314 Idiopathic Infertility - Dr. Sharmila Majumdar, Sexologist, Hyderabad
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idiopathic infertility

Unexplained infertility is idiopathic infertility in the sense that its cause remains unknown even after an infertility work-up, usually including semen analysis in the man and assessment of ovulation and fallopian tubes in the woman.

Possible causes

In unexplained infertility abnormalities are likely to be present but not detected by current methods. Possible problems could be that the egg is not released at the optimum time for fertilization, that it may not enter the fallopian tube, sperm may not be able to reach the egg, fertilization may fail to occur, transport of the zygote may be disturbed, or implantation fails. It is increasingly recognized that egg quality is of critical importance and women of advanced maternal age have eggs of reduced capacity for normal and successful fertilization. Also, polymorphisms in folate pathway genes could be one reason for fertility complications in some women with unexplained infertility. Aberrant reproductive immunology such as decreased maternal immune tolerance towards the embryo may also be a possible explanation. However, a growing body of evidence suggests that epigenetic modifications in sperm may be partially responsible.

Prevalence

In India up to 25% of infertile couples have unexplained infertility.

Management

Potential methods in unexplained infertility include oral ovarian stimulation agents as well as intrauterine insemination (IUI), intracervical insemination (ICI) and in vitro fertilization (IVF).

In women who have not had previous treatment, ovarian stimulation combined with IUI achieves approximately the same live birth rate as IVF.

On the other hand, in women who have had previous unsuccessful treatment, IVF achieves a live birth rate approximately 2-3 times greater than ovarian stimulation combined with IUI.

IUI and ICI has higher pregnancy rates when combined with ovarian stimulation in couples with unexplained infertility, for IUI being 13% unstimulated and 15% stimulated, and for ICI being 8% unstimulated and 15% stimulated. However, the rate of twin birth increases substantially with IUI or ICI combined with ovarian stimulation, for IUI being 6% unstimulated and 23% stimulated, and for ICI being 6% unstimulated and 23% stimulated.

According to oral ovarian stimulation agents should not be given to women with unexplained infertility. Rather, it is recommended that in vitro fertilization should be offered to women with unexplained infertility when they have not conceived after 2 years of regular unprotected sexual intercourse. IVF avails for embryo transfer of the appropriate number of embryos to give good chances of pregnancy with minimal risk of multiple birth.

A review of randomized studies came to the result that IVF in couples with a high chance of natural conception, as compared to IUI/ICI with or without ovarian stimulation, was more effective in three studies and less effective in two studies.

There is no evidence for an increased risk of ovarian hyperstimulation syndrome (OHSS) with IVF when compared with ovarian stimulation combined with IUI.

Prognosis

Prognosis in unexplained infertility depends on many factors, but can roughly be estimated by e.g. the Hunault model, which takes into account female age, duration of infertility/subfertility, infertility/subfertility being primary or secondary, percentage of motile sperm and being referred by a gynecologist, sexual medicine specialist or an infertility specialist.

doctorsharmila
Dr. Sharmila Majumdar is the First Female Sexologist in India, who specializes in Female & Male Sexual Dysfunction & Mental Health. Her professional experience comprises of National and International Consultations, co-authoring a Medical Handbook on “Male Infertility and Andrology”, Journal Publications, Presentations as a guest faculty at National & International Conferences on Sexology, Endocrinology, Gynecology & Psychology. She is also a Guest lecturer in several medical colleges in India. Dr. Sharmila Majumdar has also won an award for the best Presentation in Female Sexual Dysfunction in the National Conference of Sexology in 2008. She is also a columnist in leading local newspapers. She is a guest editor and a contributor in several medical portals and magazines. Dr. Sharmila Majumdar has rich experience of 11 years in the area of Sexual & Mental Health. She has successfully treated hundreds of patients globally. Her primary motto is optimal Sexual & Mental Health in Men and Women. She is up-to-date with the latest advancement in the emerging field of Sexual & Mental Health for the well-being of her patients. She strongly believes in the right to Physical, Sexual and Mental wellness. DR. SHARMILA MAJUMDAR IS AVAILABLE FOR CONSULTATION AT AVIS HOSPITAL, SEXUAL & MENTAL HEALTH CLINIC, HYDERABAD – 500033, TELENGANA, INDIA

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