Infertility is defined as inability to naturally conceive a baby or carry it out. A couple is concerned to be infertile when it cannot conceive a baby or carry the pregnancy to term after a year of practicing normal sexual intercourse.
Healthy couples in the middle of their 20’s have an estimated chance of 25% to become pregnant in every month.
6.1 million of adults are infertile in the United States. One third of cases is due to female infertility, another one third accounts for male infertility, 15% of infertile cases is due to the factors of both partners and the rest is considered to be unexplained cases.
Infertility is classified as primary and secondary infertility.
Primary infertility is when a couple cannot conceive a baby and they have had no babies before. For example, Robertsonian translocation in the chromosomes causes recurrent abortions or complete infertility.
Secondary infertility is defined when a couple have already had a baby but is not able to conceive another one or carry the pregnancy to term. This may occur due to many medical conditions, illnesses, traumas etc. In addition, a couple may not be able to have a baby due to age or because they are in a big stress of becoming another baby. If either of the partners in a couple has been changed, infertility is not considered to be secondary.
Female factors include various hormonal disorders, such as diabetes, thyroid disorders, adrenal disease. Also, female infertility may be caused by serious diseases of the liver and kidneys. Even psychological factors play an important role. There are several central factors, associated with different hypothalamic-pituitary disorders, such as hypopituitarism and hypothalamic dysfunction. Many gynecological diseases and syndromes may impair reproductive function. These include ovarian disorders, such as polycystic ovary syndrome, luteal dysfunction, ovarian neoplasm and many others. Tubal occlusion, endometriosis, pelvic inflammatory disease and pelvic adhesions are the most frequent reasons of female infertility.
Some conditions, related to the uterus, cervix and vagina may also affect fertility. These are vaginismus, vaginal obstruction, cervical stenosis, antisperm antibodies found in the cervix, insufficient cervical mucus, so the sperm cannot travel further and survive.
Certain genetic or inborn disorders also result in female infertility. These include uterine malformations, Asherman’s syndrome, intersexed conditions, turner syndrome.
Males may also be infertile due to hormonal disorders, which affect the development of their reproductive system and the sperm. Such disorders include diabetes, thyroid, hyperprolactinemia, hypopituitarism, hypogonadism. Fertility may be affected by psychological factors, alcohol, drugs and smoking. Some genetic causes impair the fertility function, such as Klinefelter syndrome. There are also many specific testicular reasons which result in infertility. These are cryptorchidism, hydrocele, varicocele, seminoma, neoplasm of the seminal cells. Mumps, a simple childhood disease, may affect the reproductive function. Different posttesticular factors, such as obstruction of the vas deferens, infection, impotence, retrograde ejaculation, when the sperm does not come out from the urethra but redirects to the urinary bladder, affect reproductive function of a man. And finally, the quality of the sperm, which is defined by its motility and number of sperm present in the ejaculate, is also very important for a man to fertilize a woman. A man may produce too few sperm or it can be of poor motility.
The couple may be infertile if both of the partners are infertile or only one of the partners have reproductive deficiency or, in a woman’s case, she is not able to carry the pregnancy to term. Also, there are cases when individually both partners are fertile but being together, they need assistance in having a baby.
There are various treatment options, which are used depending on the disorder. Fertility medicines, such as clomifene citrate, are used to stimulate ovulation. Obstructed Fallopian tubes can be treated with surgery, called tuboplasty. In vitro fertilization is especially popular these days. In in vitro fertilization donor egs or sperm may be used when a couple’s reproductive cells are unusable or impaired. Intracytoplasm sperm injection, zygote intrafallopian transfer and gamete intrefallopian transfer are three modifications of in vitro fertilization.