Thinking about Fertility Treatment Dealing with infertility is a complicated journey of options and decisions.

Infertility Treatment has come a long way in the last 30 odd years ever since Louise Brown was born on 25 July 1978. Her parents, Lesley and John Brown, had been trying to conceive for nine years. They faced complications of blocked fallopian tubes and underwent what would later become known as IVF/in vitro fertilization, a technique developed by Patrick Steptoe and Robert Edwards. Edwards won 2010 Nobel Prize in Medicine for this work. Although the media refers to ivf as "test tube baby procedure", conception actually takes place in a Petri dish and this mainly involves working with human gametes which is a challenging job which very few people around the world are trained to do.

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. According to various studies conducted across India 20%-30% couples face some kind of infertility related issues at some point of time in their lives.

Causes of Infertility in Women

1. Failure to Ovulate

a) Hormonal Problems

Failure to produce mature eggs: In approximately 50% of the cases of anovulation, the ovaries do not produce normal follicles in which the eggs can mature. Ovulation is rare if the eggs are immature and the chance of fertilization becomes almost nonexistent. Malfunction of the hypothalamus: The hypothalamus is the portion of the brain responsible for sending signals to the pituitary gland, which, in turn, sends hormonal stimuli to the ovaries in the form of FSH and LH to initiate egg maturation. If the hypothalamus fails to trigger and control this process, immature eggs will result. Malfunction of the pituitary gland: The pituitary's responsibility lies in producing and secreting FSH and LH. The ovaries will be unable to ovulate properly if either too much or too little of these substances is produced.

 b) Scarred Ovaries

Physical damage to the ovaries may result in failed ovulation. For example, extensive, invasive, or multiple surgeries, for repeated ovarian cysts may cause the capsule of the ovary to become damaged or scarred, such that follicles cannot mature properly and ovulation does not occur. Infection may also have this impact.

c) Premature Menopause

Some women cease menstruation and begin menopause before normal age. It is hypothesized that their natural supply of eggs has been depleted or that the majority of cases occur in extremely athletic women with a long history of low body weight and extensive exercise. There is also a genetic possibility for this condition.

d) Follicle Problems

Although currently unexplained, "unruptured follicle syndrome" occurs in women who produce a normal follicle, with an egg inside of it, every month yet the follicle fails to rupture.

 2. Causes of Poorly Functioning Fallopian Tubes

a. Blocked fallopian tubes Infection

Caused by both bacteria and viruses and usually transmitted sexually, these infections commonly cause inflammation resulting in scarring and damage. Genital Tuberculosis: It is one of the commonest chronic/long standing infections which results in Blocked fallopian tubes and is often overlooked.

b. Abdominal Diseases

The most common of these are appendicitis and colitis, causing inflammation of the abdominal cavity which can affect the fallopian tubes and lead to scarring and blockage.

c. Previous Surgeries

This is an important cause of tubal disease and damage. Pelvic or abdominal surgery can result in adhesions that alter the tubes in such a way that eggs cannot travel through them.

d. Ectopic Pregnancy

This is a pregnancy that occurs in the tube itself and, even if carefully and successfully overcome, may cause tubal damage and is a potentially life-threatening condition.

e. Congenital Defects

In rare cases, women may be born with tubal abnormalities, usually associated with uterus irregularities.

3. Endometriosis

This condition is characterized by excessive growth of the lining of the uterus, called the endometrium. Growth occurs not only in the uterus but also elsewhere in the abdomen, such as in the fallopian tubes, ovaries and the pelvis. The symptoms often associated with endometriosis include heavy, painful and long menstrual periods, urinary urgency, rectal bleeding and premenstrual spotting. Sometimes, however, there are no symptoms at all, owing to the fact that there is no correlation between the extent of the disease and the severity of the symptoms.

4. Behavioral Factors

It is well-known that certain personal habits and lifestyle factors impact health; many of these same factors may limit a couple's ability to conceive. Diet & Exercise, Smoking and Alcohol are some of the major reasons.

5. Environmental and Occupational Factors

The ability to conceive may be affected by exposure to various toxins or chemicals in the workplace or the surrounding environment.

Causes of Infertility in Men Lifestyle

• Smoking - significantly decreases both sperm count and sperm cell motility.

• Chronic Alcohol abuse.

• Anabolic steroid use - causes testicular shrinkage and infertility.

• Overly intense exercise - produces high levels of adrenal steroid hormones which cause a testosterone deficiency resulting in infertility.

• Inadequate vitamin C and Zinc in the diet.

• Tight underwear--increases scrotal temperature which results in decreased sperm production.

• Exposure to environmental hazards and toxins such as pesticides, lead, paint, radiation, radioactive substances, mercury, benzene, boron, and heavy metals.

• Malnutrition and anemia.

• Excessive stress.

Hormonal

• Hyperprolactinemia: Elevated Prolactin-Greater elevations of the hormones may result in reduced sperm production, reduced libido and may result in impotence.

• Hypothyroidism: Low thyroid hormone levels may cause reduction of quality of semen, poor testicular function and may disturb libido. This may be caused due to a diet high in iodine.

• Congenital Adrenal Hyperplasia: This condition occurs when the pituitary is suppressed by increased levels of adrenal androgens. Symptoms for this include low sperm count, an increased number of immature sperm cells, and low sperm cell motility.

• Hypogonadotropic Hypopituitarism: Low pituitary gland output of LH and FSH. This condition arrests sperm development and causes the progressive loss of germ cells from the testes and causes the seminiferous tubules and testosterone producing cells to deteriorate.

• Panhypopituitafism: Complete pituitary gland failure-This condition lowers growth hormone, thyroid-stimulating hormone, and LH and FSH levels. Symptoms include: lethargy, impotence, decreased libido, loss of secondary sex characteristics, and normal or undersized testicles.

Hormonal

• Variocoele: This is an enlargement of the internal spermatic veins that drain blood from the testicle to the abdomen (back to the heart) and are present in 15% of the general male population and 40% of infertile men.

• Damaged Sperm Ducts: Seven percent of infertile men cannot transport sperm from their testicles to out of their penis.

• Torsion: Is a common problem affecting fertility that is caused by a supportive tissue abnormality which allows the testes to twist inside the scrotum and is characterized by extreme swelling.

• Infection and Disease: Mumps, TB, Brucellosis, Gonorrhea, Typhoid, Influenza, Smallpox, and Syphilis can cause Testicular Atrophy.

• Klinefelter's Syndrome: Is a Genetic Condition in which each cell in the human body has an additional X chromosome--men with Klinefelter's Syndrome have one Y and two X chromosomes. Physical symptoms include peanut-sized testicles and enlarged breasts.

• Retrograde Ejaculation: Is 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.

Assisted Reproductive technology/techniques

Intrauterine insemination (IUI) is an infertility treatment also called artificial insemination. This treatment is prescribed when there is a mild male factor infertility or when women have problems with their cervical mucus.

Assisted Reproductive Technology (ART):

The main concept here is of removing eggs from a woman's body and these eggs are then mixed with sperm of a male to make embryos. These embryos are then cultured for 2 to 5 days in specialized compartments called as Incubators and put back in the woman's uterus thereby resulting in a successful pregnancy. ART has helped many couples conceive which otherwise would not have been possible.

About the Doctor:

Dr. Pratima Grover is a consultant at the Kiran Infertility Centre, Hyderabad, India (KIC). She has trained in Reproductive Biology at the Cleveland Clinic, U.S.A., one of the top most Infertility Centre's across the globe. She is a Post Graduate in Obstetrics and Gynecology.

TREATMENT FOR INFERTILITY

Male Treatment Options

• Sexual Issues: In this case doctors help men deal with impotence or premature ejaculation through behavioral therapy and/or medicines.

• Antibiotics also are used to clear up infections affecting sperm count.

• Too few sperm: In such cases the main cause of the problem can be treated through surgery

• Sperm movement: Sometimes blockage in Man's System results in no Sperm in Semen.Surgery is one of the options to correct the problem.

• In vitro fertilization/intra cytoplasmic sperm injection are advanced techniques to help deal with poor sperm count and motility

Female Treatment Options

In women,physical problems can be corrected with the help of surgery.There are number of fertility medicines that are used to treat women with ovulation problems.It is very important to talk to doctor about the effects and side effects of these Medications.

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