Fertility is God’s gift to women. And to men. But the gift is not equitable. A few have more of it, a few have less of it, and a few have none of it.
About 17% of couples have infertility. But with today’s technology, most of them can have a baby.
If a couple fails to conceive despite trying for 12 months, then it needs fertility treatment. Since infertility can be in the man, or in the woman, both of them must be evaluated. In males, more than 90% of infertility is due to low sperm counts, poor sperm quality, or both. The remaining cases can be for several reasons: anatomical problems, hormonal imbalance, and genetic defects.
In females, infertility is mostly because of problems with ovulation or cervix, or damage to fallopian tubes or uterus, or abnormal cervical mucus. Also, as a woman ages, her fertility decreases.
Female infertility is a contributory factor in about half of all infertility cases; and the only factor in about one-third of all the cases. Most frequent causes of female infertility are:
• Ovulation problems • Damaged fallopian tubes or ovary • Cervix problem • Abnormal cervical mucus which prevents, or makes it difficult, for the sperm to reach the egg and to penetrate it • Age: as a woman ages, her fertility decreases.
Female fertility is diagnosed by physical, pelvic and breast examination, medical history and one or more tests such as:
• Urine or blood tests to check for infection, hormone problem and thyroid function • Ovarian reserve tests to determine the quality and quantity of eggs available for ovulation. • Cervical mucus and tissue test to check for ovulation. • Ultrasound to look at the uterus and ovaries’ abnormalities or problems. • Hysteroscopy to look for uterine abnormalities and growth inside the uterus. • Laparoscopy to see endometriosis, scarring, blockages or irregularities of the fallopian tubes, and problems with the ovaries and uterus and surrounding area. • Genetic tests to find if a genetic defect is causing infertility.
Depending on the cause, your age, and how long you have been infertile, one or more therapies may be needed to restore fertility.
In India, 10-15 out of 100 couples (22-33 million couples) need Infertility treatment. And the number is increasing. Female infertility treatment may be medication or surgery or Assisted Reproductive Technologies (ART).
• Antibiotics for infections.
• Hormones for hormone imbalance, endometriosis, or a short menstrual cycle.
• Medicine to stimulate ovulation.
• Supplements to enhance fertility.
Laparoscopic surgery to:
• Correct an abnormal uterine shape.
Endometrial polyps and fibroids that misshape the uterine cavity.
Pelvic or uterine adhesions.
Blockage or scar tissues from the fallopian tubes, uterus, or pelvic area.
• Intra Uterine Insemination (IUI). In IUI, ovulation is monitored and millions of healthy sperms are placed inside the uterus at the time of ovulation.
• In Vitro Fertilization (IVF). In IVF, mature eggs are retrieved from the woman, fertilized with a man’s sperm in a dish in a lab, and the embryo is then transferred to womb. IVF cycle takes several weeks and requires frequent blood tests and hormone injections.
IUI is less physically demanding and a much shorter, and much cheaper (for three cycles, IUI, ₹ 10-15,000; IVF, ₹ 3-5 lakh) process than IVF; but IUI has a higher risk of multiple pregnancy.
Also, IUI success rate after three cycles is about 55%; for ART, it is 75-94%. For IUI, the rate dips sharply with woman’s age: dips to 3-14% for a woman of 45. For IVF the dip is hardly any.
For women in their late 30s and above, going directly for IVF may be a more cost-effective option.
But remember, ART is an art, not just science. Just as art depends on artist, so ART depends on the ARTist – the doctor. Just as the artist becomes more skilled with practice and experience, so does the ARTist, the doctor. So the right question to ask is not what the success rate of ART is; the right question to ask is what the success rate of the ARTist, the doctor, is.
Infertility is a complex disorder. Treatment demands significant financial, physical, psychological and time commitments. Be prepared for that.