A couple is said to suffer infertility when they are unable to become pregnant after having regular unprotected intercourse for around 1 year. It may be because one of the partners cannot take part in the conception process or because the female partner cannot carry a baby for the full pregnancy duration until it is born.
Approximately 10 % of reproductive-age women are believed to have trouble getting or staying pregnant. Around 8-12% of couples around the world face fertility issues, and in 45 to 50% of cases, infertility is due to factors affecting men only. Noted that, an intended parent is an individual or couple who, for whatever reason, are unable to conceive on their own and choose surrogacy to start a family.
Causes of Infertility in Men
Male infertility often results from issues with producing healthy sperm. Sperm may not be mature, have an abnormal shape, or be immobile.
Other possible causes are:
- Ejaculation problems
- Hormone imbalances
- Hanging testicles
- Anti-sperm antibodies
- Defects of the tubules that carry sperm
- Varicocele (an enlargement of the veins in the scrotum)
Infertility in Women
Infertility testing for women usually starts with a medical history and physical examination, which includes a pelvic exam. The physician first ensures that the woman is ovulating regularly (releasing eggs from their ovaries). The doctor then carries out blood tests to evaluate the levels of fertility hormones. The woman’s womb and ovaries may also be checked through ultrasound, and an X-ray test may be conducted to examine fallopian tubes and womb.
In approximately 80 percent of couples, infertility is caused by an ovulation problem, obstruction of the uterine tubes, or a sperm issue. In 5 to 15 percent of couples, the tests come back normal, and the cause of infertility remains unknown.
What Are the Treatments for Infertility?
Infertility in men is treated with:
- Medications and counseling to resolve erection or ejaculation problems
- Antibiotics to treat reproductive tract infections
- Hormone treatments if infertility is due to a high or low level of some hormones.
- Surgery, if the issue is caused by a varicocele (widening of the tubules that carry semen from the testicles) or an obstruction in the vas deferens.
Infertility in women is treated with:
- Fertility hormones and medications to normalize hormone levels or to help the woman ovulate.
- Surgery to get rid of tissue preventing fertility (endometriosis) or to unblock fallopian tubes.
Generally, infertility may also be treated using assisted reproductive technology (ART), such as:
- Intrauterine insemination (IUI): The doctor collects sperm and inserts it directly into the woman’s womb when she is on ovulation.
- In vitro fertilization (IVF): The physician collects sperm and eggs and “combines” them in a laboratory. The fertilized egg (now embryo) is grown for about 3-5 days and then inserted in the woman’s womb.
- Zygote intrafallopian transfer (ZIFT) and gamete intrafallopian transfer (GIFT): In both cases, sperm and eggs are taken and quickly placed in the woman’s fallopian tube. During a GIFT procedure, sperm and eggs are collected and placed straight in the fallopian tube. However, in ZIFT, the gametes are first combined in a lab, and a resulting embryo (fertilized egg) is then placed in the tube.
What Causes of Infertility Can be Treated with IVF?
IVF can be an excellent fertility option if you or your spouse is diagnosed with any of the following:
- Low sperm counts
- Poor egg quality
- Ovulation problems
- Issues with the fallopian tubes or womb
- A disease that can be passed onto the child
- Antibody problems that can affect eggs or sperm
- The inability of sperm to swim through or live in the cervical mucus
- Unexplained infertility
Are IVF Pregnancies Usually More Complicated Than Natural Pregnancies?
There is a higher risk of multiple pregnancies (twins or triplets) when you undergo an IVF, especially when two or more embryos are transferred. Multiple pregnancies come with huge risks, such as:
- Premature delivery/labor: Preterm babies (no matter how they were conceived) are at increased risk for health complications, including cerebral palsy, intestinal infections, lung development issues, learning disabilities, speech delay, and behavior problems.
- Postpartum hemorrhage
- C-section delivery
- Gestational diabetes
- Pregnancy-related hypertension
Miscarriage and Ectopic pregnancy
The more embryos transferred during IVF, the higher the risk of miscarriage and ectopic pregnancy. However, the rate of pregnancy loss following IVF is quite similar to the rate after natural conception, with the risk increasing with the intended mother’s age. The miscarriage rate can be very low (around 15%) for women in their twenties and as high as 50% for women in their forties.
Managing Your Health after Conceiving with IVF
Treatment still continues after you receive a positive pregnancy test result. Your physician may decide to place you on progesterone hormone support. How long you will keep using progesterone will depend on your specific situation.
Antenatal Care and Genetic Screening
Studies have shown that women who conceived with ART are less likely to go for Down syndrome screening or invasive testing. They also worry about the risk of congenital abnormality as much as those who conceived naturally do. This may be due to fears of procedure-related pregnancy loss or the determination to go on with the pregnancy no matter the result.
Women who become pregnant with ART need to be offered antenatal screening, i.e., the combined first-trimester screening test (nuchal translucency & maternal serum biochemistry). Also, it’s crucial to note that when donor eggs are used, the age-related risk should be calculated based on the donor’s age, not the age of the woman going through the fertility treatment.
Natalie Bowes, B.A. (Integrative Physiology with a focus on Endocrinology, Immunology, and Microbiology) Intended Parents Coordinator and Educator at RSMC (www.fertile.com). She looks after the hopeful parents walking through the doors of RSMC and makes sure their parenthood journey progresses smoothly and successfully. Her past patient care experience and academic feats allow her to help intended parents understand every aspect of the IVF journey.
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