Childbearing and raising of children are extremely important events in every human’s life and are strongly associated with the ultimate goals of completeness, happiness and family integration. It is widely accepted that human existence reaches completeness through a child and fulfills the individual’s need for reproduction. Human fertility, compared with other species of animal kingdom, is unfortunately low.
Infertility is typically defined as the inability to achieve pregnancy after one year of unprotected intercourse. If you have been trying to conceive for a year or more, you should consider an infertility evaluation. However, if you are 35 years or older, you should begin the infertility evaluation after about six months of unprotected intercourse rather than a year, so as not to delay potentially needed treatment.
Causes of Female Infertility
According to the Center of Disease Control (CDC, 2013), the causes of female infertility can be divided into three broad categories including defective ovulation, transport and implantation. These categories are further discussed below in detail.
Defective Ovulation: Defective ovulation occurs because of the following causes:
The dysfunction of hypothalamus and pituitary gland can lead to an excess amount of prolactin, this may prevent ovulation. Moreover, other endocrine glands including adrenals and thyroid may also delay ovulation. When the corpus luteum, fails to produce enough progesterone required to thicken the uterine lining, the fertilized egg may not be able to implant, thus leading to infertility.
Polycystic ovarian disease (PCO) can lead to infertility because of an increased amount of testosterone and LH and decrease uptake of glucose by muscle, fat and liver cells resulting in the production of large amounts of insulin by the pancreas. Low FSH levels also hinder the production of eggs from the ovarian follicles, and lead to form fluid-filled ovarian cysts that eventually cover the whole ovaries and prevent conception.
This refers to a condition in which sections of the uterine lining implant in the vagina, ovaries, fallopian tubes or pelvis. These implants form fluid- filled cysts that grow with each menstrual cycle, and eventually turn into blisters and scars. These scars then block the passage of the egg and delay pregnancy.
Defective Transport: The following can lead to defective transport of ovum and sperm:
Occurrence of Pelvic Inflammatory Disease (PID), gonorrhea, peritonitis, previous tubal surgery, and fimbrial adhesions can cause tubal obstruction; as a result the egg is not released or trapped, therefore, delaying conception.
Scar tissue after abdominal surgery
After abdominal surgeries, presence of scar tissue may alter the movement of the ovaries, fallopian tubes, and uterus, resulting in infertility.
Presence of psychosexual problem such as vaginismus, or dyspareunia may hinder fertilization and make the couple infertile.
Trauma, surgery, infection, anti-sperm antibodies in the cervical mucus may also delay pregnancy.
Defective Implantation: Defective implantation can occur because of the following causes:
Congenital anomaly and fibroids
Congenital uterine anomaly such as bicornuate uterus and uterine fibroids near the fallopian tubes or cervix may alter implantation of the zygote and cause infertility.
Causes of Male Infertility
According to the CDC (2013), male causes of infertility are divided into the following four main categories:
Presence of endocrine disorders such as diabetes mellitus and hyperthyroidism lead to azospermia or the formation of faulty sperms that are not capable to fertilize the ovum. Moreover, testicular disorder such as undescended testis can also affect fertility.
Obstruction of the seminal vesicles or absence of the seminal ducts may affect the mobility of the sperms, and thus end up in infertility.
The psychosexual problems like impotence, ejaculatory dysfunction, physical disability, hypospadias, and epispadias can affect fertility of males.
Infertility treatment depends on the cause, duration, both partners age, and personal preferences. The couple should be explained that some of the causes of infertility cannot be corrected. Financial, physical, and time commitment is required for infertility treatment. The following treatment modalities can be explained to the couple after assessing and evaluating the couple’s health:
Intra-uterine Insemination (IUI): This could be used for unexplained infertility and female cases with minimal endometriosis and mild male factor infertility problems. In this, healthy sperms that have been collected and concentrated are placed directly in the uterus around the time of ovulation. The timing of IUI can be coordinated with the normal cycle or by using fertility medications.
In-Vitro Fertilization (IVF): In IVF, multiple mature eggs from a woman are retrieved, and fertilized with a man’s sperm outside the womb and inside a laboratory. Then, the fertilized embryos are implanted in the uterus after three to five days of fertilization.
Zygote Intra-fallopian Transfer (ZIFT) and Gamete Intrafallopian Transfer (GIFT): In ZIFT, the fertilized egg is directly transferred into the fallopian tube; whereas, in GIFT a mixture of sperms and eggs is placed in the fallopian tube and fertilization occurs there.
Intracytoplasmic Sperm Injection (ICSI): In ICSI, a single healthy sperm is injected directly into a mature egg. ICSI is used when there is a problem with the quality of the semen, or there are few sperms, or prior IVF cycles have failed.
Assisted Hatching: Through this technique, implantation of the embryo into the uterus is assisted by breaking the outer covering of the embryo. This helps the embryo to smoothly implant
Donor Eggs and Sperms: Assisted reproductive technology mostly uses the married couple’s eggs and sperms, but when there are severe issues with the eggs and sperms then donor sperms or even embryo is taken to enhance fertility.
Gestational Carrier: This is sometimes called as surrogate pregnancy, when a woman who does not have a uterus or if the uterus is not functional and to whom the pregnancy can endanger health, the couple can decide to have a gestational carrier, who carries the couple’s embryo in the uterus.
Adoption: This can be an option for couples who have multiple unexplained IVF failure cycles.