According to the estimation of the World Health Organization, about 50-80 million people which is 8-10% of the world population are faced with infertility. It is estimated that in about 30-40% of the cases, infertility is exclusively a female problem, and exclusively a male problem in about 10-30% of the cases8. Infertility can be primary or secondary. Primary fertile is defined as the inability to achieve a pregnancy after a year of unprotected, unlimited intercourse, or the inability to carry a pregnancy to birth. Secondary infertility is the terms applied to those women who have conceive again. This is often called second pregnancy infertility. All in all as according to the reproductive endocrinologists, couple is considered to be infertile if:
the couple has not conceived after 12 months
the couple has not conceived after 6 months of contraceptive-free intercourse if the female is over the age of
the female is incapable of carrying a pregnancy to term
On the other hand, couples who are not having this problem are undergoing normal cycle of reproduction of children, the reproductive cycle of a female generally runs through three phases, which are controlled by hormonal feedback mechanisms in the hypothalamus and the pituitary gland at the base of the brain. It is usually cyclical, but becomes irregular or ceases altogether if the hormonal balance is disturbed for any reason.
Fig. 1: Female with normal reproductive cycle.
There are lot causes of infertility and their offered treatments. Some causes of infertility cannot be corrected and as for my studies, I would like to go through those common causes that give failure in having a child either for man or women. As for women, ovulatory disturbances and blocked fallopian tubes are most common. On the other hand, man is more familiar with varicocele problem and immunological disorders.
Female infertility and its treatment
Normal women do not necessarily ovulate optimally every month and it is thought that this explains why some normal, healthy women do not conceive at the first opportunity. Some eggs are also probably of poorer quality than others but no one knows why. A doctor can tell whether a woman is ovulating properly or not by these three ways:
Menstrual history will be abnormal
Basal temperature will be monophasic and not biphasic
The blood levels of the hormone progesterone will be low throughout the cycle (instead of rising during the second half of the cycle)
Fig 2: The hormonal changes which occur during a normal ovulatory cycle, if pregnancy occurs. The purple line marks the point when the embryo implants.
Clomiphene citrate (Clomid) is an anti-oestrogen which stimulates FSH production by the hypothalamus. Ovulation usually occurs between four and ten days after the last dose of Clomid is taken. A woman will know if she is ovulating by keeping her daily temperature. Two gonodotrophic hormones which are drugs, also used to stimulate ovulation.
HCG (human chorionic gonadotrophin) - obtained from urine of pregnant women
HMG (human menopausal gonadotrophin) - obtained from urine of menopausal women
However, these drugs are expensive and in very short supply. The treatment is time-consuming, needs careful monitoring at expert centres and can be hazardous unless the dose is strictly controlled. Bromocriptine is a drug that specifically suppresses the production of prolactin by pituitary to decrease the FSH.
Fallopian tube problem
The fallopian tubesÂ need to be open and fully functional, as the egg is fertilised in these delicate tubes. But then, when an obstruction prevents the egg from travelling down the tube, the woman has a blocked fallopian tube. It can occur on one or both sides.
Blockages or other problems in the fallopian tubes can often be surgically repaired. However, if a woman only has one open tube which is healthy, she might be able to get pregnant without too much help. This is not an option however, if both tubes are blocked. Here, laparoscopic techniques allow delicate operations on the fallopian tubes. Unluckily, this treatment does not always work as the chance of success depends on:
How bad and where the blockage is
Cause of blockage.
The chances are higher to get pregnant after the surgery if there are just a few adhesions between tubes and ovaries. However, if there are multiple adhesions and scaring between tubes and ovaries, surgery may not be a good option for you. In these cases, IVF treatment is the best solution.
If conservative medical treatments fail, the physician may suggest the patient undergo in vitro fertilization (IVF).
Male infertility and its treatment
As people knew there are three categories of treatment for male infertility:
Assisted reproduction therapy includes methods to improve erectile dysfunction, induce ejaculation, obtain sperm, and inseminate an egg:
Sperm retrieval and washing
In vitro fertilization (IVF)
Intracytoplasmic sperm injection (ICSI)
Gamete intrafallopian transfer (GIFT)
Drug therapy used to treat testosterone deficiency. Tamoxifen (NolvadexÂ®), an anti-estrogens' agent, may be used to stimulate gonadotrophin release, which leads to testosterone production. Antibiotics, like levofloxacin (LevaquinÂ®) and doxycycline (PeriostatÂ®), are used to treat fertility-impairing infections of the urinary tract, testes, and prostate, and STDs.
Surgery for male infertility is performed to treat reproductive tract obstruction and varicocele.
Â Ethical and social implication
There are religious leaders' opinions on fertility treatments which are opposite the scientist who expert in this infertility field. Plus, the costs for those treatments are out of financial reach for some couples. Infertility caused by DNA defects on the Y chromosome is passed on from father to son. If natural selection is the primary error correction mechanism that prevents random mutations on the Y chromosome, then fertility treatments for men with abnormal sperm (in particular ICSI) only defer the underlying problem to the next male generation. IVF and other fertility treatments have resulted in an increase in multiple births, provoking ethical analysis because of the link between multiple pregnancies, premature birth, and a host of health problems. In many cultures, inability to conceive bears a stigma. In closed social groups, a degree of rejection (or a sense of being rejected by the couple) may cause considerable anxiety and disappointment.
This problem also affects our country's target to achieve to huge population in order to reduce foreign workers. Women trying to conceive often have clinical depression rates similar to women who have heart disease or cancer. Even couples undertaking IVF face considerable stress. Babies conceived via assisted reproduction are more likely to be born prematurely as babies conceived naturally, but this is less so in twin pregnancies.
Benefit and risks
The treatment of infertility could include a variety of services such as laboratory testing, diagnostics, workups, drug therapy, and artificial insemination, surgery to repair reproductive organs, hormone and steroid injections, and in-vitro fertilization (IVF). IVF involves the joining of sperm and egg in the laboratory and the implantation of the resulting embryo in the mother. Expenses for examination, tests and related medical costs for the diagnosis and treatment of infertility will be covered. However, expenses related to the actual clinical fertilization of an ovum (artificial insemination) and implantation into the uterus of a fertilized ovum (in vitro fertilization) are not covered expenses. Those treatment that had been done actually give those who affected a hope or chance, unfortunately even the very effective treatment works on this problem it does not means that it cannot be unsuccessful for certain times. There are also problems with In Vitro Fertilization which are not only super-high tech but then expensive too, plus it caused serious ethical and legal problem and most important is it has a low success rate during treatment.
One of the most difficult issues is the uncertainty about whether treatment for infertility will be successful. After many different treatments have been tried unsuccessfully, partners also need to agree on when to give up. However, there is often just one more, possibly more expensive medical treatment that holds some promise of working.
Treatments depend on the cause of the problem and generally include advice on diet and vitamin supplements as well as acupuncture or MOXIBUSTION treatment to the bladder, kidney, stomach and conception meridians. Plus there's autogenic training that may help when infertility related to stress or tension. The nutritional intake of the couple trying to conceive may need improving. A high-potency, multivitamin and mineral supplement is often very valuable. Aromatherapy is said to increase fertility by reducing the stress level in the woman's body. It also improves the overall health of the woman. This method makes use of essential oils extracted from various plants. Essential oils are the highly concentrated form of parts such as leaves, bark, roots, and seeds. These essential oils relieve muscular tension and help the body to relax. Usage of herbs is one of the most popular methods of treating infertility through natural methods. Herbs such as chaste berry are particularly known for improving hormonal imbalances in the body. It also regulates the menstrual cycle. But it should not be taken before ovulation, as it has properties that may hamper the process. It is advisable, therefore, that wild yam be taken only after ovulation has taken place.
Problems common to both partners are diagnosed in 15-30% of infertile couples. After thorough medical investigations, the causes of the fertility problem remain unexplained in only a minority of infertile couples (5-10%). By and large it is fair to say that women fare better than men in the treatment of their infertility because research into contraception has provided a body of knowledge which can be applied to the problem of low infertility. A woman may be infertile for one of three main reasons and in about 35% there are two or more of these operating in any one woman. First, something mechanical may be blocking her cervix, uterus or fallopian tubes and this obviously prevents sperm and egg from meeting. Second, her endocrine system may be at fault, thus producing problems with ovulation. Third, she may have abnormalities of her reproductive organs. Survey results vary when it comes to deciding which of these factors the most prevalent cause is but ovulatory disturbances are probably most common, followed by blocked fallopian tubes. In about 12% of infertile women, no cause of any kind is found.
"Treatment may include medication, surgery, or in vitro fertilization (IVF). About 25-30 % of all couples who receive treatment are able to conceive. Success with IUI or IVF is related to the patient's age-older patients have lower success rates. Sex-steroid markers that may be used to determine egg quality or ovarian reserve include FSH (normal is 6-10) and E2 (estradiol; normal range is 25-65). Other factors involved in the initial evaluation include prolactive levels, progesterone levels, LH (luteinizing hormone), and TSH (thyroid-stimulating hormone). Any of these factors that are outside of the normal range can point the reproductive endocrinologist in the right direction for creating an appropriate and often successful treatment plan..." By Makar RS, Toth TL (2002). "The evaluation of infertility". Am J Clin Pathol.