7-26% of couples worldwide are infertile. There are many causes of infertility. Many cases of apparent infertility are treatable. Infertility may have a single cause in one of the partners, or it could be the result of a combination of factors.
Table of Contents
- Assisted Reproductive Technologies
Infertility due to male factor accounts for at least 40% of infertility cases. For this reason, it is very important that men also be investigated for fertility problems. While blockages and problems producing healthy sperm are often the main reasons for male infertility, there are a variety of issues that can be diagnosed.
Once a diagnosis has been made by a fertility specialist, a proper course of treatment can be recommended. Depending on the cause of male infertility, possible forms of treatment may include surgery, drugs, or assisted reproductive technologies, like ICSI.
Decreasing male fertility rates
Recent studies have identified several factors causing a decline in male fertility: The anti-impotence drug Viagra could be damaging sperm acrosomes, and lowering the taker’s ability to conceive (40% less). (Fertility and Sterility). Another study suggests that pollution from chemicals such as dioxin can lower a man’s sperm count. (in the environmental journal the Ends Report) .Endocrine-disrupting chemicals are also thought to be affecting fertility rates. Menevit is the ‘first ever drug for male infertility’ was developed in Australia. It contains antioxidants which work by acting on free radicals that fragment sperm, the main cause of infertility. In a preliminary study of 60 infertile men, the rate of pregnancy was increased significantly, but larger clinical trials are required before the drug can be merited.
Female infertility has many causes. One of them is delayed marriage and child-bearing. Choosing to have children later isn’t entirely about personal preference. First, for women who don’t want to go at it alone, there’s the question of finding someone to be a parent with. Second, it’s often difficult to have children and keep working if women want to do both.
With both the means and the incentive to wait to have children, more women are making the choice to delay. Yet fertility begins to decrease at 32 and the downward slope gets steeper after 37. That’s because as women get older, they have fewer and fewer eggs left. The eggs that remain are more likely to have abnormal DNA that will prevent them from becoming healthy babies. To find out whether the woman is infertile ultrasound is likely to be done first, as this can alert your specialist to any possible problems. There are also a number of blood tests that can be performed.
In women, the most common ones include Day 3 FSH testing, Luteinizing hormone (LH) testing, Progesterone testing, Estradiol Level testing, Hysterosalpingogram. For women who are suspected of having low ovarian reserves, a Day 3 Inhibin and a Clomiphene Challenge test may be performed.
A large percentage of couples face difficulties in getting pregnant, many have found success with Assisted Reproductive Technology (ART). ART involves a number of different procedures to help address fertility problems and increase the likelihood of pregnancy.
There is a long history of Doctors trying to provide ART to help couples start a family. John Hunter, the famous Scottish surgeon, carried out the first documented artificial insemination in the 1770s. Since then, there have been many new techniques introduced and new advances have brought better chances of success.
Assisted Reproductive Technologies
1. In Vitro fertilization method
It is a method in which egg cells are fertilized by sperm cells outside the mother’s womb (in vitro). The resulting embryos are then transferred back into the uterus.
Some steps of IVF includes
- Follicle suppression
- Controlled ovarian hyperstimulation
- Aspiration of eggs from follicles
- Fertilization, incubation, and selection of embryos
- Embryo transfer
2. Intracytoplasmic sperm injection (ICSI)
It involves the direct injection of sperm into eggs obtained from in-vitro fertilization (IVF).
How Is ICSI Performed?
The mature egg is held with a specialized pipette. A very delicate, sharp, and hollow needle is used to immobilize and pick up a single sperm. The needle is then carefully inserted through the shell of the egg and into the cytoplasm of the egg. The sperm is injected into the cytoplasm, and the needle is carefully removed. The eggs are checked the following day for evidence of normal fertilization.
Who needs it?
Men who have very poor semen quality or azoospermia should be offered ICSI. Low sperm count, Poor sperm motility, Experienced fertilization failure for unknown reasons in a previous IVF cycle, Lack of any sperm in ejaculate would benefit from it.
3. Intrauterine insemination (IUI)
It is a fertility treatment that involves placing sperm inside a woman’s uterus to facilitate fertilization. The goal of IUI is to increase the number of sperm that reach the fallopian tubes and subsequently increase the chance of fertilization. It is a less invasive and less expensive option compared to in vitro fertilization.
Before IUI, ovulation-stimulating medications may be used. The IUI procedure will then be performed around the time of ovulation, typically about 24-36 hours after the surge in LH hormone that indicates ovulation will occur soon. A semen sample will be washed by the lab to separate the semen from the seminal fluid. A catheter will then be used to insert the sperm directly into the uterus. This process maximizes the number of sperm cells that are placed in the uterus, thus increasing the possibility of conception.
4. Gamete Intra Fallopian Tube Transfer
The GIFT is an assisted reproductive procedure which involves removing a woman’s eggs, mixing them with sperm, and immediately placing them into a fallopian tube. One of the main differences between this procedure and IVF and ZIFT procedures is that in GIFT the fertilization process takes place inside the fallopian tube rather than in a laboratory.
How is GIFT performed?
Patients must first have an x-ray to determine the presence of at least one healthy fallopian tube. The doctor will also use a laparoscopy to ensure that there is not any scar tissue on the outside of the fallopian tube. Using a laparoscopy, eggs are then retrieved from the ovaries. The male provides a sperm sample the same day that the eggs are retrieved. The eggs are then mixed with the sperm in a catheter. The egg and sperm mixture is inserted into the fallopian tubes with a catheter. The woman is then provided with medication to build up the uterine lining to support implantation of a fertilized egg.
5. Zygote Intrafallopian Transfer: ZIFT
ZIFT is an assisted reproductive procedure similar to in-vitro fertilization and embryo transfer, the difference being that the fertilized embryo is transferred into the fallopian tube instead of the uterus. Because the fertilized egg is transferred directly into the tubes, the procedure is also referred to as tubal embryo transfer (TET).
How Is ZIFT Performed?
A woman’s ovaries are stimulated with medications to increase the probability of producing multiple eggs. Eggs are then collected through an aspiration procedure. Those eggs are fertilized in a laboratory in a procedure identical to IVF, with the exception of the time frame. During the ZIFT procedure, fertilized eggs are transferred within 24 hours, versus 3-5 days as used in a regular IVF cycle. The fertilized eggs are then transferred through a laparoscopic procedure where a catheter is placed deep in the fallopian tube and the fertilized eggs injected. The final step is to watch for early pregnancy symptoms.
It is the practice by which a woman (called a surrogate mother) becomes pregnant and gives birth to a baby in order to give it to someone who cannot have children.
In gestational surrogacy, an egg is removed from the intended mother or an anonymous donor and fertilized with the sperm of the intended father or anonymous donor. The fertilized egg, or embryo, is then transferred to a surrogate who carries the baby to term. In traditional surrogacy, the surrogate is impregnated naturally or artificially, but the resulting child is genetically related to the surrogate. Intended parents may seek a surrogacy arrangement when either pregnancy is medically impossible, pregnancy risks present an unacceptable danger to the mother’s health.
The creation of ‘female’ sperm and ‘male’ eggs might be a revolutionizing breakthrough if it is ever developed. It is suggested that such artificial gametes could offer the possibility of genetic reproduction to people in same-sex relationships, In fact, artificial gametes offer people to have genetically related offspring regardless of age, gender, relationship status or sexuality. Women could use the technique to produce eggs even after having gone through the menopause. Individuals who cannot find reproductive partners could even use artificial gamete technology to create complementary gametes from their own bodies to fertilize their ‘natural’ sperm or eggs.