Fertility Solutions

Fertility Solutions

INFERTILITY – Causes & Remedies

Definition: An inability to conceive after 1 year of unprotected intercourse

Causes:

In a couple:

  • Male – 35%
  • Female – 50%
  • Tubal & pelvic pathology – 35%
  • Ovulatory dysfunction – 15%
  • Unexplained – 10%
  • Unusual – 5%
Causes of male infertility
Pre-Testicular
  • Endocrine – gonadotrophin deficiency
  • Thyroid dysfunction
  • Hyperprolactinemia
  • Psychosexual – erectile dysfunction
  • Impotence
  • Drugs – Anti-hypertension
  • Anti-psychotics
  • Genetic
Testicular
  • Undescended testes
  • Varicocele
  • Mumps
  • Kartagener’s immotile cilia syndrome
Post Testicular
  • Obstruction of efferent duct
  • Cystic fibrosis
  • TB
Others – ejaculatory failure
  • Retrograde ejaculation
Causes of Female Infertility
Ovarian Factors
  • Anovulation
  • Luteal phase defect
  • Decreased ovarian reserve
Tubal & Peritoneal Factors
  • Pelvic inflammatory disease
  • Previous surgeries
  • Endometriosis
  • Tubal polyp or mucus debris
Uterine Factors
  • Fibroid, polyp
  • Intrauterine adhesion
  • Congenital malformation
Vaginal Factors
  • Vaginal Septum
  • Vaginal Atresia
Cervical Factors
  • Polyp
  • Pinhole cervix
  • Retroverted uterus
  • Congenital elongation of cervix or uterine prolapse
  • Infections
  • Immunological
Treatments
Ovulatory Factors
  • Ovulation induction drugs
  • Clomiphere citrate
  • Gonadotrophin
  • Ovulation induction drugs should be started between 2-7 day of menstrual cycle with monitoring of follicle size by transvaginal USG
  • When follicle reaches to the size of mature follicle (20mm size)
  • Human Chronic Gonadotrophic (HCG) is given for ovulation & evaluation occurs after 24-36 hrs of HCG
  • Couples are advised to stay together after ovulation
Adjuvant Drugs-
  • Cabergoline for hyperprolactinemia
  • Eltroxin for hypothyroidism
  • Metformin for insulin resistances
  • Laparoscopic ovarian drilling in cc- resistant PCOS (Polycystic Ovary Syndrome)
Tubal Factors
  • Laparoscopic surgeries
  • Laparoscopic salpingo ovariolysis (to remove peritubal adhesions)
  • Hysteroscopic cannulation for proximal tubal block
  • Tubo-tubal anastomosis for mid-tubal block
  • Fimbrioplasty & Neosalpingostomy for distal tubal block
Utero -Vaginal Factors
  • Myomectomy for fibroids
  • Metroplasty for uterine septum
  • Adhesiolysis with IVCD insertion
  • Enlargement of vaginal introitus (Fenton’s operation)

Laparoscopic Surgery

  • For endometriosis (Removal of chocolate cyst & fulguration of endometriotic spots
Intrauterine insemination
  • (IVI) 0-3ml of washed & concentrated sperm is injected through a flexible polythene catheter within the uterus
  • Indication – cervical stenosis
  • Immunological factors
  • Impotence or hypospadias
  • Oligospermia or asthenospermia
  • Unexplained infertility
Assisted Reproductive Techniques
  • IVF – ET – In – vitro fertilization embryo transfer
  • GIFT – Gamete intra-fallopian transfer
  • ZIFT – Zygote intra-fallopian transfer
  • ICSI – Intracytoplasmic sperm injection
Indications
  • Tubal disease
  • Endometriosis
  • Unexplained infertility
  • Failed ovulation induction
  • Ovarian failure
  • Male factor infertility
  • Women with genetic risk
Principal Steps
  • Controlled ovarian hyperstimulation
  • Monitoring of follicular growth
  • Oocyte retrieval
  • Fertilization in vitro (IVF, ICSI)
  • Embryo or gamete transfer
  • Luteal support with progesterone
Gestational Surrogacy
  • Woman with normal ovaries but no functional uterus
Embryo or Oocyte Donation
  • Women with premature ovarian failure
  • Women with removed ovaries
  • Poor ovarian reserve
  • Genetic disease