does not shed regularly. Women who don’t menstruate regularly are at increased risk for developing cancer of the lining of the uterus (endometrial cancer). This can be prevented by treatment with a medication known as Provera®, which will induce a menstrual flow. Provera® is a tablet taken daily for 12 to 14 days every two or three months.
If a woman with PCOS wishes to conceive, ovulation can usually be stimulated with a medication known as clomiphene citrate. If this treatment is unsuccessful, injectable medications, called gonadotropins, may be necessary. Gonadotropins are very successful in inducing ovulation, though they are more often associated with multiple pregnancies than is clomiphene citrate.
Another treatment that has helped some patients is surgical “drilling” of the ovaries or wedge resection. This laparoscopic procedure temporarily reduces androgen production by the ovaries and may result in spontaneous ovulation or may improve the response of the ovaries to ovulation inducing medications.
If your mother, grandmother or sister has had difficulty becoming pregnant, this does not necessarily mean you will have the same problem! Most infertility problems are not hereditary, and you need a complete evaluation.
Some common medicines used to treat infertility in women include:
Many fertility drugs increase a woman’s chance of having twins, triplets, or other multiples. Women who are pregnant with multiple fetuses have more problems during pregnancy. Multiple fetuses have a high risk of being born too early (prematurely). Premature babies are at a higher risk of health and developmental problems.
As IVF cycle may be an emotional and stressful time for some couple, it may be helpful for a lady to talk to a supportive person like friend or a close family member. She can also take a help from counselor from the fertility clinic.
Infertility means not being able to get pregnant after one year of trying, or six months, if a woman is 35 or older. Women who can get pregnant but are unable to stay pregnant may also be infertile.
Pregnancy is the result of a process that has many steps. To get pregnant:
Infertility can happen if there are problems with any of these steps.
Fertilization rates for ICSI: Most IVF programs see that about 70-85% of eggs injected using ICSI become fertilized. We call this the fertilization rate, which is different from the pregnancy rate.
Pregnancy success rates for in vitro fertilization procedures with ICSI have been shown in some studies to be higher than for IVF without ICSI. This is because in many of the cases needing ICSI the female is relatively young and fertile (good egg quantity and quality) as compared to some of the women having IVF for reasons other than male factor infertility. Another way to say this is – average egg quantity and quality is usually better in ICSI cases (male factor cases) because it is less likely that there is a problem with the eggs – as compared to cases with unexplained infertility in which there is more probability of a somewhat reduced egg quantity and quality (on the average, since some women in this group have egg related issues).
ICSI success rates vary according to the specifics of the individual case, the ICSI technique used, the skill of the individual performing the procedure, the overall quality of the laboratory, the quality of the eggs, and the embryo transfer skills of the infertility specialist physician performing the procedure.
The miscarriage rate is about the same for ART as the general population. Since for ART patient we observe fetal sac in early stage, we often know about spontaneous miscarriages in the very early stages of pregnancy. These miscarriages probably go unnoticed in the general population.
You should approach a fertility unit for help if the female partner is:
We do this because we recognize that female age is one of the most important predictors of subsequent conception.
When female age is a factor, moving more aggressively towards completing the evaluation and initiating treatment can help to maximize the chances of pregnancy.
There is no normality, but for a young couple 2-3 times a week is considered normal for conception to occur. The sexual act should be had in the fertile window of the menstrual cycle.
Doctors will do an infertility checkup. This involves a physical exam. The doctor will also ask for both partners’ health and sexual histories. Sometimes this can find the problem. However, most of the time, the doctor will need to do more tests.
In men, doctors usually begin by testing the semen. They look at the number, shape, and movement of the sperm. Sometimes doctors also suggest testing the level of a man’s hormones.
In women, the first step is to find out if she is ovulating each month. There are a few ways to do this. A woman can track her ovulation at home by:
Doctors can also check ovulation with blood tests. Or they can do an ultrasound of the ovaries. If ovulation is normal, there are other fertility tests available.
Finding the cause of infertility can be a long and emotional process. It may take time to complete all the needed tests. We are here to support you every step of your journey.
For the male partner a semen examination with 4 – 5 days abstinence. For the female partner a day 2 or day 3 hormonal evaluation i.e. FSH, LH, Prolactin and TSH. A sonography in the form of ovulation studies is done from Day 9 of the cycle. However in some patients due to some clinical findings the doctor may ask for a laparoscopy/ hysteroscopy.
A routine gynecology examination does not provide all the probable causes of infertility. So you will need a schematic work up. Since infertility can also be due to a male factor, a simple semen examination will rule out a male factor. Later on, hormonal assays, a trans-vaginal sonography, a hysterosalpingography and if required alaparo/ hysteroscopy would be done.
Infertility can be treated with medicine, surgery, artificial insemination, or assisted reproductive technology. Many times these treatments are combined. In most cases infertility is treated with drugs or surgery.
Doctors recommend specific treatments for infertility based on:
Doctors often treat infertility in men in the following ways:
In women, some physical problems can also be corrected with surgery.
A number of fertility medicines are used to treat women with ovulation problems. It is important to talk with your doctor about the pros and cons of these medicines. You should understand the possible dangers, benefits, and side effects.
A lead follicle should be at least 18 mm before you can have your hCG shot. The hCG will induce the follicle to ovulate after 36 hours.
Assisted reproductive technology (ART) is a group of different methods used to help infertile couples. ART works by removing eggs from a woman’s body. The eggs are then mixed with sperm to make embryos. The embryos are then put back in the woman’s body.
Common methods of ART include:
Admission is not necessary for IVF cycle as both egg-pick-up and embryo transfer, are outpatient procedures.
You can carry on your normal activities (including working) during IVF stimulation program. But once the embryo is transferred back, you should have more rest. Heavy lifting, climbing and long journey of walking should be avoided. No bed-rest is required unless advised by your doctor.
No type of food is related to infertility not even so called healthy foods, but foods which are rich in fats and carbohydrates can lead to obesity which in turn can cause ovulatory problems.
Although there are no scientific tests to prove that stress causes infertility, all infertile patients are under stress, and it is infertility which causes the stress. It is important to note that many a patients have conceived if they are able to relax.
If your Body Mass Index (weight in Kg/ height in Meters) is below 26 then it is normal. 26-30 BMI is obese and above 30 is a cause of concern. Obesity is the cause of PCOS ovaries which cause ovulatory problems. Thus weight loss of at least 10% of your body weight is important.
Infertility in men is most often caused by:
Sometimes a man is born with the problems that affect his sperm. Other times problems start later in life due to illness or injury. For example, cystic fibrosis often causes infertility in men.
A man’s sperm can be changed by his overall health and lifestyle. Some things that may reduce the health or number of sperm include:
Seminal fluid consists of secretions from test is, seminal vesicles and prostate. Producing a good volume or thick semen does not mean that the semen is normal. Semen examination should be done for sperm count & motility.
For most men, a 2-3 day break is ideal. This period gives the “sample” an opportunity to regenerate. Too “old” a sample raises the risk of poor motility, white cells, and other problems of “old” sperm. (An “old” sample would be one that is taken after more than 7 days of abstinence).
There is no simple drug treatment that can help in improving your semen quality. Assisted reproductive technique is advised.
Statistics show that infertility affects 10% of couples in the Middle East. With the advancements of Assisted Reproductive Treatment, more than 8 million babies born from IVF since the world’s first in 1978.
At Orchid we offer a holistic approach, which encompasses both lifestyle and medical management of the condition, that can boost your chances of conceiving.
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