Infertility: A Serious Health Concern

Infertility: A Serious Health Concern

Infertility has been defined as the inability of a couple to conceive
after one year of regular intercourse without the use of
contraceptives. The definition has also come to include couples who
are able to conceive but, due to repeated miscarriages, are unable to
carry a pregnancy to term.
The World Health Organization (WHO) estimates that approximately 8-10%
of couples experience some form of infertility problem. On a worldwide
scale, this means that 50-80 million people suffer from infertility.
However, the incidence of infertility may vary from region to region

Factors affecting conception
 The chances of achieving pregnancy for a couple in a given cycle
depend upon many factors, and the most important ones are:

The age of the woman. As age increase the number of eggs and their
quality starts decreases. After puberty, women become less fertile as
they age. Fertility declines sharply after the age of 35, then again
between 37 and 40. If possible, women should start to build a family
in their twenties or early thirties. In addition, fertility treatments
tend to be more successful in younger women, so seek treatment as soon
as infertility is suspected. Older women who are infertile can have
success with donor eggs.

Frequency of intercourse, couples who have less frequent intercourse
have diminished chance of conceiving. A couple is only fertile for
about six days each month. Using the basal body temperature, vaginal
secretions, and other fertility signs, a couple can be certain that
they are having intercourse when the woman is most likely to conceive.
Much is made of using the correct position and elevating the woman's
pelvis, but during the most fertile times of the month, sperm are able
to swim up to the uterus from any position. However, many consider the
missionary position (man on top, face to face) the most successful
because it allows deep penetration. The woman can elevate her pelvis
with a pillow during intercourse and for about 15-20 minutes afterward
so that gravity can assist the sperm in reaching their goal. After 20
minutes, all of the motile sperm will have made the trek. Any
"leakage" won't reduce the likelihood of pregnancy.

  
FINDING YOUR FERTILE DAYS
 
You can identify the days you are most likely to be fertile by
charting your temperature each day and checking your normal vaginal
discharge (note on the chart when it be comes clear, stretchy, and
abundant). According to this chart, this woman probably ovulated
around day 14 (right before a steep rise in her temperature) and
noticed a change in her discharge on days 12 to 14.
Reference:
American Medical Association.
 
"Trying time" that is how long the couples have been trying to get
pregnant. This is an important concept. The longer a couple has been
trying to conceive without success, the lesser their chances of
getting pregnant without medical help.

The presence of fertility problems. Example: Polycystic Ovary Syndrome
(PCOS)

Possible Causes of infertility

 There are numerous causes of infertility. In men, these include
environmental and hormonal factors that affect the production of
healthy, motile sperm and normal semen, as well as blockages that
affect the delivery of sperm. In women, the causes are more varied
since she plays a greater role in reproduction. First, one of the
organs involved in reproduction may be absent, mal-formed or
non-functional such as damaged fallopian tubes. Less frequent causes
include, for example, endometriosis and hyperprolactinemia.. Second,
the organs may be normal, but the complex hormonal feedback system
that is necessary to support follicular development, ovulation and
implantation of the fertilized egg may be disrupted.

Other causes
Body weight
Women who are significantly overweight or underweight can face
difficulties in getting pregnant. Low weight or excessive weightloss
can lead to decrease in important hormonal "messages" that the brain
sends to the ovaries in women and testes in men. Gonardotropin
releasing hormone(GnRH) is produced in the part of the brain called
Hypothalamus. The release of GnRH leads to release of hormonal
messangers LH and FSH by the pitutary glands. LH and FSH are critical
for the development of eggs in ovaries and sperm in the testes.
Similarly being overweight or obese can affect the hormonal signals to
the ovaries and testes. Increased weight can also increase insulin
levels in women which in turn may cause the ovaries to overproduce the
male hormones and stop releasing eggs. Weight loss is the best plan of
action in such cases supported with clomiphene or gonadotropins. Body
fat plays a critical role in human reproduction. Both excess and
deficiency of body fat lead to reproductive failure. Body weight
disorders is one of the first potential causes of reproductive failure
in both men and women. This is a problem that can be corrected by the
affected individual and the infertile couple.

Diet & exercise
Foods rich in manganese (oats, wheat germ, rye bread and peas) promote
the action of oestrogen, and vitamin B's  (wholegrains such as brown
rice, wheat germ, pulses oats and green vegetables), involved in
oestrogen metabolism. Their deficiency can hamper pursuing pregnancy.
Soya beans and wholemeal bread will provide magnesium.

Infertility is associated with low vitamin D, and PMS can be
completely reversed by addition of calcium, magnesium and vitamin D.
Vitamin D supports production of estrogen in men and women. PMS has
been completely reversed by addition of calcium, magnesium and vitamin
D. Menstrual migraine is associated with low levels of vitamin D and
calcium. Ten minutes of daily exposure of the arms and legs to
sunlight will supply us with all the vitamin D that we need as humans
can manufacture vitamin D from cholesterol by the action of sunlight
on the skin.

Proper diet and exercise is essential to maintain a healthy weight. At
the same time extreme exercise can lead to reduced sperm production in
men and lack of ovulation in women by decreasing the brain message to
the testes and ovaries. It is impossible to know how much exercise for
a person is too much. Generally running more than 10 miles a week is
considered too much when trying to conceive. Try bringing about
modifications in your exercise routine in order to treat reproductive
problems.

Smoking
Smoking is a known contributor to infertility problems in women and
can lead to an increased rate of miscarriage. Women who smoke
regularly also may enter menopause at an earlier age because of the
damaging effect of tobacco smoke on ovaries. Men who smoke may have
diminished sperm function.

Drugs and Alcohol
Alcohol is known to cause structural and developmental defects in a
fetus. This group of disorders is termed the "Fetal Alcohol Syndrome."
It is best to avoid drinking alcohol during the course of your
infertility treatment or during pregnancy. Marijuana use in men leads
to poor sperm counts that take many weeks to recover after exposure.
Other recreational drugs can lead to other significant problems for
pregnancy. At the same time it is desirable to limit the intake of
tea, coffee, soft drinks which contains caffeine.

Vitamins 
Women who take folic acid before they conceive reduce their risk of
neural tube defects in the fetus by 50%. It is recommended that all
women undergoing infertility treatment take at least 0.4 mg of folic
acid (folate) before they conceive and during the course of their
pregnancy. Some high potency vitamins may have a detrimental effect in
pregnancy (i.e. too high level of vitamin A).

Medication
Regular medications of modern medicine in certain ailments like ulcer,
high blood pressure etc, causes low sperm count & negative side
effects that causes infertility problems in both man & woman.

STDs & PID
Pelvic inflammatory disease (PID) is a major cause of infertility in
women. Any sexually transmitted disease (STD), such as gonorrhea or
syphilis, may cause PID, which can lead to infertility. Prevent STDs
by abstaining from sexual intercourse or by using condoms.

Stress
Does stress cause infertility or does infertility cause stress? Most
doctors agree that reducing stress won't ensure pregnancy, but it may
help a couple cope with infertility and making treatment decisions.

Eating Disorders
The eating disorders anorexia and bulimia can have long lasting
impacts (several years) on fertility. Women with these conditions may
not ovulate even if they menstruate. Eggs may not develop properly. In
these cases, treating the disease is essential to restoring fertility.

Evaluation of Female Infertility

Infertility Evaluation process involves several steps. The steps in
the evaluation portion of the process will include a complete history,
physical examination and specific tests that should be clearly
outlined by your physician at your first visit.
The physician should provide her patient with the following
information:

The 4 Goals In The INFERTILITY EVALUATION for women are:

To determine potential causes so that effective therapy can be given. 

To dispel misinformation and provide accurate information. 

To create an environment of emotional support. 

To determine the proper time of discontinuing investigation and
treatment.

1) To determine potential causes so that effective therapy can be
given.

Inability to conceive can be very frustrating & depressing , more so
when the "trying time" has been going on for too long . We completly
understand that motherhood is a blessing for every women. In the light
of the same WF health & fitness experts will try in the best of their
capacity to answer your innumerable doubts and questions through this
article so as to facilitate you in taking a decision to overcome this
crisis .
To understand the possible causes it is important that you consult a
doctor who will go into a complete medical, surgical, sexual, social
and family history, as a part of initial evaluation.


Possible questions your doctor might ask

Your medical history includes questions concerning illnesses or
diseases you & your partner have had or have including what
medications, both prescription and over-the-counter preparations you
currently use.

Consumption of tobacco products, alcohol, marijuana or other street
drugs. Also the amount of caffeinated beverages you drink may be asked
as all of these may adversely affect reproduction.

Questions about your previous contraceptive practices such as use of
an Intrauterine Device (IUD) .
Your occupation and your potential exposure to environmental hazards
such as pesticides, heavy metals like mercury and lead, organic
solvents, hot tubs and saunas.

Frequency of sexual intercourse. 

How long you have been attempting pregnancy . 

Your partners inability to achieve or sustain an erection (impotence)
can also be a factor, as can pain on ejaculation if you experience or
pain with intercourse, which is called (dyspareuia).

A history of previous pelvic infections or sexually transmitted
diseases .

Your physician will also ask you questions concerning your menstrual
history such as how old were you when you got your first period, when
was your last period, how often does it come and how many days does it
usually last.
You may also be asked whether you experience premenstrual symptoms
called molimina, which usually indicate ovulatory (egg release from
the ovary) cycles. Moliminal symptoms often include breast tenderness,
fluid retention (swelling) and irritability and pelvic discomfort
experienced approximately 2 weeks before your period (mid-cycle pain
or Mittleshmeritz) may also indicate ovulation. If you experience
this, you will be asked if you take medications for this mid-cycle
pain.

Questions concerning your bowel and bladder habits and whether you
experience pain or bleeding with these .

How you and your partner are dealing with the intense emotional issues
involved with infertility as it can be a life crises for many couples.
 

2) To dispel misinformation and provide accurate information.

It must be the goal of a health provider to help patient in doing away
with the misconceptions regarding fertility/infertility and provide
them easy to understand accurate information. To begin with they need
to be listened to, before starting upon any advice . It is very
important to understand patient's state of mind, put their doubts at
rest and provide them with essential information.

3) To create an environment of emotional support.

Emotional support is an essential part of every therapy , more in the
case of women suffering from this life crisis. Feeling alone, anxious,
or even out of control are common reactions. The woman should be
convinced that her behavioral reactions are normal and unpreventable
.It might seem hard to seek out emotional support because of the fear
of being left emotionally out of control at a time when they are
already experiencing an enormous loss of control around their
body’s ability to perform a basic function.

Try to come out with your problem and discuss it with your friend or a
counselor. For some meeting with a group of individuals struggling
with infertility is more comfortable.
A counselor can help with questions about multiple pregnancy,
pregnancy loss, and when and whether to start or stop treatment.
Having a regular place to “leave” your emotional burdens
can also help free you up to enjoy life more fully and spend less time
obsessing about infertility

Whatever you decide, know that you are not alone in this struggle if
you don't want to be, and feel free to talk with us about your
frustrations and fears.

4) To determine the proper time of discontinuing investigation and
treatment.

Treatment prescribed by the gynaecologist might need to be repeated in
6-7 cycles. If results are not achieved, your doctor might advice to
other treatments options available.


Tests of Infertility in female

 There are many potentially useful tests that can be obtained as part
of the infertility evaluation for women. However, therapeutic options
largely depend on the results of three fundamental tests:

Uterine Structural Tests 
(i.e. for patency of fallopian tubes and anatomy of uterus)

Hysterosalpingography (HSG) 

Office Hysteroscopy 

Sonohystogram 

Ovarian Reserve Testing

This includes a Cycle Day 3 FSH or preferably, a Clomiphene citrate
Challenge Test.

There are several additional tests that have been used to evaluate
infertility.

Tests for Ovulation

Problems of ovulation (egg release from the ovary) account for
approximately 25% of infertility and may be suggested on the basis of
the history and physical examination.

If your menstrual periods occur at monthly intervals and you also have
breast tenderness, fluid retention, irritability and menstrual cramps,
then your cycles are usually ovulatory, but not necessarily. Therefore
some test of ovulation is necessary:

Urine LH Testing 

Blood LH Testing 

Basal Body Temperature Graph (BBTG) 

Ultrasound Monitoring 

MidLuteal Progesterone Testing 

Endometrial Biopsy 

More Tests in the Female

There are many tests that have been designed to evaluate potential
causes of infertility in women. Very few of these tests, however have
been well standardized or even definitively associated with
infertility. Definitive therapy relating to abnormal test results is
also lacking. The following tests although sometimes suggested are
generally no longer recommended as part of the basic infertility
evaluation:

Post Coital Test (Sims-Huhner Test, PK) 

Cervical Mucus Penetration 

Cervical Cultures 

Immune Testing 

Hormone Testing 

Laparoscopy 

Diagnostic tests are guided by the history and physical examination
and include simultaneous analysis of both you and your partner.
Testing implies that the knowledge of the result can be used to guide
therapy leading to a successful pregnancy.

There are many tests that have been suggested. However, perhaps the
most cost-effective and arguably the most clinically useful are a
semen analysis, an intrauterine structural study and a test of ovarian
age (ovarian reserve) and tubal patency tests.

Infertility testing in women is designed primarily to determine
anatomical factors, most commonly abnormalities within the uterine
cavity, and problems with ovarian function and tubal patency.

Treatment Options Available

If you think that you are having difficulty becoming pregnant, you
should seek the assistance of your physician. There are several types
of treatment. Appropriate treatment depends on your particular
situation or underlying medical or surgical condition largely depends
on the reason thought to be responsible for difficulty in becoming
pregnant.

These treatments may range from the simple like appropriate timing of
intercourse to the complex, high-tech therapies like in vitro
fertilization (IVF) in which medications are given to induce the
production of eggs that can be collected and then put together with
sperm in the laboratory so that fertilization occurs. The fertilized
eggs can then be cultured for 3 to 5 days followed by embryo transfer
to the uterus.

IVF (In Vitro Fertilization) 

IVF has been used safely and effectively for more than two decades. In
a typical IVF procedure, a woman is treated with fertility drugs to
regulate her menstrual cycle and stimulate the development of
higher-quality eggs. This process helps to ensure that a sufficient
number of healthy eggs are available for fertilization. Eggs are then
"retrieved" or collected and prepared for insemination using sperm
from the male partner or a donor. Fertilization occurs in a laboratory
dish specially prepared with a culture medium that supports and
nourishes the fertilized eggs. Within about 72 hours after
fertilization, embryos are transferred into the woman's uterus.

Since the introduction of IVF, there have been many other important
developments that have made infertility treatment even more effective
for both men and women:

In vitro fertilization with endometrial cell co-culture is a special
technique for couples with poor embryo quality where cells from the
woman's uterus are used to enhance development of fertilized eggs.
CRMI refined this procedure using the woman's own endometrial cells
rather than cells from animals.

Intracytoplasmic sperm injection (ICSI) is a procedure where a single
sperm is selected and delivered directly into a woman's egg. ICSI is
an effective option for men with low sperm count or sperm that cannot
reach the egg successfully.

Cryopreservation is the ability to freeze and store embryos that are
not transferred right away. This process can allow couples to achieve
a pregnancy later, either after a first birth or following medical
treatments that might affect fertility such as chemotherapy for cancer
treatment.

Preimplantation genetic diagnosis (PGD) can be used to identify
embryos that do not carry the gene for certain inherited diseases
(such as cystic fibrosis and sickle cell anemia). This capability
greatly reduces the risk that these diseases will be passed on to
children.

For male factor infertility, our comprehensive services include
microsurgical repair of obstructions and vasectomy reversals, surgical
repair of varicoceles, and epididymal and testicular sperm retrieval
for use with IVF and ICSI.

Diet & Lifestyle modifications

There are several important lifestyle changes that you can do that
will not only improve your overall health but may also positively
increase your chances for a successful pregnancy. Good lifestyle
choices and habits promote good health for years to come.

Your diet should include a variety of selections from the 5 basic food
groups.

Meat, fowl, legumes, (peas, beans) 

Dairy 

Grain, cereal, pasta, rice 

Fruits 

Vegetables 

Approximately 1600 to 1800 calories a day is a good range for most
women to stay in without gaining wait.

Basic rules for a good weight reducing diet include:

Don't eat less than 1200 calories a day 

Drink plenty of water (8-10 glasses a day) 

Eat a balanced diet with reduced fat intake 

Don't skip meals 

Reduce alcohol intake 

Avoid fad diets 

Exercise 

Consult your physician before dieting 

When dieting goes too far it can lead to being too thin and can lead
to very serious eating disorders, anorexia nervosa and bulimia, which
are also associated with difficulty becoming pregnant.

Anorexia nervosa is characterized by a morbid fear of fatness that
leads to drastic dieting to the point of self starvation. Bulimia is
characterized by binge eating (overeating) and purging (forced
vomiting). These eating disorders can be treated with counseling and
sometimes medication for depression which often is associated with
eating disorders.

If you are unsure whether you have an eating disorder the following
questions may be helpful:

Do you have regular menstrual periods? 

How many times a day do you weigh yourself? 

Have you lost or gained a significant amount of weight in the past 3
months?

Do you use laxatives or diuretics regularly to help you loose weight? 

Do you often eat large amounts of food in secret? 

Do you make yourself vomit after a large meal? 

Do you exercise excessively to lose or keep off weight? 

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