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Facts about Infertility

What is Infertility?

Infertility is inability to achieve pregnancy. Successful Conception depends upon many factors: on the production of healthy sperm by the man and healthy eggs by the woman; unblocked fallopian tubes that allow the sperm to reach the egg; the sperm's ability to fertilize the egg when they meet; the ability of the fertilized egg (embryo) to become implanted in the woman's uterus.

For the pregnancy to continue to full term, the embryo must be healthy and the woman's hormonal environment adequate for its development. When any one or more of these factors is impaired, infertility can result.

Incidence of Infertility

  • 15-20% of couples who want to conceive have infertility problems.
  • Infertility problems can result from either the man or woman. In 15-20% of infertile couples, both the man and woman have problems.

When Should a Couple See a Specialist?

  • After 6 months:
    • If the woman has been treated any time for a pelvic infection, and attempts to conceive have failed for six months. Pelvic infections can block the fallopian tubes that contribute to infertility.
    • If the woman has irregular menstrual cycles, which indicate that ovulation (release of eggs) does not occur every month, and attempts to conceive have failed for six months.
    • If the women is 35 years or older.
  • After one year:
    • If attempts to conceive have failed for one year with no apparent reason.

Age and Infertility

Your fertility naturally declines as you get older. When this decline begins, however, and the rate at which it progresses vary widely in women. Generally, fertility begins to drop in your late 20s or early 30s and falls more rapidly after the age of 35. If you decide to attempt pregnancy after age 35, it is important that you consult a specialist if you are not successful in 6 months. Learning about all of the options and being aware of your own needs and goals, you and your partner will be prepared to make the best decisions for you both.

As you age, your fertility declines due to normal, age-related changes that occur in your ovaries. You are born with all the eggs that you will ever have in your ovaries, unlike men who continue to produce sperm their entire lives. Even though you have over a million eggs in your ovaries at birth, you only have about 300,000 eggs left by the time you reach puberty. Of the eggs remaining at puberty, only about 300 will be ovulated during your entire reproductive years and the rest will undergo atresia. Atresia is a degenerative process that occurs regardless of whether you are pregnant, have normal menstrual cycles, use birth control, or are undergoing infertility treatment. Smoking appears to accelerate atresia and is linked to earlier menopause.

Causes of Infertility

Approximately one-third of infertility cases can be attributed to male factors, and about one-third to factors that affect women. For the remaining one-third of infertile couples, infertility is caused by a combination of problems in both partners or, in about 20 percent of cases, is unexplained.

Causes of Infertility in the Female

The most common female infertility factor is lack of ovulation (failure to release of egg). Polycystic ovary syndrome (PCOS) is the most common reason for anovulatory infertility. Dr.Nagamani is a nationally known specialist in the treatment of and has done extensive research and has published widely in this area. She has more than 25 years experience treating women with PCOS resulting in excellent pregnancy rates. Other common cause of female infertility is blocked fallopian tubes, which can occur when a woman has had pelvic inflammatory disease or endometriosis (presence endometrial lining outside the uterus. Congenital anomalies of the structure of the uterus or uterine fibroids can also lead to infertility or repeated miscarriages.

Causes of Infertility in the Male

Common male infertility factors include azoospermia (no sperm cells are produced) and oligospermia (few sperm cells are produced). Sometimes, sperm cells are malformed or they do not survive before they can reach the egg. Varicocele (dilatation of the Vein surrounding the testis) is one of the common cause of abnormal sperm parameters, which can be corrected with a simple surgical procedure.

Diagnosis of cause for Infertility

It is important that both partners are present at the initial visit. First step is to determine whether intercourse is taking place adequately and at the time ovulation for conception to occur.

Studies in men: A semen analysis is done during the first visit to determine any problems with the sperm with regards to number, motility and morphology (appearance of the sperm). Abnormal sperm analysis results indicate need for further evaluation of the male to rule out a varicocele and hormone analysis.

Studies in women: An analysis of body temperature and evaluation for ovulation and x-ray of the fallopian tubes and uterus (hysterosalpingogram) is performed in all women. Women above age 35 will need hormone analysis (FSH, estradiol and Mulleriian Inhibiting hormone levels) on cycle day 2 to evaluate their ovarian reserve.