Infertility pdf

Published by Elsevier Inc. All rights reserved. Abstract Infertility is a disease characterized by the failure to establish a clinical pregnancy after 12 months of regular and unprotected sexual intercourse. 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.

A doctor can give advice and carry out some preliminary assessments. It is better for a couple to see the doctor together.

Tests and trials are available, but testing does not always reveal a specific cause. 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. A woman will undergo a general physical examination, and the doctor will ask about her medical history, medications, menstruation cycle, and sexual habits.

Some complications can result from infertility and its treatment. If conception does not occur after many months or years of trying, it can lead to stress and possibly depression. The ovaries can swell, leak excess fluid into the body, and produce too many follicles, the small fluid sacs in which an egg develops.

Ovarian hyperstimulation syndrome OHSS usually results from taking medications to stimulate the ovaries, such as clomifene and gonadotrophins. It can also develop after IVF. Rarely, a blood clot may develop in an artery or vein, liver or kidney problems can arise, and respiratory distress may develop. In severe cases, OHSS can be fatal. This is when a fertilized egg implants outside the womb, usually in a fallopian tube.

If it stays in there, complications can develop, such as the rupture of the fallopian tube. This pregnancy has no chance of continuing. Immediate surgery is needed and, sadly, the tube on that side will be lost.

However, future pregnancy is possible with the other ovary and tube. Women receiving fertility treatment have a slightly higher risk of an ectopic pregnancy. An ultrasound scan can detect an ectopic pregnancy. It is impossible to know how long treatment will go on for and how successful it will be. Coping and persevering can be stressful. The emotional toll on both partners can affect their relationship. Some people find that joining a support group helps, as it offers the chance to talk to others in a similar situation.

It is important to tell a doctor if excessive mental and emotional stress develop. They can often recommend a counselor and others who can offer appropriate support. Online support from organizations such as Resolve can be helpful.

Peritoneal factor infertility refers to abnormalities involving the peritoneum lining of the surfaces of your internal organs such as scar tissue adhesions or endometriosis Figure 4. Endometriosis is a condition where tissue that normally lines the uterus begins to grow outside the uterus.

Endometriosis is found more commonly in women with infertility, pelvic pain, and painful intercourse. Endometriosis may affect the function of the ovaries, your ovarian reserve, the function of the fallopian tubes, and implantation. For further information concerning this problem, see the ASRM patient education booklet, Endometriosis. Laparoscopy is a same-day, minimally invasive surgical procedure that is performed to diagnose and treat adhesions or endometriosis.

During the procedure, a narrow, lighted telescopic instrument called a laparoscope is inserted through a small incision within or just below your navel Figure 5.

The physician then looks through the laparoscope directly into your abdominal cavity and inspects the ovaries, fallopian tubes, and uterus. During laparoscopy, a dye may be injected through the cervix to determine if the passage to the uterus and tubes is open. One or more additional smaller incisions may be made above your pubic area in order for the physician to insert additional instruments to better examine your pelvic organs and treat any disease, if found. A variety of specialized surgical instruments, including robotic-controlled instruments and lasers, may now be used laparoscopically to treat such conditions as endometriosis, adhesions, and ovarian cysts such as endometriomas fluid-filled cysts on the ovaries.

In many cases, laparotomy, which involves a larger abdominal incision than laparoscopy and an approximately six-week recovery, is no longer necessary since many problems can now be treated laparoscopically. Although it is reasonable and sometimes advisable to perform laparoscopy to identify and treat pelvic disease, this procedure is not routinely performed in every infertility evaluation or part as the initial infertility evaluation.

Laparoscopy is expensive and involves some small surgical risk. You and your physician should discuss whether or not laparoscopy is recommended in your particular case. Sometimes your physician may not recommend a laparoscopy initially, but may instead recommend it at a later time depending on your response to treatment.

In a much higher percentage of couples, only minor abnormalities are found that should not be severe enough to result in infertility. Fertility drugs and IUI have been used in couples with unexplained infertility with limited success. If no pregnancy occurs within three to six treatment cycles, IVF may be recommended, and has been shown to be the most effective treatment for unexplained infertility.

Some men and woman may carry genetic abnormalities that make it more difficult to become pregnant and more likely that a pregnancy ends as a miscarriage. One example is a translocation, or a rearrangement of genetic material. This may be tested for, in appropriate circumstances, by blood testing of the couple. Some couples may even carry a known genetic illness and wish to avoid passing this illness on to a child. In special circumstances, a more advanced fertility treatment known as pre-implantation genetic testing PGT may be offered in conjunction with IVF.

This treatment is only helpful in certain couples and requires specific genetic counseling. Your physician may discuss this form of treatment depending on your individual situation. Each couple has a unique set of circumstances, and the chances of treatment success vary widely. The success of IVF depends on many factors, especially your age and the quality of your embryos. National and regional ART success rates are available on the Internet at: www.

Infertility is a medical condition that has many emotional aspects. Feelings such as anger, sadness, guilt, and anxiety are common and may affect your self-esteem and self-image. You may find it difficult to share your feelings with family and friends, which can lead to isolation. It is important to know that these feelings are normal responses to infertility and are experienced by many couples.

Although a physician will describe various treatments and realistic odds of success with treatments, you must decide how far you will go in your attempts to conceive. Coming to a joint decision with your partner about goals and acceptable therapies is important.

Setting endpoints for therapy may also be advisable. For more information, visit the Topic on Psycological Counseling or www. Sometimes the factors affecting your fertility are easy to detect and treat, but in many cases a specific reason for infertility may be difficult to identify. After a full evaluation, your physician can give you a reasonable idea of your chances of achieving pregnancy with various treatment options.

The choice of which treatment to pursue, if any, is strictly a personal one. Side effects, costs, the risk of multiple births, which is increased with some infertility treatments, and expected success rates are important factors to consider when choosing a treatment plan.

It is helpful when beginning fertility treatment to develop a long-term plan with your physician so that you will have an idea of how long to pursue a particular treatment before moving on to more aggressive therapy or stopping treatment. Since your initial treatment may provide additional answers as to the cause of your infertility, it is very important to continually re-evaluate your plan by discussing treatment results with your physician.

It may be necessary at times to temporarily cease therapy and begin again at a later date. Thanks to the many options existing today, including advanced reproductive technologies and adoption, most infertile couples will be able to experience the joy of parenthood.

The sooner you meet with a specialist, the sooner you will find answers and be able to realize your dream of having a child. Adhesions can result from infections, endometriosis, or previous surgeries. Antral follicle count AFC. A transvaginal ultrasound machine is used to determine the number of pre-stimulated follicles in the ovary during the first days of the menstrual cycle. Assisted reproductive technologies ART. The narrow, lower part of the uterus that opens into the vagina.

The cervical canal runs through the cervix and connects the vagina with the uterine cavity. The cervix produces mucus through which sperm must swim before entering the uterine cavity and then the fallopian tubes.

Egg donation. The female partner will not be biologically related to the child, although she will be the birth mother on record. The male partner will be biologically related to the child. The lack of accurate information in this case may lead to improper timings of sexual intercourse, thus possibly delaying the pregnancy. The participants in this study correctly identified most of the causes of infertility but also incorrectly highlighted factors that do not cause infertility such as use of IUCD and OCP.

This may lead to underutilization of contraceptionfor incorrect fear that the method will cause sterility. This reflects prevalence of the strong belief that all ailments cannot be cured by medical science. The less educated participants were more likely to attribute the causes of infertility to an evil force or supernatural power, outside human control.

It was disturbing to discover that people believe husbands should be allowed to remarry and have a second wife in case he is not able to conceive with the previous wife. According to Islam, the religion of majority of Pakistan, infertility is not a ground for divorce for either the male or the female. Yet this study showed that people were still in favor of divorce. Knowledge about treatment option for infertility, such as IVF, is very low because it is an advanced option with limited availability in Pakistan.

On the other hand, the awareness level of men regarding infertility risks of chloride in swimming pool was significantly higher than women. The study results suggested that the average awareness level of women regarding the infertility risk factors in the study area was higher than that of men. The level of awareness about Cell phone radiations, air pollution, Anxiety, Fast foods, Smoking, alcohol and some medical drug consumption was relatively higher than the other risk factors.

A Study in Nigeria 28 reported that A substantial number did not recognise smoking, alcohol consumption and diabetes mellitus as risk factors for infertility.

Over a third of women however spontaneously mentioned evil spirits and witchcraft as causes of infertility. In contrast to good risk knowledge, false beliefs were abundant.

Participants erroneously believed that they could increase their fertility by, e. An article reported 30 the negative consequences of infertility are much stronger in developing countries than in the Western societies and these are mainly characterized by personal suffering and social stigmatization.

In Nigeria, there has been a general belief that women are at fault for any case of infertility. That is why in some communities like Mbano, a name for infertile women Nwanyiaga but no name for an infertile man.

The majority of childless women visit traditional infertility healers most, their first point of call is usually the hospital. The greatest stigmatization comes from mother-in- law. The attitude of mother-in-laws towards their infertile daughters-in-law is usually unfavorable.

The attitude of in-laws is relatively unfavourable towards the childless woman and in the long-run; they do support her dehumanization because they believe that the childless woman is aiding the termination of their lineage.

As such, in-laws encourage the marriage of a second wife in attempt to ensure the continuation of their lineages. Other women do look down on the childless women,most of the time believe that the childless women are the architect of their condition. The attitude of most children to the childless at times demands pity. The attitude exhibited by most children towards infertile women is not good.

They do not usually respect the childless women. Sometimes, children do mock the childless women, calling them witches and they hardly help or assist them in any chore. Thus, childless women are strongly stigmatized in Nigeria.

This finding could mean that women depended on their religion to cope with their situation. The social meaning of infertility in south-west Nigeria 32 mentioned that the Yoruba word agan defines a person who has never been pregnant despite having been married for some time, which in the medical literature refers to primary infertility.

By contrast, idaduro is used to describe a person who has difficulty in achieving another pregnancy after having had one or more babies, a situation of secondary infertility. Agan is generally regarded as being more serious than idaduro , however idaduro could be particularly serious if there is no male child among the surviving children.