All About Infertility
What Is Infertility?
Infertility is the inability, following a year of regular, unprotected sexual intercourse, to become pregnant, or to bring a pregnancy to term. The average chance to conceive for a normally fertile woman, who has regular unprotected intercourse, is approximately 25% during each menstrual cycle. It is estimated that 10% of normally fertile women fail to conceive within their first year and 5% after 2 years. The two types of infertility are primary, without a previous pregnancy, and secondary, with a prior pregnancy. Age is an important infertility factor – especially if a woman is approaching or passing 35-years of age. A cause of infertility can be diagnosed in about 80% of cases and the source of infertility is almost equal between men and women. However, not all causes of infertility are known.
What Causes Infertility?
The two most common causes of female infertility are ovulatory disorders and anatomical abnormalities. Ovulation dysfunction means that the ovaries are not producing eggs normally or egg production has diminished with age. Ovulation and anatomical causing abnormalities include:
- Type 1 Diabetes
- Thyroid disease
- Lupus
- Pelvic inflammatory disease (PID) results from an infection, usually a sexually transmitted disease that frequently leads to adhesions (scarring) within the fallopian tubes. Fallopian adhesions can result in blocked or distorted tubes, infertility and increased incidence of ectopic pregnancy in which a fetus develops outside the uterus. This can also be life threatening
- Polycystic ovarian disease
· Endometriosis, uterine lining tissue overgrowth, is believed to be a common cause of infertility in 30-40% of infertile women. Scarring and inflammation from endometriosis may immobilize reproductive organs or obstruct the fallopian tubes preventing fertilized eggs from traveling to the uterus for implantation.
· Appendicitis (e.g. ruptured)
· Previous abdominal, pelvic operations or pregnancy
· Scar tissue or adhesions can restrict mobility of reproductive organs
· Uterine fibroids (generally benign tumors) may cause excessive uterine bleeding, recurrent miscarriages and pain
· Irregular menstruation
· Thin or abnormal uterine lining or abnormally shaped uterus
· Inadequate cervical mucous
Additional factors include:
- Immunological disorders
- Chromosomal abnormalities
- Cancer or other serious illnesses
- Radiation and chemotherapy
- Stress
Diagnosing Infertility
An important step in determining the cause(s) of infertility is for a woman to know her body, e.g. recognizing ovulation signs, and conception obstacles. The doctor will perform the following infertility evaluation to determine which partner(s) is infertile and the cause(s):
- Thorough medical history, including medical conditions, history of drug usage or ob/gyn problems
- Physical exam
- Blood tests
- Semen analysis
- Hysterosalpingogram to assesses anatomy of the uterine cavity and fallopian tubes
- Laparoscopy to visualize the abdominal and pelvic cavities through a thinly lit telescope inserted into the abdominal wall
Treatment Options
A woman who is experiencing infertility should seek early medical consultation with her doctor. Shrinking or slowing the growth of pelvic abnormalities, preserving or restoring fertility through medications, hormonal therapy, surgical procedures or alternative treatment will be determined in coordination with a physician based on:
- Age and duration of the couple’s infertility
- Overall health
- Extent of the disorder
- Tolerance for specific medications, procedures and therapies
- Expectations
- Previous reproductive surgery
- Coexistent infertility factors
- Cervical or immunological factors
- Financial considerations
Depending on the type of infertility, the following assisted-reproduction techniques are available to women:
- Ovarian stimulation medication and/or using hormonal injections concurrent with intercourse
- In vitro fertilization (IVF)
- Sperm injection
- Gamete intrafallopian transfer (GIFT) is where a mixture of sperm and eggs are introduced into the end of the fallopian tube during a laparoscopy
- Donor-egg in vitro fertilization
- Frozen embryo transfer
Surgical Options
Before choosing surgery, a woman must consider the severity of her condition, since reported pregnancy rates following surgical treatment of pelvic abnormalities vary.
- Laparoscopy is a minimally invasive surgical procedure involving a thin lit telescope and surgical instruments, that are inserted through tiny incisions below the navel. This surgery minimizes postoperative scarring. Laparoscopic laser ablation is used to destroy endometriosis and improve fertility. General laparoscopic side effects may include pelvic or abdominal infections and blood clots.
- Hysteroscopy is minimally invasive surgery for the treatment of fibroids, endometriosis and tubal adhesions. It uses a thin lit telescope passed through the cervix and into the uterus. A tuboplasty is performed on women with blocked fallopian tubes. This procedure, depending on the area of blockage, utilizes hysteroscopy with micro- or laser surgery. These procedures are performed on an outpatient basis. Side effects may include cramping. Some bleeding, clotting and discharge are common for a few weeks after surgery.
· Lysis of adhesions is a laparoscopic procedure to remove scar tissue that has developed from previous abdominal or pelvic surgery, endometriosis or pelvic infections. This procedure may be performed by a laparoscopy or a hysteroscopy, depending on where the scar tissue has formed. These procedures are performed on an outpatient basis
- Laparotomy is an invasive procedure in which an incision is made in the lower abdomen to access large areas of the pelvis and to remove fibroids (myomectomy), endometriosis, ovarian cysts or pelvic adhesions. A reverse sterilization can also be performed by a laparotomy. Laparotomy requires hospitalization and several weeks of recovery. Side effects may include pelvic or abdominal infections and nerve damage.
- Endoscopy involves the use of either a laparoscope, a thinly lit telescope inserted into the abdominal wall, or a hysteroscope, a small telescope inserted within the uterine cavity. These procedures are performed on an outpatient basis.
Pelvic reconstructive surgery may be performed to improve a woman’s chances of fertility.
Adhesion formation and reformation are still unavoidable in reproductive pelvic surgery in spite of a physician’s skills in micro-, endoscopic or laser surgery. However, a woman and her partner must consider all options when deciding on the course of treatment for infertility. |
