OUTLINE

Introduction Causative Factors

o Ageo Fallopian tubeso Ovulation problemso Endometriosiso Cervical Causeso Uterine causeso Behavioural factorso Unexplained Infertilityo Environmental and occupational factors

Diagnostics And Treatments In-vitro Fertilization

o The IVF Procedure Preventive Measures

o Maintaining a Healthy life Styleo Treating and Preventing existing Diseaseso Not Delaying Parenthood

References

INTRODUCTION

“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.

CAUSATIVE FACTORS :

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:

(1) Infection 

(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

occur.

Possible solutions: Ovulation-stimulating drugs such as clomiphene, follicle-stimulating

hormones, human chorionic gonadotrophin (HCG) and in vitro fertilisation (IVF) using

these drugs.

4. Endometriosis:

“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

inseminations.

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

Smoking

Alcohol

 Drugs

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. 

Lead

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. 

 Ethylene Oxide

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:

Hysterosalpingography (HSG):

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.

Laparoscopy:

 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

time.

IN-VITRO FERTILIZATION

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

III. Fertilization

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.

3. Fertilization:

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

pregnancy.

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.

PREVENTION:

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 or abnormalities.

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 parenthood.

REFERENCES

http://www.stanford.edu/class/siw198q/websites/reprotech/New%20Ways%20of %20Making%20Babies/Causefem.htm

http://www.babycentre.co.uk/e6020/major-causes-of-infertility-chart#ixzz2QedceUL3 D efinition of infertility By Mayo Clinic staff

Developmental Biology By F.Scott Gillbert www.gschool.com www.wikipedia.com