o Fallopian tubes
o Ovulation problems
o Cervical Causes
o Uterine causes
o Behavioural factors
o Unexplained Infertility
o Environmental and occupational factors
Diagnostics And Treatments
o The IVF Procedure
o Maintaining a Healthy life Style
o Treating and Preventing existing Diseases
o Not Delaying Parenthood
“Infertility is the absence of fertility or inability to sustain it after an appropriate duration
of attempting conception by regular intercourse.”
It is not a disease,neither a condition or symptom that prevents the physical well-being of the
infertile individual or couple. However,the desire to have children makes it certainly an important
condition,and it is usually managed in the context of clinical madicine.
About 10% of couples are affected by infertility, which means that they've been trying to get
pregnant for at least a year — or for at least six months. Both men and women can be infertile.
According to the Centers for Disease Control, 1/3 of the time the diagnosis is due to female
infertility, 1/3 of the time it is linked to male infertility, and the remaining cases of infertility are
due to a combination of factors from both partners. For approximately 20% of couples, the
cause cannot be determined.
The cause of female infertility can be difficult to diagnose, but many treatments are available.
Treatment isn't always necessary. Half of all infertile couples will go on to conceive a child
spontaneously within the next 24 months.
Female infertility can be also be caused by a number of factors, including the following:
1. Effect of Age:
Women are born with a finite number of eggs. Thus, as the reproductive years
progress, the number and quality of the eggs diminish. Eggs that become damaged or
develop chromosomal abnormalities cannot sustain a pregnancy. The chances of
having a baby decrease by 3% to 5% per year after the age of 30. This reduction
in fertility is noted to a much greater extent after age 40.
Possible solutions: Egg donation or surrogacy. Success rates 43 per cent of women
who have a fertilised donor egg implanted become pregnant
2. Damage to fallopian tubes:
Blocked or damaged fallopian tubes prevent eggs from getting to the uterus and
sperm from getting to the egg. Leading causes include pelvic inflammatory disease,
sexually transmitted diseases such as chlamydia, and previous sterilisation surgery.
Possible solutions: Laparoscopic surgery to open tubes, if possible (small area of
blockage). If surgery fails, in vitro fertilisation is an option.
The main causes of tubal damage include:
(2) Abdominal Diseases
(3) Previous Surgeries
(4) 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.
(5) Congenital Defects
In rare cases, women may be born with tubal abnormalities, usually
associated with uterus irregularities.
3. Ovulation problems (failing to ovulate a mature oocyte):
“Any condition (usually hormonal) that prevents the release of a mature egg from
an ovary,causes infertility. Possible symptoms include infrequent periods and
excessively heavy or light bleeding.”
(1) Hormonal Problems
These are the most common causes of anovulation. The process of ovulation
depends upon a complex balance of hormones and their interactions to be successful,
and any disruption in this process can hinder ovulation. Polycystic ovary syndrome, the
most common disorder responsible for this problem. This syndrome is characterized by
a reduced production of FSH, and normal or increased levels of LH, oestrogen and
testosterone. The current hypothesis is that the suppression of FSH associated with this
condition causes only partial development of ovarian follicles, and follicular cysts can be
detected in an ultrasound scan. The affected ovary often becomes surrounded with a
smooth white capsule and is double its normal size. The increased level of oestrogen
raises the risk of breast cancer.
(2) Scarred Ovaries
(3) Premature Menopause
(4) 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. The egg, therefore, remains inside the ovary and proper ovulation does not
Possible solutions: Ovulation-stimulating drugs such as clomiphene, follicle-stimulating
hormones, human chorionic gonadotrophin (HCG) and in vitro fertilisation (IVF) using
“Excessive growth of the lining of the uterus.”
Approximately 10% of infertile couples are affected by endometriosis For women with
endometriosis, the monthly fecundity (chance of getting pregnant) diminishes by 12 to
36%. Growth occurs not only in the uterus but also elsewhere in the abdomen, such as
in the fallopian tubes, ovaries and the pelvic peritoneum.
This condition, in which endometrial tissue (the uterine lining that sheds with
each monthly period) grows outside the uterus, is a major cause of infertility in women.
Possible symptoms: include painful menstrual periods, irregular or heavy bleeding and
possibly, repeated miscarriages.
Possible solutions: Laparoscopic surgery to remove abnormal tissue or unblock tubes
and assisted conception treatments.
5. Cervical causes:
A small group of women may have a cervical condition in which the sperm
cannot pass through the cervical canal. Whether due to abnormal mucus production or a
prior cervical surgical procedure, this problem may be treated with intrauterine
6. Uterine causes:
Abnormal anatomy of the uterus; the presence of polyps and fibroids.
7. Unexplained infertility:
The cause of infertility in approximately 20% of couples will not be determined
using the currently available methods of investigation.
8. Behavioral Factors:
Diet and Exercise
9. 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. Substances that can cause mutations,
birth defects, abortions, infertility or sterility are called reproductive toxins.
Exposure to lead sources has been proven to negatively impact fertility in humans. Lead
can produce teratospermias (abnormal sperm) and is thought to be an abortifacient, or
substance that causes artificial abortion.
Medical Treatments and Materials
Repeated exposure to radiation, ranging from simple x-rays to chemotherapy, has been
shown to contribute to a wide array of ovarian problems.
A chemical used both in the sterilization of surgical instruments and in the manufacturing
of certain pesticides, ethylene oxide may cause birth defects in early pregnancy and has
the potential to provoke early miscarriage.
DIOGNOSTICS AND TREATMENT:
If female infertility is suspected, your doctor may order several tests, including:
A blood test to check hormone levels
An endometrial biopsy to check the lining of the uterus
Two diagnostic tests that may be helpful in detecting scar tissue and tubal obstruction are
hysterosalpingography and laparoscopy:
This procedure involves either ultrasound or X-rays taken of the reproductive organs. Either dye
or saline and air are injected into the cervix and travel up through the fallopian tubes. This
enables the ultrasound or X-ray to reveal if the fallopian tubes are open or blocked.
In this procedure, a laparoscope (a slender tube fitted with a fiberoptic camera) is inserted into
the abdomen through a small incision near the belly button. The laparoscope enables the doctor
to view the outside of the uterus, ovaries, and fallopian tubes to detect abnormal growths, as in
endometriosis. The doctor can also check to see if the fallopian tubes are open at the same
Most infertile couples respond well to less complicated treatments, such as Hormonal
therapies and artificial insemination. However IVR remains the most commonly used for ART
procedures. Many people mistakenly believe that IVF is the only treatment option for infertile
couples.Actually, fewer than 5% of all patient who seek treatment for infertility receive IVF.
In-vitro fertilization is a kind of Assisted Reproductive Technology(ART) in which oocytes
and sperm retrieved from the male and female partners are placed together in a petri dish
where fertilization can take place. After the fertilized egg have begun dividing, they are
transferred into the female partner’s uterus, where implantation and embryonic development
can occur as in a typical pregnancy.
THE IVF PROCEDURE:
The IVF procedure has four basic steps:
I. Ovarian stimulation and monitoring
II. Egg retrieval
IV. Embryo transfer
1. Ovarian stimulation and monitoring:
Having several mature oocytes available for IVF increases the possibility that atleast one
will result in pregnancy. Typically women are injected with gonadotropins or anti-
estrogens over a period of days or weeks in order to “hyperstimulate” the ovaries to
produce mature oocytes.
2. Egg retrieval:
Once the follicle has matured (but not ruptured yet), the physician retrieves as many
oocytes as possible. This is done surgically, guiding an aspiration pipette to each mature
follicle and sucking up the oocyte. Once recovered , those oocytes that are mature and
healthy are transferred to a sterile container to await fertilization in the laboratory.
A semen sample is coolected from the male partner approximately 2 hours before the
female partner’s oocyte retrieval. These sperms are processed by a procedure called
‘’sperm washing’’ . The capacitated or washed sperms are placed in the petri dish with
oocyte, and the gametes are incubated at body temperature for 12 to 18 hours with
50,000 to 100000 motile sperms. If fertilization is successful, eggs will begin to divide.
4. Embryo transfer:
Embryo transfer is not complicated and can be performed without anethesia or surgery.
This procadure is usually done three days after egg retrieval and fertilization. The 6-8
celled healthy embryos are sucked into a tubular catheter and then transferred to the
uterus. Normal implantation and maturation of atleast one embryo is required to achieve
In cases, in which fertilization has been achieved in vitro, but after a number of cycles,
implantation into uterus fails, the physician may suggest “assisted hatching” , in which
a small hole is lysed in zona pellucida prior to inserting the embryo in the uterus.
This procedure ensures that the embryo will be able to hatch from zona pellucida in time
to adhere to the uterus.
Some cases of female infertility may be prevented through identified interventions:
Maintaining a healthy lifestyle.
Excessive exercise, consumption of caffeine and alcohol, and smoking are all associated
with decreased fertility. Eating a well-balanced, nutritious diet, with plenty of
fresh fruits and vegetables (plenty of folates), and maintaining a normal weight are
associated with better fertility prospects.
Treating or preventing existing diseases.
Identifying and controlling chronic diseases such as diabetes and hypothyroidism increases
fertility prospects. Lifelong practice ofsafer sex reduces the likelihood that sexually
transmitted diseases will impair fertility; obtaining prompt treatment for sexually transmitted
diseases reduces the likelihood that such infections will do significant damage.
Regular physical examinations (including pap smears) help detect early signs of infections
Not delaying parenthood.
Fertility does not ultimately cease before menopause, but it starts declining after age 27
and drops at a somewhat greater rate after age 35.Women whose biological mothers had
unusual or abnormal issues related to conceiving may be at particular risk for some
conditions, such as premature menopause, that can be mitigated by not delaying
D efinition of infertility By Mayo Clinic staff
Developmental Biology By F.Scott Gillbert