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Primary infertility is the term used to describe a couple that
has never been able to conceive a pregnancy, after at least
1 year of unprotected intercourse. A broader view of infertility
includes not being able to carry a pregnancy to term and deliver
a baby.
Secondary infertility is generally defined as the inability
of a couple to conceive after a year of unprotected and appropriately
timed intercourse when one or both partners have previously
conceived children. |
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[ What Is Infertility? ]
[ What Causes Infertility
In Women? ]
[ What Causes Infertility
In Men? ]
[ How Is Infertility Tested?
]
[ What Are The Complications
Of Infertility? ]
[ What Is The Treatment For
Infertility? ]
[ What Is ART (Assisted Reproductive
Technology)? ]
[ The Basic Steps Of IVF
] |
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| What Causes Infertility In Women? |
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It is a myth that infertility is always
a "woman's problem." About one third of infertility
cases are due to problems with the man (male factors), another
third are due to problems with the woman (female factors). The
rest are due to a combination of male and female factors or
to unknown causes.
Ovulation problems, or ovulation dysfunction, account for
most infertility cases in women. Without ovulation, eggs are not
available to be fertilized. Signs of problems with ovulation
include irregular menstrual periods or no periods. Other "female"
factors include - endometriosis, scarring from sexually transmitted
disease, poor nutrition, hormonal imbalance, ovarian cysts,
pelvic infection, tumours, blocked fallopian tubes and other
uterine abnormalities.
Simple lifestyle factors - including stress, diet, or athletic
training - can affect a woman's hormonal balance. Much less
often, a hormonal imbalance from a serious medical problem
such as a pituitary gland tumor can cause ovulation problems.
Aging is an important factor in female infertility. The ability
of a woman's ovaries to produce eggs declines with age, especially
after age 35. About one third of couples where the woman is
over 35 will have problems with fertility. By the time she
reaches menopause, when her monthly periods stop for good,
a woman can no longer produce eggs or become pregnant. |
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| What Causes Infertility In Men? |
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Infertility in men is often caused
by problems with making sperm or getting the sperm to reach
the egg. Problems with sperm may exist from birth or develop
later in life due to illness or injury. Some men produce no
sperm (commonly known as azoospermia), or produce too few sperm
(oligospermia).
Lifestyle can influence the number and quality of a man's
sperm. Alcohol and drugs can temporarily reduce sperm quality.
Environmental toxins, including pesticides and lead, may cause
some cases of infertility in men. |
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Varicocoele |
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A varicocele occurs
when the valves within the veins along the spermatic cord
don't work properly. The abnormal valves prevent normal
blood flow and cause blood to back up, which dilates and
enlarges the veins. The veins are swollen and twisted
over the testicle, which is sometimes known as a "bag
of worms".
There are numerous theories that postulate how a varicocoele
can affect fertility:
- Due to abnormal blood flow in the veins draining
the testicle and in the artery entering the scrotum,
testicular temperature increases, and this prolonged
elevated testicular temperature has detrimental effects
on sperm production.
- Abnormal concentrations of adrenal and renal substances
may impede development of normal sperm.
- Abnormal venous blood flow from the scrotum increases
metabolic waste products and decreases the availability
of oxygen and nutrients required for sperm development.
- Abnormal blood flow can also interfere with testosterone
concentration, which in turn can interfere with sperm
production. The long-term effects of compromised circulation
may interfere with normal male androgen production.
The diagnosis of a varicocoele can usually be made
on physical examination of the scrotum while the patient
is standing or by using an ultrasound machine.
Repair of the varicocoele (varicocoelectomy) is indicated
when:
- The infertile couple, with normal or potentially
normal female partner but a male with one or more
abnormal semen parameters and the presence of a varicocoele
on physical examination.
- Varicocoele causes testicular pain or discomfort
or there is a significant discrepancy between the
sizes of the two testicles.
The surgical treatment of choice these days is Laparoscopic
Varicocoelectomy (the key-hole surgical correction of
varicocoeles), which is performed on a Day Surgery, outpatient
basis.
Semen improvement is expected in up to 80% of men and
pregnancy in up to 40% of couples within the first two
years after successful correction of the varicocoeles
(Chen C: Videolaparoscopic Varicocoelectomy for Male
Infertility. In: XVI World Congress on Fertility &
Sterility, Melbourne, Australia 2001; 184.) (Chen C:
Videolaparoscopic Reproductive Surgery For The Treatment
Of Some Major Male And Female Infertility Problems.
In: Abstracts, XXXIV World Congress of the International
College of Surgeons, Quito, Ecuador, October 2004; 293).
Even in men with worst-case scenarios who were not
candidates for IVF because they had no sperm in the
ejaculate or no moving sperm, varicocoele repair restored
sperm or motility in 55-69% of patients. Twenty percent
of these men were able to father children after varicocoele
repair without any other assistance. |
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| How Is Infertility Tested? |
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If you have been trying to have a
baby without success, you may want to seek medical help. If
you are over 35, or if you have reason to believe that there
may be a fertility problem, you should not wait for one year
of trying before seeing a health care provider. A medical evaluation
may determine the reasons for a couple's infertility. Usually
this process begins with physical exams and medical and sexual
histories of both partners. If there is no obvious problem,
like improperly timed intercourse or absence of ovulation, tests
may be needed.
For a man, testing usually begins with tests of his semen to
look at the number, shape, and movement of his sperm. Sometimes
other kinds of tests, such as hormone tests, are done.
For a woman, the first step in testing is to find out if she
is ovulating each month. There are several ways to do this.
For example, she can keep track of changes in her morning body
temperature and in the texture of her cervical mucus.
Checks of ovulation can also be done in the doctor's office,
using blood tests for hormone level or ultrasound of the ovaries.
If the woman is ovulating, more tests will need to be done. |
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| What Are The Complications Of Infertility? |
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Although infertility itself does
not cause physical illness, the psychological impact of infertility
upon individuals or couples affected by it may be severe. Couples
may encounter marital problems, as well as individual depression
and anxiety. |
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| What Is The Treatment For Infertility? |
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Depending on the test results, different treatments can be
suggested. Eighty-five to 90 percent of infertility cases
are treated with drugs or surgery.
Various fertility drugs may be used for women with ovulation
problems. It is important to talk with your health care provider
about the drug to be used. You should understand the drug's
benefits and side effects. Depending on the type of fertility
drug and the dosage of the drug used, multiple births (such
as twins) can occur in some women.
If needed, surgery can be done to repair damage to a woman's
ovaries, fallopian tubes, or uterus. Sometimes a man has an
infertility problem that can be corrected by surgery. |
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| What Is ART (Assisted Reproductive Technology)? |
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ART uses special methods to help infertile couples. ART involves
handling both the woman's eggs and the man's sperm. Success
rates vary and depend on many factors. Though ART can be expensive
and time-consuming, it has made it possible for many couples
to have children that otherwise would not have been conceived.
In IVF, eggs are surgically removed from the ovary and fertilised
outside the body. After about 40 hours, the eggs are examined
to see if they have become fertilized by the sperm and are
dividing into cells. These fertilized eggs (embryos) are then
placed in the women's uterus, thus bypassing the fallopian
tubes. |
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Ovulation Induction |
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During ovulation
induction, ovulation drugs (fertility drugs) are used
to stimulate the ovaries to produce several mature eggs
rather than the single egg that normally develops each
month. Chances of pregnancy are better if more than one
egg is fertilised and transferred to the uterus in a treatment
cycle. The drug type and dosage vary depending on the
programme and the patient. Most often, ovulation drugs
are given over a period of 14 days. Our specialist can
explain how each drug works and its possible side effects.
In the meantime, the ovaries are scanned frequently with
ultrasound to monitor the development of ovarian follicles,
the fluid-filled cysts within the ovaries where the oocytes
(eggs) grow. Blood samples are taken regularly to check
and monitor the level of hormones for optimum outcome.
Our specialist will check for follicular maturity to determine
the appropriate time for egg retrieval. |
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Egg Retrieval |
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Egg (Oocyte) retrieval
is accomplished by transvaginal ultrasound aspiration. |
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Process of Assisted
Fertilization & Making of Embryos |
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The eggs are identified, isolated and cultured in medium
in the CO2 incubator. The Embryologist injects each
mature egg with a single sperm, a process described
as ICSI, which is one of the most exciting new procedures
of ART.
The injected eggs are checked for fertilization on
the following day. The fertilized egg was cultured further
and would start to divide into blastomeres (2-8 cells).
A maximum of 3 embryos are selected and hatched before
being transferred back to the uterus. The remaining
good embryos are kept frozen for future use. |
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Embryo Transfer |
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This is a minor
procedure where the fertilized embryos are placed back
into the uterus. |
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