General Information on Infertility

Infertility

‘Infertility’ is the term generally used to indicate the inability of a couple having normal, unprotected sex for over a year to conceive.
‘fertile’ couples.

Infertility is a very common problem. The World Health Organisation (WHO) believes there are approximately 60 - 80 million infertile couples in the world. According to WHO, about 15% of couples wishing to have children seek help with infertility at some point in their reproductive lives, usually after having tried for two years to conceive.

’s reproductive system at any time preventing them from conceiving. Generally speaking, it has been found that the source of infertility in couples is:

- in 30-40% of the cases, exclusively due to the female;
- in 10-30% of the cases, exclusively due to the male;
- in 15-30% of the cases, due to both the partners having detectable abnormalities.

Being unable to conceive comes as a surprise to most couples. Many would have spent years working at not getting pregnant. With no previous medical history to suggest fertility problems, many couples assume that once they discontinue practicing birth control, conception will take place easily. While for some couples this may be true, others learn to their dismay, that getting pregnant is not as simple as they assumed it would be.

There are a number of causes leading to infertility. Common causes among women are related to problems with the ovaries, fallopian tubes, uterus and aging. Men generally have infertility problems relating to sperm production and ejaculation. Poorly timed intercourse could also contribute towards infertility.

Feeling robbed of their virility; some men find it difficult to deal with their infertility while women suffer feelings of inadequacy and depression. Whatever the cause, infertility can lead to loss of self-esteem and confidence. These responses are normal and can be overcome through mutual support within the relationship.

While treating infertility is not a health need, many couples wishing to have a baby can choose to go in for infertility treatment. Infertility treatment has been the subject of scientific research for over 200 years and there a number of options available today to combat specific infertility-related problems. For instance, if ovulation is the problem, then tablets or injections may be prescribed to stimulate better egg production and if it is a case of blocked fallopian tubes, IVF (in vitro fertilization) or even tubal microsurgery may be recommended. Problems in the womb like fibroids or scarring can be removed through surgery. If it is a case of low sperm count then IVF (creating test tube babies) or IVF with ICSI (Intra cytoplasmic sperm injection - where individual sperm are directly injected into the female egg with a very fine glass needle), allows fertilization of the female egg to take place that would normally not have been possible.

Before opting for infertility treatment, it is absolutely essential to undergo investigations by qualified and experienced infertility treatment specialists. Tests should be conducted on both the male and the female. There are a number of tests that can be performed but the basic ones include hormone tests, ultrasound and sometimes an x-ray called HSG (hysterosalpingogram) that checks the womb and the tubes. The results of these tests could lead to further investigations being called for.

Most couples wishing to have a baby now no longer need to worry about conceiving. Under the guidance of a qualified health provider, they can go ahead and realize their dream of having a baby.

The Impact Of Infertility

Fertility is normally taken for granted. Couples imagine that getting pregnant is easy and often put a lot of effort into trying to avoid that very eventuality. Until one day, they feel they’re ready and decide it’s time to start a family. They do away with contraception and eagerly await the signs that will tell them that ‘it’s happened’!!
And they try, and they try, and still……nothing happens!

And that’s when the feelings of confusion start. They wonder if they’re doing something wrong, or worse still start fearing that there may be something wrong with one of them. They put more effort into ‘making the baby’ at the cost of their natural joy in each other and in their lovemaking, stressing themselves even further.

Until one day, they finally decide it’s time to visit a health professional. A physical examination and then maybe a few preliminary tests are called for, to ascertain the cause of non-conception. The tests can cause some couples a fair bit of distress and if it’s confirmed that one or both of them are infertile and with further testing they discover they may need to go in for assisted fertility treatment, their level of emotional turmoil becomes even greater.

A confirmed diagnosis of infertility can trigger feelings of bereavement, of loss and anger, frustration, disappointment, deep sadness and at some level, even guilt. An understanding that family, friends or society in general expects a baby can deepen the stress and feelings of inadequacy. Jealousy over others’ successful pregnancies causes some people to withdraw from interacting with those who have children or are pregnant, causing them to become isolated. All these negative emotions can trigger a depression and a sense of losing control over their lives.

The couple’s relationship may get impacted, their communications get affected, they lose their spontaneity and may even lose sexual interest in each other. At a time when they need to be closest, they might find themselves drifting away from each other.

It’s a vicious circle. A person discovers he/she or both of them are infertile. This information stresses them out, further impacting their fertility. They find themselves on an emotional roller coaster that very often leaves them feeling overwhelmed and incapable of coping with normal routine activities.

If these feelings continue for a long time without abating and if it impacts day-to-day functioning, maybe it’s time to seek help in learning to cope with these emotions.

Signs that it’s time to seek the help of a mental health professional include:

• Strained relationships over a long period
• Problems in completing tasks
• Problem concentrating on anything else but infertility
• Increased anxiety levels
• Altered sleeping patters
• Changes in appetite and weight
• Increased intake of alcohol or drugs
• Thinking about death
• Continued pessimism and feelings of worthlessness or guilt
• Constant state of anger.

Many patients find it helpful to be counseled while they are undergoing infertility treatment and today, counseling of infertile couples is considered part of a holistic approach to dealing with infertility. Becoming a part of a support group as well as communicating with other infertile couples has also been found to be very useful.

Coping With Infertility

Most people think it’s real easy to get pregnant. In fact, they spend a major amount of their time and energy working at not having a baby until they feel they’re ready for it. And when the time comes they feel is right, they stop all forms of contraception and make love, anticipating creating their own little bundle of joy.

And nothing happens! And they try again, and again … and again. Doubts begin to creep in until it’s staring them in the face, that something, somewhere, is wrong.
Contrary to popular belief, this is not uncommon. The couple decides to visit their health provider, who recommends certain tests and sometimes, the results point to one or the other or both partners being infertile. The news comes as a shock; they can’t believe this could be happening to them. All their excitement and eagerness at having their own baby is crushed. They may experience extreme sadness and an overwhelming sense of loss. One or both of them could get stressed and bitter.

While for some there may be no solution to their infertility, for the others today, there are a number of options available that make it possible for infertile couples to have their own baby. But the first step towards moving ahead is learning how to cope with the knowledge of their infertility.

You may be reading this because you find yourself in this very situation. Listed below are some suggestions on how to deal with the knowledge of one’s infertility and the best way to cope is to work along with your partner in a mutually supportive manner.

1. Accept reality. You or your partner or both of you are infertile. This is real and one needs to come to terms with this. The good news is that being infertile is not life-threatening. The bad news is that you cannot produce a baby the normal way. This is not your fault so don’t go berating yourself unnecessarily and feel there is something wrong with you or your partner. Accept you have a problem and gear up mentally and emotionally to deal with it. Know that there are many others out there facing the same reality.

2. Be sensitive. Just as you are experiencing strong emotions at learning about your inability to have a baby normally, your partner is also going through similar emotions. That does not necessarily mean that you will both be experiencing the same emotions at the same time. Be sensitive and supportive of each other and give each other the space and time to come to terms with the situation. Besides a feeling of not being alone, supporting each other will only strengthen the relationship.

3. Educate yourself and tap into a support network. There are many treatments available today to help infertile couples conceive. Educate yourself on all aspects of infertility and all the options available as well as all that is involved in availing of those options. Also, meet and interact with others who are in a similar situation and gain access to a wealth of information that will be available with infertility support groups.

4. Set limits. While there are a number of treatments available to deal with infertility, they are expensive, time consuming and involve a number of procedures that sometimes, could be traumatic. No one can tell you when to stop trying for a baby, but be real. Decide how much of yourself you want to dedicate towards getting pregnant and how much you are willing to spend.

5. Get professional help if you need to. Learning about one’s infertility can be extremely painful and if coming to terms with it is proving difficult, don’t hesitate to access professional help in learning to deal with it.

6. Decline to get involved in baby-focused issues or activities. Until you feel you are ready for it, it is perfectly alright for you to stay away from events or issues that are baby-centric. You need time to come to terms with your infertility and declining to participate in activities that concentrate on babies, if that upsets you, is pretty sensible.

7. Be optimistic and yet, realistic. With all the treatments and options available today to infertile couples, it is quite possible to get one’s expectations up. While optimism will aid fertility treatments be successful, be realistic and don’t set yourself up for disappointment. Know what the odds are and be prepared for any outcome.

8. Get involved in other activities. The shock of learning about your infertility may have robbed you of your natural enthusiasm and energy. Don’t allow yourself to fall into a rut of depression and negativity. Get involved in other activities that take your attention away from your inability to naturally have a baby. Do things that energize and interest you and bring back your enjoyment of life.

Treating Infertility

Infertility is defined as the failure to become pregnant after one year of normal, unprotected sex. There are many causes for infertility and while some of them are not treatable, today there are a number of infertility treatments available that make it possible for infertile couples to have a baby. The ultimate goal of infertility treatment is a healthy pregnancy and the birth of a healthy baby.

Infertility treatments for women are often used to:

• Bypass a blocked fallopian tube by collecting eggs from the ovaries for in vitro fertilization and placement of a fertilized egg in the uterus.
• Correct fallopian tube damage and structural ovarian or fallopian tube problems through tubal surgery.
• Bypass cervical problems (such as a narrow cervical opening or presence of sperm antibodies) with intrauterine insemination.
• Treat ovulation related problems with medications that stimulate production and the release of eggs. Clomiphene (Clomid, Serophene), GnRH, gonadotropins, and bromocriptine are some of the medications used for stimulating ovulation. However, treatments can vary according to the cause. For example, initial treatment of women with polycystic ovary syndrome (PCOS) often focuses on weight loss and metabolism.
• Treating the growth of uterine lining cells in other parts of the abdominal cavity (endometriosis) using laparoscopic surgery.
In the case of inexplicable or undetectable infertility even after extensive testing, some treatment options are available. Studies have shown that stimulating multiple egg production (superovulation) using clomiphene increases chances of pregnancy, as does flushing sperm through the vagina and cervix into the uterus using intrauterine insemination [IUI]

Male Infertility Treatments

• Semen without sperm can be treated by surgically taking mature or immature sperm from the testicles and using intracytoplasmic sperm injection to inject a sperm into an egg. Conception is then attempted by placing the fertilized egg in the uterus or fallopian tube.
• Low sperm counts can be treated by collecting and concentrating healthy sperm for insemination or assisted reproductive technology (ART) treatment.
• Structural problems can be treated surgically, increasing the chances of natural conception. Surgery can sometimes reverse a vasectomy, repair an enlarged vein in the scrotum (varicocele repair), or correct blockages in or absence of the vas deferens.
• Loss of sperm due to retrograde ejaculation (where the semen flows back into the bladder) can be recovered from the bladder, washed, and used for insemination.
• Sperm production problems caused by hormonal imbalances can be treated with medication or hormones that aid the hypothalamus and pituitary gland start producing normal sperm.
• If healthy sperm is not available using the above treatments, some couples may choose to use donor sperm combined with insemination or Assisted Reproductive Technology (ART). Others may opt for adoption.

Considerations while choosing treatment:

Although the underlying causes are not yet fully clear, studies show that conceiving using ART or IUI have slightly higher incidences rates of low birth weight and birth defects.
Both super ovulation medication and assisted reproductive technology increase your risk of conceiving a multiple pregnancy. Complications of a multiple pregnancy become more likely with each additional fetus.

Infertility treatment success is influenced by many factors, including your doctor's skill and experience, and the cause or causes of your infertility.

Infertility treatment centers are not widely available in some parts of the country, especially in rural areas. You may need to travel for treatment.

You need to be aware when reviewing clinic success rates, that infertility treatment centres treating more severe infertility problems may have lower success rates. Therefore, it's possible for a clinic with a lower success rate to have greater overall expertise than clinics with higher success rates.

When reviewing treatment success rates, remember that live birth rates are always lower than ovulation and pregnancy rates. Miscarriages are common among all women and are more likely among older women and women with poorly controlled, chronic health problems.

As you evaluate your long-term options, discuss whether and under what circumstances adoption would be a reasonable alternative to infertility treatment.