Infertility: Causes, diagnosis, risks, drugs, and treatments

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Infertility is defined as the inability to conceive after 12 months of unprotected sexual intercourse. Infertility may be attributed to the man,woman (Infertility does not mean that a couple will never have a child).There are several treatments available that may help to improve the chances of a conception and a successful pregnancy.

Infertility in men and women


Infertility is defined as the inability to conceive after 12 months of unprotected sexual intercourse. Infertility may be attributed to the man, the woman, or both partners. Infertility does not mean that a couple is sterile and will never have a child.

Approximately half of all couples who seek help for infertility will eventually conceive a child. There are several treatments available that may help to improve the chances of a conception and a successful pregnancy.

In Africa, More than 100 thousand cases per year (Nigeria). Ages affected 14-60. And usually self-diagnosable and treated by a medical professional.
Infertility: Causes, diagnosis, risks, drugs, and treatments

Causes of Infertility

Not all causes of infertility are known, however, infertility may be affected by genetic disorders, previous radiation and chemotherapy treatments for cancer and medical conditions such as thyroid problems or diabetes. Other factors may also play a role in the cause of infertility and may include:

In Women:
  • Advanced age
  • Endometriosis
  • Ovulation disorders
  • Abnormalities with the uterus or cervix
  • Damage or blockage in the fallopian tubes
  • Eating disorders.

Medications, treatments, and drugs that can affect fertility in a woman

Some drugs can affect fertility in a woman. This include:

  • Non-steroidal anti-inflammatory drugs (NSAIDs)
  • Chemotherapy
  • Radiation therapy
  • Illegal drugs.
Cholesterol
One study has found that high cholesterol levels may have an impact on fertility in women.


In Men:
  • Low sperm count
  • Varicocele or other testicle problems
  • Hormone problems
  • Exposure to certain chemicals or toxins
  • Abnormal spam

Also, if the sperm does not have the right shape, or they cannot travel rapidly and accurately towards the egg, conception may be difficult. Up to 2 percent of men are thought to have suboptimal sperm.

Abnormal semen may not be able to carry the sperm effectively too.

This can result from:

  • A medical condition
  • Overheated testicles the scrotum, the use of saunas or hot tubs, wearing tight clothes, and working in hot environments.
  • Ejaculation disorders
  • Hormonal imbalance.
In some cases, lifestyle factors such as obesity, smoking, and heavy alcohol or drug use can affect ovulation and sperm count and decrease levels of fertility.

Diagnosis of Infertility

During the initial infertility evaluation, both the female and male partner will undergo a full physical examination and their complete medical histories will be reviewed. In addition, blood tests and urine tests will be performed. Additional tests to determine the cause of infertility will also be performed and may include:

For Women:
  • Hysterosalpingography to evaluate the condition of the uterus and fallopian tubes
  • Hormone testing to check levels of hormones that control reproductive processes
  • Ovulation testing
  • Imaging tests of reproductive organs

For Men:
  • Semen analysis
  • Hormone level testing to check testosterone levels
  • Transrectal and scrotal ultrasound

Also, both partners may also be tested for any genetic defects that may be causing infertility.

Treatment of Infertility And Fertility Drugs

Treatment for infertility aims to maximize the couple's fertility potential and allow for successful conception. Recommendations for increasing fertility may be as simple as quitting smoking, avoiding alcohol and losing weight.
The couple may be advised to have sexual intercourse more often around the time of ovulation. Sperm can survive inside the female for up to 5 days, while an egg can be fertilized for up to 1 day after ovulation. In theory, it is possible to conceive on any of these 6 days that occur before and during ovulation.

Treatments may vary depending on the cause and may include:

Fertility drugs might be prescribed to regulate or induce ovulation.

They include:

  • Clomifene (Clomid, Serophene): This encourages ovulation in those who ovulate either irregularly or not at all, because of PCOS or another disorder. It makes the pituitary gland release more follicle-stimulating hormone (FSH) and luteinizing hormone (LH).
  • Metformin (Glucophage): If Clomifene is not effective, metformin may help women with PCOS, especially when linked to insulin resistance.
  • Human menopausal gonadotropin, or hMG (Repronex): This contains both FSH and LH. Patients who do not ovulate because of a fault in the pituitary gland may receive this drug as an injection.
  • Follicle-stimulating hormone (Gonal-F, Bravelle): This hormone is produced by the pituitary gland that controls estrogen production by the ovaries. It stimulates the ovaries to mature egg follicles.
  • Human chorionic gonadotropin (Ovidrel, Pregnyl): Used together with clomiphene, hMG, and FSH, this can stimulate the follicle to ovulate.
  • Gonadotropin-releasing hormone (Gn-RH) analogs: These can help women who ovulate too early—before the lead follicle is mature—during HMG treatment. It delivers a constant supply of Gn-RH to the pituitary gland, which alters the production of the hormone, allowing the doctor to induce follicle growth with FSH.
  • Bromocriptine (Parlodel): This drug inhibits prolactin production. Prolactin stimulates milk production during breastfeeding. Outside pregnancy and lactation, women with high levels of prolactin may have irregular ovulation cycles and fertility problems.

For Men:
  • Surgery to correct a varicocele
  • Medication to correct impotence
  • Sperm retrieval
  • Hormone treatments

Reducing the risk of multiple pregnancies

Infertility treatments may have side effects and the most common complication is multiple births, and as a result the greater the number of fetuses, the higher the risk of premature labor and delivery. Also, some infertility treatments that stimulate ovulation may cause a serious condition called ovarian hyperstimulation syndrome.
Careful monitoring during treatment and pregnancy can help reduce the risk of complications. The more fetuses there are, the higher the risk of premature labor.

If a woman needs an HCG injection to activate ovulation and ultrasound scans show that too many follicles have developed, it is possible to withhold the HCG injection. Couples may decide to go ahead regardless of the desire to become pregnant is very strong.

If too many embryos develop, one or more can be removed

Intrauterine insemination may also be performed to assist with pregnancy. In this procedure, a large amount of healthy sperm is implanted directly into the uterus at the time of ovulation through a thin catheter. If these infertility treatments are unsuccessful, the couple may decide to use other assisted reproductive technology options such as in vitro fertilization, intracytoplasmic sperm injection, eggs donor or sperm, or a surrogate.

Many couples may experience physical and psychological stress during infertility treatments, which can be costly, and may not be covered by insurance. The couple should discuss all fertility treatment options with a physician in order to determine the best approach to treat issues of infertility.

Types of Infertility

Infertility can be primary or secondary.

Primary infertility is when a couple has not conceived after trying for at least 12 months without using birth control

Secondary infertility is when they have previously conceived but are no longer able to.

Diagnosis of Infertility

Most people will visit a physician if there is no pregnancy after 12 months of trying.

If the woman is aged over 35 years, the couple may wish to see a doctor earlier, because fertility testing can take time, and female fertility starts to drop when a woman is in her 30s.

Infertility tests for men

The doctor will ask the man about his medical history, medications, and sexual habits and carry out a physical examination. The testicles will be checked for lumps or deformities, and the shape and structure of the penis will be examined for abnormalities.

  • Semen analysis: A sample may be taken to test for sperm concentration, motility, color, quality, any infections, and whether any blood is present. Sperm counts can fluctuate, so that several samples may be necessary.
  • Blood test.
  • Ultrasound: This may reveal issues such as ejaculatory duct obstruction or retrograde ejaculation.
  • Chlamydia test: Chlamydia can affect fertility, but antibiotics can treat it.

Infertility tests for women

A woman will undergo a general physical examination, and the doctor will ask about her medical history, medications, menstruation cycle, and sexual habits.

She will also undergo a gynecologic examination and a number of tests:

  1. Blood test.
  2. Hysterosalpingography: Fluid is injected into the woman's uterus and X-rays are taken to determine whether the fluid travels properly out of the uterus and into the fallopian tubes. If a blockage is present, surgery may be necessary.
  3. Laparoscopy: A thin, flexible tube with a camera at the end is inserted into the abdomen and pelvis, allowing a doctor to look at the fallopian tubes, uterus, and ovaries. This can reveal signs of endometriosis, scarring, blockages, and some irregularities of the uterus and fallopian tubes.
Other tests include:

  • ovarian reserve testing, to find out how effective the eggs are after ovulation
  • genetic testing, to see if a genetic abnormality is interfering with fertility
  • pelvic ultrasound, to produce an image of the uterus, fallopian tubes, and ovaries
  • Chlamydia test, which may indicate the need for antibiotic treatment
  • thyroid function test, as this may affect the hormonal balance

Additional Resources:

References

  • College of Medicine, University of Ibadan and others. Learn more
  • Montgomery fertility center, Rockville, MD 20852, USA. Learn more

  • MLA
  • Nordqvist, Christian. "Infertility in men and women." Medical News Today. MediLexicon, Intl., 4 Jan. 2018. Web.
  • 4 May. 2018. <https://www.medicalnewstoday.com/articles/165748.php>

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Health soothe: Infertility: Causes, diagnosis, risks, drugs, and treatments
Infertility: Causes, diagnosis, risks, drugs, and treatments
Infertility is defined as the inability to conceive after 12 months of unprotected sexual intercourse. Infertility may be attributed to the man,woman (Infertility does not mean that a couple will never have a child).There are several treatments available that may help to improve the chances of a conception and a successful pregnancy.
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