The post Idiopathic Infertility appeared first on Dr. Sharmila Majumdar - Sexologist Psychoanalyst in Hyderabad.
]]>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.
In India up to 25% of infertile couples have unexplained infertility.
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 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.
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]]>The post Various Causes Of Infertility appeared first on Dr. Sharmila Majumdar - Sexologist Psychoanalyst in Hyderabad.
]]>Sperm problems will contribute to about 40% of infertility cases. The normal working of the male reproductive system involves first the production of sufficient numbers of functional sperm cells and then the delivery of these sperms to the ejaculate. Key to the diagnosis of male infertility is a semen analysis, which assesses primarily sperm numbers, sperm movement and sperm form.
Dysfunction of the female reproductive organs is also apparent in around 40% of infertile couples. The most common identifiable causes of female fertility problems are outlined below:
Ovulatory dysfunction (or anovulation) where an egg is not released from the ovary every month, is the single most common cause of female infertility. Predominantly anovulation is caused by hormonal imbalances such as Polycystic Ovarian Syndrome (PCOS) but ovarian scarring and premature menopause can also result in failure to ovulate.
Tubal disease comprising anything from mild adhesions to complete blockage of the fallopian tubes, prevents fertilized eggs from travelling from the site of fertilization to the uterus. It may also prevent the sperm from reaching the egg. Normal uterine implantation can therefore not occur. The main causes of tubal infertility are pelvic infections caused by bacteria such as chlamydia, previous abdominal disease or surgery and ectopic pregnancy.
Endometriosis is characterized by excessive growth of the lining of the uterus. These endometrial cells can extend as far as the outside of the fallopian tubes, the ovaries and the bladder. As they respond to hormones the same way as they would do in the uterus, that is by growing and shedding cyclically, endometriosis can cause both fallopian tube and ovarian scarring.
Some people may not have difficulty conceiving, but have suffered from miscarriages. This is obviously extremely distressing for the couples involved. Our miscarriage clinic can help investigate these issues and attempt to help couples with any future pregnancy.
The following other factors may also be responsible for infertility in a smaller proportion of cases:
Please do consult a competent sexologist for unexplained infertility problems. Dr. Sharmila Majumdar also sees patients suffering from unexplained Infertility at our ‘Sexual & Mental Health Clinic’, Avis Hospital in Jubilee Hills, Hyderabad.
The post Various Causes Of Infertility appeared first on Dr. Sharmila Majumdar - Sexologist Psychoanalyst in Hyderabad.
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