You are not alone — it is common for couples to seek help and advice if they are having difficulty conceiving. Infertility cannot always be explained, however there are sometimes reasons why couples find it difficult to become pregnant.
Fertility treatment is an intensive process that requires sensitivity and an understanding of the physical and emotional aspects of every patient’s journey. With the help of our elite fertility specialists, we can introduce you to advanced treatment options, which can in many cases bring light on your journey to parenthood.
In women, fertility problems can be —
- Age: a crucial factor in female fertility as the biological clock limits the ability to conceive. Women start to become less fertile when they are in their 30s and female fertility declines dramatically when women reach their 40s.
- Hormone problems: an imbalance in the hormones that regulate egg production and ovulation can mean that eggs are not produced, released or do not develop properly each month.
- Problems with the fallopian tubes: these lead from the ovaries to the womb and if they are blocked, scarred or damaged in any way, it can stop the egg travelling along them preventing it from meeting the sperm. Damage can be caused by infection or scar tissue.
- Endometriosis: a condition where tissue similar to the womb lining starts growing elsewhere around the reproductive organs.
- Polysystic Ovary Syndrome (PCOS): where there are undeveloped follicles (or cysts) just under the surface of the ovaries that can disrupt ovulation.
- Premature Menopause or Premature Ovarian Failure (POF): where the ovaries stop functioning many years before they should. This can be caused by chemotherapy or radiotherapy for the treatment of any kind of cancer. POF may also occur in cases where genetic conditions are present such as hypoplastic atrophic ovaries or Turner syndrome.
In men, fertility problems can be —
- Azoospermia (no sperm) or Oligozoospermia (low sperm count)
- A blockage in the testes: Where sperm cannot be transported to the penis for ejaculation.
- Retrograde ejaculation: A condition in which semen is ejaculated into the bladder rather than out through the urethra because the bladder sphincter does not close during ejaculation.
- Varicoceles: A varicocele is the enlargement of the internal spermatic veins that drain blood from the testicle to the abdomen (back to the heart). A varicocele develops when the one way valves in these spermatic veins are damaged causing an abnormal back flow of blood from the abdomen into the scrotum creating a hostile environment for sperm development. Varicocoeles may cause reduced sperm count and abnormal sperm morphology which cause infertility.
PCOS and Infertility
PCOS is sometimes associated with fertility. In PCOS LH goes higher than FSH. Due to the low levels of FSH, many follicles will develop however it will not mature. These follicles which are present in ovaries form cysts once they become ataractic. Hence the ovaries seem to be polycystic. Follicles do not mature and that is the reason no eggs are released and subsequently there is no ovulation. Infertility is primarily caused by anovulation or lack of ovulation. Ovulation drugs (Clomid & metformin) by gonadotrophins help in ovulation or correcting the resistance to insulin.
Symptoms of PCOS
Some common symptoms of PCOS include an excessive hair growth in the face and body along with weight gain and, irregular and infrequent periods or absent periods. Ovulation is infrequent or mostly absent. The symptoms can vary from one woman to another and may also include obesity, high levels of cholesterol or even acne. There have been some symptoms of skin tags as well as extreme tiredness, or lack of mental alertness combined with depression, anxiety and decreased sex drive. Excess male hormones and infertility are also observed in some cases.
A common misconception is that infertility affects only women. Actually, in 45% of couples who experience difficulties conceiving, male infertility is the reason.
Unlike women’s eggs, male sperm does not necessarily deteriorate with age, however, despite the fact that men can continue producing sperm and theoretically fathering children into their 90’s, low sperm count and poor quality sperm is becoming more common.
Sperm is released with semen when a male ejaculates. Usually, over 40,000 sperm are released and it only takes one sperm to fertilise an egg and result in pregnancy. Healthy sperm has good motility, meaning the sperm can move easily and is the correct shape to penetrate the shell of and fertilise the ova.
Factors of Male Infertility
Low Sperm Count
One of the increasing problems facing men is a low sperm count. A male sperm count is the number of sperm that are released in semen. The lower the concentration of sperm in semen the less likely the chance of fertilisation.
If few sperm are present in semen, the higher the quality of the sperm needed for conception to take place. The benefit of IVF is that following the extraction of the sperm from semen, healthy sperm can be identified and used to fertilize the egg.
Poor Quality Sperm
High quality sperm is determined by three main factors – the morphology, or shape, of sperm; the motility of sperm that is the ability of the sperm to move; the speed of the sperm.
Sperm is shaped similar to a tadpole. The genetic cells needed for fertilisation of the ova are contained in the front of the sperm and the tail end of the sperm directs it forward. Sperm that is abnormally shaped does not move as well through the semen, reducing the chance of fertilization.
Motility of Sperm
Sperm motility is determined in part by the shape of sperm as well as by the speed. Sperm motility, the ability of the sperm to move forward through the cervical canal to the egg, defines the overall health of the sperm.
Speed of the Sperm
As soon as sperm is ejaculated in semen, the quality of the sperm begins to decrease. The faster the sperm, the healthier the sperm that reaches the egg. Sperm that move quickly and have good motility can penetrate ova without any artificial assistance.
Impaired delivery of sperm
Healthy sperm is often produced but for various reasons cannot be ejaculated. Ejaculation problems can be caused by a blockage in the testes, as a side effect of another illness or by impotence problems.
Infections, viruses and hormonal imbalances all damage sperm. Past illnesses, certain medications and injuries to the testes can damage the quality or amount of sperm produced. Overheating testicles or being exposed to lead and x-rays can all cause male factor infertility.
Surgical Treatments for Male Infertility
Generally, male infertility is caused by problems with sperm or the ejaculation of sperm. For some men, surgery may be required to treat the cause of the infertility.
Commonly known as varicose veins of the testis, varioceles make the temperature of the testis higher which can affect cause low sperm counts. The procedure to remove the varioceles involved removing the blood supply from the varioceles. Following a varicocelectomy procedure the chances of conception are increased.
Blockages in the epididymal prevent sperm from being ejaculated naturally. These blockages are often caused by scarring or cysts which can be removed in a microsurgery procedure called a vasoepididymostomy. This surgical procedure is complex and is only performed if the scarring or cysts are severe.
How Common is Male Factor Infertility?
Male factor infertility is commonly related to the quality or quantity of sperm present in semen. Male infertility can be as a result of blockages that prevent the ejaculation of semen. This cause of male infertility can be overcome by using sperm retrieval methods such as TESE to collect sperm for use in IVF.
World Health Organisation defines Infertility as not being able to become pregnant after a year of trying. If a woman keeps having miscarriages, it is also called secondary infertility. Today, lots of couples have infertility problems in every part of the world. Infertility may be due to a single cause in either you or your partner, or a combination of factors that may prevent a pregnancy from occurring or continuing. About a third of the time, infertility can be traced to the women. In another third of cases, it is because of the man. The rest of the time, it is because of both partners or no cause is found. Drugs, surgery and IVF are common treatments. Happily, two-thirds of couples treated for infertility go on to have babies.
When to see a doctor for infertility:
In general, don’t be too concerned about infertility unless you and your partner have been trying regularly to conceive for at least one year. You should see your doctor earlier, however, if you’re a woman and:
- You’re age 34 or older and have been trying to conceive for six months or longer
- Your periods are irregular or not at all.
- Your periods are very painful
- You have been diagnosed with endometriosis or pelvic inflammatory disease (PID) before.
- You’ve had more than one miscarriageIf you’re a man, talk with your doctor if you have:
- Low sperm count
- A history of testicular, prostate or sexual problems
Infertility is one of the main specialities of Medicana International Hospital. Infertility treatments such as IUI, IVF/ICSI, laparoscopies and hysteroscopies are performed everyday. Medicana International Hospital does over a thousand IVF cycles each year with high success rates.The clinic has also its own andrology lab for male infertility and perform procedures such as TESA or microscopic TESE (testicular biopsy).
What is IVF ?
In vitro fertilization (IVF) today is a well-known common word to most of us. But not so long ago, it was a mysterious procedure for infertility that produced what were then known as “test-tube babies.” Louise Joy Brown, born in England in 1978, best known as the world’s first “test-tube baby” had conceived outside her mother’s womb.
Unlike the simpler process of intrauterine (IUI) or artificial insemination — in which sperms are placed in the uterus and conception precedes otherwise normally — IVF involves combining eggs and sperms outside the body. Once an embryo or embryos form and observed as healthy, they are then placed into the uterus. IVF is a complex and expensive procedure; only about 5-10 % of couples with infertility seek it out. However, since its introduction in the GB in 1978, IVF and other similar techniques have resulted in more than 1 million babies in all over the world.
What Causes of Infertility, Can IVF help ?
When it comes to infertility, IVF may be an option if you or your partner have been diagnosed with:
- Low sperm counts
- Problems with your womb or fallopian tubes
- Problems with ovulation ( egg production)
- Antibody problems that harm sperm or eggs
- The inability of sperm to penetrate or survive in the cervical mucus
- An unexplained fertility problem
Certainly, IVF is not the first step in the treatment of infertility. Instead, it’s reserved for cases in which other methods such as fertility drugs, surgery, and artificial insemination haven’t worked. Also with advanced maternal age ( over 40 ) ivf may be considered as a first line treatment option not to lose much time.
If you think that IVF might make sense for you, carefully assess any treatment center before undergoing the procedure.
Here are some questions to ask your doctor at the fertility clinic:
- How many cycles per year do you do?
- What is your pregnancy ratio per embryo transfer?
- What is your pregnancy rate for couples in our age group and with our fertility problem?
- Are the doctors and staff always available and accessible ?
- How many of those deliveries are twins or other multiple births?
- How much will the procedure cost, including the cost of the drugs?
- How much does it cost to store embryos and how long can we store them?
- What Can I Expect From IVF?
The first step in IVF involves injecting hormones to yourself so you produce multiple eggs instead of only one each month. You will then be tested in every other day to determine whether you’re ready for egg retrieval.
Prior to the retrieval procedure, you will be finally given an injection that makes the developing eggs mature. Timing is important; the eggs must be retrieved just before they emerge from the follicles in the ovaries. It is about 36 hours after the final injection. If the eggs are taken out too early or too late, they won’t develop normally. Your doctor may do blood tests or an ultrasound to be sure the eggs are at the right stage of development before retrieving them.. All women are given pain medication and full anesthesia during the retrieval in our Centre.