Infertility
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Infertility primarily refers to the biological inability of a man or a woman to contribute to conception. Infertility may also refer to the state of a woman who is unable to carry a pregnancy to full term. There are many biological causes of infertility, some which may be bypassed with medical intervention.
Women who are fertile experience a natural period of fertility before and during ovulation, and they are naturally infertile during the rest of the menstrual cycle. Fertility awareness methods are used to discern when these changes occur by tracking changes in cervical mucus or basal body temperature.
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| Infertility |
| Reproductive endocrinologists, the doctors specializing in infertility, consider a couple to be infertile if: |
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the couple has not conceived after 12 months of contraceptive-free intercourse if the female is under the age of 34 |
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the couple has not conceived after 6 months of contraceptive-free intercourse if the female is over the age of 35 (declining egg quality of females over the age of 35 account for the age-based discrepancy as when to seek medical intervention) |
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the female is incapable of carrying a pregnancy to term. |
| Sub fertility |
| A couple that has tried unsuccessfully to have a child for a year or more is said to be subfertile meaning less fertile than a typical couple. The couple's fecundability rate is approximately 3-5%. Many of its causes are the same as those of infertility. Such causes could be endometriosis, or polycystic ovarian syndrome. |
| Primary vs. secondary infertility |
Couples with primary infertility have never been able to conceive, while, on the other hand, secondary infertility is difficulty conceiving after already having conceived and carried a normal pregnancy. Technically, secondary infertility is not present if there has been a change of partners.
Some women are infertile because their ovaries do not mature and release eggs. In this case synthetic FSH by injection or Clomiphene citrate via a pill can be given to stimulate follicles to mature in the ovaries. |
| Prevalence |
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Generally, worldwide it is estimated that one in seven couples have problems conceiving, with the incidence similar in most countries independent of the level of the country's development. |
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Fertility problems affect one in seven couples in the UK. Most couples (about 84 out of every 100) who have regular sexual intercourse (that is, every 2 to 3 days) and who do not use contraception will get pregnant within a year. About 92 out of 100 couples who are trying to get pregnant do so within 2 years. |
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Women become less fertile as they get older. For women aged 35, about 94 out of every 100 who have regular unprotected sexual intercourse will get pregnant after 3 years of trying. For women aged 38, however, only 77 out of every 100 will do so. The effect of age upon men’s fertility is less clear. |
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In people going forward for IVF in the UK, roughly half of fertility problems with a diagnosed cause are due to problems with the man, and about half due to problems with the woman. However, about one in five cases of infertility have no clear diagnosed cause |
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In Britain, male factor infertility accounts for 25% of infertile couples, whilst 25% remain unexplained. 50% are female causes with 25% being due to anovulation and 25% tubal problems/other |
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In Sri Lanka, approximately 10% of couples are infertile. In approximately 50% of these cases the man is the factor, in one third the woman is the factor. |
| Causes |
| Male |
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Insufficient sperm produced |
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Poor quality sperm may be produced – such as low motility or abnormally shaped sperm |
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Sperm is affected by chromosome disorders |
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Blockages in the special tube that transports sperm |
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The manufacturing process is damaged (sperm take about 70 days of development before they are mature) |
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Sperm have failed to fertilise eggs after IVF although they seemed normal (there are biochemical factors in sperm that cannot be seen by a microscope but are essential to sperm function) |
| Female |
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Ovaries fail to develop mature eggs |
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Ovaries fail to release eggs |
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The fallopian tubes that carry the eggs from the ovaries to the womb are blocked, damaged or absent |
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The cervix may prevent sperm swimming towards an egg by way of a chemical or physical barrier |
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The womb lining doesn’t allow a fertilised egg to implant itself |
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There are certain blood products that either prevent the embryo implanting or reject it some days or weeks later |
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Embryos fail to develop or implant due to chromosome problems |
| Assessment |
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If both partners are both young and healthy, and have been trying for a baby for 12 months to two years without success, a visit to the family doctor could help to highlight potential medical problems earlier rather than later. He or she may also be able to suggest lifestyle changes you can make to increase your chances of conceiving. |
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Women over the age of 35 should see their family doctor after six months as fertility tests can take some time to complete, and your age may affect the treatment options that are open in that case. |
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A family doctor will take a medical history and give you a physical examination. They can also carry out some basic tests on both partners to see if there is an identifiable reason for not having achieved a pregnancy yet. If necessary, they can refer you to a fertility clinic or your local hospital for more specialist tests. The results of these tests will help determine which is the best fertility treatment for you and your partner. |
| Treatment |
| Medical treatments |
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Medical treatment of infertility generally involves the use of medication, surgery, or both. If the sperm are of good quality, and the mechanics of the woman’s reproductive structures are good (patent fallopian tubes, no adhesions or scarring) physicians may start by prescribing a course of ovarian stimulating medication. The physician may also suggest intrauterine insemination (IUI), in which the doctor introduces sperm into the uterus during ovulation, via a catheter. In these methods, fertilization occurs inside the body. |
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If conservative medical treatments fail to achieve a full term pregnancy, the physician may suggest the patient undergo in vitro fertilization (IVF). IVF and related techniques (ICSI, ZIFT, GIFT) are called assisted reproductive technology (ART) techniques. |
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ART techniques generally start with stimulating the ovaries to increase egg production. After stimulation, the physician surgically extracts one or more eggs from the ovary, and unites them with sperm in a laboratory setting, with the intent of producing one or more embryos. Fertilization takes place outside the body, and the fertilized egg is reinserted into the woman’s reproductive tract, in a procedure called embryo transfer. |
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Other medical techniques are e.g. tuboplasty, assisted hatching and PGD |
| Psychological impact |
Infertility may have profound psychological effects. Partners may become more anxious to conceive, ironically increasing sexual dysfunction. Marital discord often develops in infertile couples, especially when they are under pressure to make medical decisions. 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.
Emotional stress and marital difficulties are greater in couples where the infertility lies with the man.
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