Infertility means inability to reproduce after one year or for a woman aged 35 years or above, six months. A woman who is able to be impregnated but is unable to maintain her pregnancy can also be called infertile. About 30% of the time, infertility factors can be found in women.

Diagnosing infertility in women can be difficult. There are numerous procedures available, depending on the source of infertility. After trying to conceive a child for two years, around 95% of the couples are successful.

The process of getting pregnant involves multiple stages:

1. The woman must go through ovulation
2. The egg must proceed past the fallopian tube to the womb
3. The egg must be fertilized by a man’s sperm
4. The fertilized egg requires to be embedded in the uterus

In an instance where any of these stages is disturbed, infertility occurs.

The most obvious factor is the inability to be impregnated. Menstrual cycles that are too long, too short, absent, or irregular can mean that the woman is not ovulating. No outward symptoms may emerge.

When should you seek professional help?

At least one year is recommended by most experts. Women 35 years old and above should seek medical expertise past 6 months of intercourse. In women, the chances of conceiving decrease every year following the age of 30.

Some health disorders may also hinder fertility. Women should seek medical help if they have:

• Irregular periods or absence of menstrual cycle
• Endometriosis
• Painful periods
• If they have had more than one miscarriage
• Pelvic inflammatory disease

It is better to consult a doctor before attempting to get pregnant. They can aid you in preparing your body for conception.

Causes of Female Infertility

Age: Women above 35 have a much lesser number of eggs. Since the amount of eggs deplete each year, it is increasingly difficult to get pregnant starting at this age.

Ovulation disorder: Disturbance in the functioning of pituitary gland which is responsible for regulating the menstrual cycle and the body’s hormones can result in ovulation disorder. Some women may suffer from very irregular menstrual cycle, or have no ovulation due to the following reasons:

• Thyroid disorder
• Stress
• Overweight
• Underweight
• Poor nutrition

Endometriosis: It is a condition where the tissue that constitutes the uterus lining enlarges exterior of the woman’s uterus. With every menstrual cycle, the tissue also witnesses bleeding resulting in pain and inflammation. Scarring can arise and obstruct the fallopian tube or damage the uterus, resulting in infertility.

Polycystic ovary syndrome: This syndrome disturbs the production of eggs in the woman’s ovaries. Prolonged or irregular menstrual cycle may be endured by a female suffering from this syndrome.

Symptoms include skin problems, insulin resistance, and weight gain. Some women can experience no symptoms at all. It is difficult to recognize this syndrome.

Fallopian Tube Blockage: Fallopian establishes a linkage between the ovaries and uterus. These tubes can become blocked or inflamed due to a number of reasons:

• Infection
• Pelvic inflammatory disease
• Endometriosis disease

Most eggs get fertilized in the fallopian tube. This condition can obstruct pregnancy.

Autoimmune diseases and some forms of cancer may also lead to infertility.

Risk Factors

There are women under certain categories who are more at risk of infertility. They can include:

Age: Older women have fewer chances of getting impregnated in comparison to younger. After reaching her 30s a woman’s quality of eggs deteriorates with each year.

Sexual history: Sexually transmitted diseases like gonorrhea and chlamydia can disrupt the fallopian tubes. Having unprotected sex with numerous partners heightens the probability of contracting STD infection which can cause problems for fertility.

Weight: Ovulation can be affected if the woman is severely over or underweight. Achieving a healthy body mass may increase the rate of ovulation and the chances of getting pregnant.

Smoking: Smoking can cause damage to a woman’s fallopian tubes and cervix. Smoking can also increase your chances of a miscarriage as well as ectopic pregnancy. It is believed to exhaust your eggs prematurely and age your ovaries. Avoid smoking before starting fertility treatment.

Alcohol: Excessive alcohol consumption must be avoided.

How to Prevent Infertility in Women

Healthy lifestyle choices can improve your overall health and promote fertility in both you and your partner

A woman can improve her chances of normal fertility by following some methods like:

• Maintain ideal weight
• Quit smoking
• Limit caffeine
• Reduce stress
• Avoid alcohol

Diagnosis of female infertility

Some of the fertility tests include:

• Ovulation testing: At home or over the counter ovulation kits are available to test the rate of luteinizing hormone that happens prior to ovulation. A blood specimen might be collected for inspecting progesterone or hormone levels, such as for prolactin, may also be examined.
• Hysterosalpingography: X-ray contrast is inserted into the woman’s uterus to search for discrepancies within the uterine cavity.
• Imaging tests: An ultrasound for the pelvic area can be performed to examine for fallopian tube or uterine disease
• Ovarian reserve testing: This will determine the number and quality of eggs ready for ovulation. Women upwards of 35 years may have to take this series of imaging and blood tests.
• Other hormone testing: Various hormone tests relating to reproductive processes may be done. For example, ovulatory hormones, pituitary and thyroid hormones.

Rarely, the following test may also be included:

• Genetic testing: To determine genetic issues that may obstruct fertility.
• Laparoscopy: Incision is created and a tiny viewing device is inserted to look for problems.
• Other imaging tests: Hysteroscopy may be recommended by your doctor to examine for fallopian tube or uterine disease.

Treatments for Female Infertility

1. Laparoscopy

If you have been diagnosed with a Pelvic or tubal disease, surgery can be initiated to reconstruct your reproductive organs. Laparoscopy is a surgical procedure where a laporoscope is inserted through an incision near your belly button to eliminate scarred tissue, open blocked tubes, remove ovarian cysts, or treat endometriosis.

A Laparoscopy is recommended when other methods fail such as ultrasound, and x-ray, cannot verify the source of the condition.

Indications for Laparoscopy

A laparoscopy can help diagnose many conditions that cause infertility such as:

• Blocked fallopian tubes
• Endometriosis
• Scar tissue build up
• Fibroids
• Any abnormality in the reproductive system

A physician may also recommend laparoscopy when the cause of infertility in a woman cannot be explained. When other diagnostic tests show normal results, this diagnosis is recommended.

By having a close look at the reproductive organs, your physician may be able to find out the issues preventing the conception.

Laparoscopy might be followed to:

• Inspect tissue mass
• Verify the cause of discomfort in the abdominal and pelvic area
• Validate Endometriosis
• Confirm Pelvic Inflammatory disease
• Inspect for obstruction in the fallopian tube
• Other cause for infertility

Procedure

General anesthesia is given to avoid discomfort during the procedure. A tiny incision is created nearby the naval. The laparoscope is set and the abdomen is aerated to make it easier for viewing the organs. The Laparoscope might also be supported with surgical equipment for removing scars or collecting tissue samples.

An additional incision may be created near the pubic area. This will create an extra opening for accomplishing minor surgeries.

Following the surgery, patients typically stay in the recovery room for about an hour. After this, they are transferred to an outpatient unit for examination.

What to Expect

It is normal to experience a minimal level of discomfort and pain after the surgery.

As the gas starts to dissipate from the body, you may experience pain in the abdomen or on the shoulders. Relieving all of the gas and the discomfort will take a couple of days. Drink peppermint tea and walk around to help speed it up.

Your physician will provide you with instructions during discharge concerning what to do and what to expect during the recovery.

When to Call Your Doctor?

Complications are quite rare but if you experience any of these issues, contact your physician right away:

• Fainting
• Severe, worsening pain
• Inability to use bathroom
• Constant nausea and vomiting exceeding 24 hours
• Swelling, redness, bleeding, and drainage near the incision
• Fever exceeding 100 degrees for 24 hours or heavier menstrual flow than usual, hefty bleeding with clots, soaked sanitary pads within 2 hours the day following surgery

If you experience any of these, communicate with a doctor

Benefits of Laparoscopy

Here are some benefits of laparoscopy:

• Less invasive
• Lower infection risk
• Smaller scar
• Faster recovery
• Possibility of correcting the issue during the surgery

The chance of getting pregnant also increases when a person receives treatment during the procedure.

Risks and Complications

Laparoscopy is overwhelmingly safe. Out of a possible 1000 women who opted for laparoscopy, only 3 endure complications. This risk can include bleeding, trauma to nearby organs, or issues related to anaesthesia.

Possible Side Effects

• Swollen Abdomen
• Sore throat
• Mild nausea
• Acidity or Gas

Vaginal bleeding post surgery for a period of a month is normal. Many women do not experience their normal menstruation up to 6 weeks post surgery. When normal cycle resumes, heavier bleeding and further discomfort might be felt.

Outlook

In many cases, you physician will be able to diagnose and repair any issues during the procedure. The results should be explained to you in detail after the surgery and even inform you about the next steps to be taken.

It is advisable to wait for several weeks or months before trying out IVF or other another treatment.

It is also recommended to abstain from sexual activity for a week.

2. In Vitro Fertilization

In this procedure, the retrieved sperm and egg are fused in a special dish external of the body and then transplanted into the woman’s uterus.

How Many Times Can IVF Be Tried?

Generally, it is recommended that partners try for at least 6 rounds of IVF for optimal results.

Reasons for Failure of IVF

Failure of IVF can depend on numerous reasons such as:

• Failure of the eggs to fertilize
• Low-quality eggs
• Insufficient quantity of follicles
• Embryo transplantation
• Non-conducive embryo

3. Intracytoplasmic Sperm Injection

Intracytoplasmic Sperm Injection or ICSI is a procedure in which the egg is directly injected with a sperm in a dish and then transplanted into the woman’s uterus.

Basically, it consists of five steps

• A pipette holds the developed egg
• A very sharp and hollow needle disables and obtains one single sperm
• The same needle is then precisely injected into the cytoplasm of the egg
• The sperm is then inserted into the egg. The needle will then be carefully detached
• The next day, the eggs are inspected for evidence of fertilization

Once the full steps of ICSI are accomplished, the embryo is embedded into the uterus of the patient.

Then signs of pregnancy are awaited. Ultrasound or blood test might be performed to determine pregnancy.

Will it Work?

50 to 80 per cent of eggs are fertilized through ICSI. However, the issues mentioned below might arise.

• All or some of the eggs may encounter damage
• The egg might fail to develop even after the injection of sperm
• The embryo may experience termination of growth

Effects on Child

The probability of conceiving a child through ICSI with defects is extremely low. It is only 1%.

Another risk is multiple births. It can be harmful to the mother as well as the children. But this risk can be avoided by precisely controlling the number of embryos transferred into the uterus

4. Hysteroscopy

Hysteroscopy is usually performed when your doctor wants to check the cause of your infertility or when your menstrual flow is heavy. This method allows your doctor to get an up-close look at your fallopian tubes and uterine cavity.

The procedure involves inserting a Hysteroscope into your uterus through the cervix. It is carried out to remove blocked tubes, divide scar tissue, remove polyps as well as fibroid tumors.

Who Needs This Procedure?

By inserting a thin tube with light (hysteroscope) inside your vagina, your doctor will be able to see the inside of your uterus and your cervix. If any abnormality is detected, samples will be taken for further lab testing.

Two most common reasons for performing hysteroscopy are infertility and heavy menstrual periods or bleeding.

Hysteroscopy is also recommended for these situations:

• Abnormal Pap test results
• There are polyps, scarring or fibroids on your uterus
• Difficulty getting pregnant or occurance of more than one miscarriage
• Bleeding after menopause
• Tissue sample retrieval from the uterus lining for biopsy
• Sterilization for permanent birth control

How it’s Done

A hysteroscopy is done either at your doctor’s clinic or in a hospital. You will either be under general anesthesia or awake for the procedure. If not under general anesthesia, you will be given medication to relax. Your doctor will use tools like dilators or medication to open up the cervix.

It’s also likely for your doctor to use a speculum, which is a tool to help keep your vagina open. Next, the hysteroscope will be inserted into the uterus through the vagina and the cervix.

Then, your doctor will push a liquid-like saline or carbon dioxide past the hysteroscope and into the uterus to clear out mucus and blood and expand it further. Afterwards, the light will be emitted through the hysteroscope to give a clear view of the lining and fallopian tubes.

If surgery is required, compact instruments are inserted past the hysteroscope and into the uterus

The duration varies from five minutes up to an hour.

After Procedure

Commonly, patients are able to go back home right after the surgery, but if you have been under general or local anaesthesia, you will need an adult companion to drive you home.

It is normal to experience mild bleeding or cramping after the procedure. It is also common to be gassy for 24 hours after the procedure. You may be prescribed medication depending on the severity of the procedure to help control the pain.

Before going home after the procedure, your doctor will brief you on how to take care of the treated area.

It is recommended to avoid sexual intercourse for a minimum of 2 weeks following the procedure.

Possible Complications of Hysteroscopy

Hysteroscopy is overwhelmingly safe and the chances of complications are less than 1%.  Some of the risks may involve:

• Anaesthesia-related complications
• Heavy bleeding
• Infection
• Damage or tearing to the cervix although rare
• Damage to neighbouring organs like ovaries, bowel, or bladder
• The substance utilized to expand the uterus may result in adverse reactions
• Intrauterine scarring
• Inflammation in the pelvis

Use of gas may result in shoulder pain. It is also common to feel sick.

If any of the following symptoms are experienced, contact your doctor:

• High fever
• Severe abdominal pain
• Significant vaginal discharge or bleeding

5. Intrauterine Insemination (IUI)

IUI or Intrauterine Insemination is one of the most popular methods of artificial insemination. This was initially developed by medical scientists to breed livestock but later on was successfully adapted for human use.

Why Opt for IUI?

IUI can benefit individuals or couples with a wide range of needs. According to the Center for Disease Control and Prevention (CDC), it is said that 6% of women in the United States aged between 15 – 44 years fail to conceive or get pregnant after 1 year of unprotected sex.

It is recommended to consult a fertility doctor and discuss treatment options if you are:

• Past 35 years and trying to get pregnant
• Cannot get pregnant after a year of unprotected sex
• Not getting regular periods

It is also advisable to seek fertility treatment if you have had more than two spontaneous miscarriages.

Here are some medical conditions in which IUI can be helpful:

• Couples with healthy eggs and sperm but are unable to have sex due to possible medical conditions like erectile dysfunction.
• Women who are diagnosed with cervical factor infertility where the cervix is unable to produce mucus to help the sperm travel to the womb or the mucus kills the sperm due to some substances present in it.
• Endometriosis where the tissue in the uterine lining (womb) starts growing on other organs like the fallopian tube or the ovaries. IUI works in cases of mild to moderate endometriosis. Most women diagnosed with endometriosis are able to conceive naturally.
• Although rarely, some women may get allergic reactions to certain chemical proteins present in the semen or sperm. This can be prevented through the “washing” or separation process.
• Some men may not be able to produce a substantial amount of sperm for fertilization, or the sperms may be motile. In this case, the sperm fails to get inside the egg.
• Some medical treatments, like radiation therapy, may cause infertility. Patients may choose to freeze their sperm to be used in artificial insemination in the future.

IUI is also suggested in some cases where there is no clear reason behind the couple’s infertility.

Preparing the Semen Sample

Generally, the sperm is donated by the male partner, but if the partner cannot provide the sperm, a sperm donor can be an option. This is also a popular choice among single women or women who are in same-sex relationships and want to have a baby.

If a sperm donor is used, a sample is first sent to a sperm bank where it is quarantined and tested for any signs of transmittable diseases. Here the sperm is frozen and then thawed out for the procedure.

A chemical called cryptoprotectant is added to the sperm before freezing to protect the sperm from the extreme temperatures.

If the male partner is providing the sperm, the sample can be derived through several methods:

• Collecting semen from the condom after sexual intercourse
• Masturbation
• Sperm surgical aspiration where sperm is retrieved directly from the reproductive tract
• Electric or vibratory stimulation if the ejaculation cannot be done without devices or assistance

After retrieving the sperm, it is then “washed” or separated from any proteins or chemicals that could cause an allergic reaction in the uterus or interfere with the fertilization.

Procedure

Ovulation stimulation medications are used prior to intrauterine insemination. This invites careful examination to ascertain the maturity of eggs. The IUI procedure is conducted about the time of ovulation. This generally occurs about 24 hours post-surgery in Lh hormone which specifies that ovulation will take place.

The semen will be injected directly into the uterus using a fine catheter while keeping the vagina open with the help of a speculum. The sperm is pushed into the uterus through the cervix. This procedure augments the quantity of sperm increasing the probability of conception.

It takes only a few minutes and involves minimal discomfort. The next step will be to look out for signs of pregnancy.

Risks of Intrauterine Insemination (IUI)

The chances of having twins or triplets are heightened if fertility medication is undertaken during IUI such as gonadotrophin. It also minimizes the chances of infection.

The chances of complications also increase, such as miscarriage or premature birth when the woman conceives more than one fetus.

These days fertility medications are prescribed only when there is difficulty in production of egg cells from which the embryo develops, or there is difficulty in ovulation.

Ovarian Hyper-stimulation Syndrome(OHSS) also causes the ovaries to swell when IUI and fertility medication are combined. Although it is quite rare and the symptoms may be mild to moderate, it can cause serious complications.

Mild symptoms of OHSS include mild abdominal pain, bloating, possible nausea, and vomiting. Severe symptoms include shortness of breath, pain in the chest, and dehydration.

Paracetamol and hydration will typically ease the pain, but severe cases will require treatment at the hospital.

Success Rate

Although IUI may be less successful than more intensive alternatives like In-Vitro Fertilization(IVF), it still has a success rate of 5 – 15%  during the first attempt.

The chances of success increase dramatically around the 6th insemination, especially for women under 40 years of age as per a study conducted in 2013 by a German clinic.

The study also revealed that the average number of attempts to get a successful conception was 2.24.

Doctors normally do not recommend IUI beyond the 6th cycle as the chances of conception decrease dramatically. At this stage, more invasive treatments like In-Vitro Fertilization (IVF) would be more successful.

A pregnancy test should be done at least 2 weeks after IUI as it takes time for pregnancy hormones to show up. For more accurate results, take a blood test.

Outlook

IUI or artificial insemination is a medical procedure to help a woman get pregnant.

The sperm is injected directly into the womb by a fertility doctor using specialized surgical tools. IUI is usually recommended for couples where either or both the partners are infertile as a result of previous treatments or underlying conditions.

The sperm is first collected from the male partner or a donor and then stored in very low temperatures before it is implanted into the woman’s uterus.

It usually takes a few cycles before a woman is able to conceive successfully. The rate of success is very high by the 6th cycle.

6. Medication to treat Female Infertility

Fertility drugs can help with many problems like increasing the chances of getting pregnant and also carrying the baby to the full term. These drugs target specific infertility issues so a woman should take them only at the recommendation of a doctor.

Note: Without a diagnosis, fertility drugs will not increase the possibility of conceiving.

If a couple cannot get pregnant, it could be due to infertility issues in both or either of the partners. It is recommended to seek medical treatment if the female partner fails to get pregnant or continually have miscarriages after attempting to get pregnant for 12 months or more.

Older women above the age of 35 years are recommended to seek treatment within 6 months of trying to conceive.

For those women who have medical conditions that could potentially affect pregnancy or have irregular menstruation, you should consult a doctor before you try to get pregnant.

Different Types of Fertility Drugs for Women

There are some fertility pills that can trigger ovulation when a woman does not ovulate regularly.

Other types of drugs include hormones that should be taken right before an artificial insemination.

Drugs That Cause Ovulation

There are some women who do not ovulate regularly while some do not ovulate at all. It is said that 1 out of 4 women cannot get pregnant because of ovulation issues.

Below are some drugs that can treat ovulation issues:

• Metformin: Also known as Glucophage, this drug can decrease the resistance to insulin. Polycystic Ovary Syndrome or a body mass index above 35 can cause resistance to insulin, which in turn creates issues with ovulation.
• Dopamine Agonists: This type of drugs reduces the level of a hormone known as prolactin. For some women, the presence of excessive prolactin can create issues with ovulation.
• Clomiphene: It is also known as Clomid. This is a drug that can trigger ovulation. It is commonly recommended as the first option during infertility treatment for women facing ovulation issues.
• Letrozole: Also known as Femara, this drug can trigger ovulation just like letrozole and clomiphene. Letrozole may be more effective for obese women, especially those diagnosed with PCOS.

In 2014, a study found that about 27.5% of women diagnosed with PCOS who regularly took letrozole were able to conceive as opposed to 19.1% of women who took clomiphene.

• Gonadotropins: These hormones can stimulate ovulation. This is usually recommended when all other treatments fail to work. Your doctor may typically recommend using a combination of a luteinizing hormone and a follicle stimulating hormone.

This treatment is usually administered in the form of a nasal spray or an injection.

It is said that out of about 10% of infertility cases, doctors are not able to find a cause. Medically, it is referred to as “unexplained infertility.” Drugs that trigger ovulation may be able to help in such cases.

A woman can optimize her chances of getting pregnant by timing sexual intercourse when under these medications. It can also address the issues of unidentified ovulation.

Hormones for Artificial Insemination

Not all cases of infertility can be treated by drugs.

When the cause of infertility cannot be determined by the doctor, artificial insemination is recommended.

Intrauterine Insemination or IUI is a procedure where the sperm is inserted directly into the uterus during ovulation. It may be able to treat cases where infertility is due to sperm mobility or cervical mucus or “unexplained infertility.”

Your doctor may prescribe these drugs before performing IUI:

• Ovulation Trigger: Since it is essential to perform IUI at the time of ovulation, doctors usually recommend shots to “trigger” ovulation like the Human Chorionic Gonadotropin (hCG) hormone.
• Ovulation Drugs: Letrozole or Clomiphene can stimulate ovulation and even release extra eggs.
• Progesterone: This hormone is usually taken through vaginal suppository and can sustain early pregnancy.

In Vitro Fertilization (IVF) is a procedure where one or more eggs are removed to fertilize with the sperm in a petri dish. The eggs are implanted into the uterus once it grows into embryos.

Drugs for IVF

Here are some drugs that IVF requires:

• Ovulation Suppression: IVF may not be successful if the ovulation happens too early. Gonadotropin antagonist hormones are usually prescribed to prevent the chances of ovulating too early.
• Ovulation Drugs: Like IUI, there is a higher chance for IVF to succeed if the ovaries are able to produce several eggs. Letrozole or clomiphene is usually prescribed for this.
• Ovulation trigger shot: Ovulation trigger shots like the hormone hCG can increase the rate of success in IVF.
• Progesterone: This drug helps to support early pregnancy through IVF.

During infertility treatment, a doctor may prescribe hormonal birth controls in order to regulate the period cycle. This will also prepare the body and make it more receptive to artificial insemination.

What to Expect

Before taking fertility drugs, make sure your doctor diagnose the problem using ovulation tests, blood tests, and image tests of the fallopian tubes and uterus.

You may also be asked to keep track of your period cycle and test the basal body temperature every morning.If the diagnosis is such that it may not be treated by medication, your doctor will recommend IVF or IUI.

It is essential to wait for a few months before starting the treatment as it is important to take fertility drugs on fixed days of the cycle. If it is not successful in the first treatment, you may be recommended more tests, another treatment, or even a different treatment.

Side Effects of Fertility Medications

It is common for women to experience side effects after taking fertility drugs, especially those medications that contain hormones.

Some of the common side effects include:

• Changes in mood including depression, anxiety, and mood swings
• Temporary side effects including breast tenderness, cramps, headaches, vomiting and nausea
• Ovarian Hyper-stimulation Syndrome
• Higher risk of pregnancy loss
• Multiple births

There is also the possibility of an increased risk of endometrial and ovarian cancers besides others.

Considerations

Infertility treatment is not covered under a lot of health insurance policies in the U.S. That said, if the infertility is a result of some serious medical issue like PCOS or infection, the insurance may cover the treatment.

The cost may be a concern for many individuals. You need to weigh on the potential benefits and costs when choosing the right treatment.

Here are some questions to ask your doctor:

• What’s the success rate of this procedure among patients with the same diagnoses as mine?
• How long does it take on average to successfully conceive through this treatment?
• What’s the overall cost for this treatment?
• Are there more affordable alternatives?
• What’s my chance of getting pregnant without fertility drugs?
• What else can I do to increase my chances of conceiving?

Male and female couples trying to get pregnant should both undergo fertility tests. In certain cases, both partners tend to have fertility problems and treating just the female partner will not help.

Not all infertility issues can be treated with drugs. For example, a blocked fallopian tube can be fixed by a procedure called hysteroscopy.

Outlook

It can be stressful trying to get pregnant with fertility issues.

It is possible for many women to get pregnant after undergoing infertility treatment, but a lot depends on the right diagnosis, especially with drug-based treatments. Therefore it is crucial to consult a doctor beforehand.

For women with infertility problems due to ovulation disorders, fertility drugs are the primary treatment.

7. Egg Donation

This can work if the woman has a regular uterus but the ovaries might be disturbed. Eggs are withdrawn from a donor who is under fertility drugs. The donor is usually younger.

What is Egg Donation?

Egg donation is a procedure that involves collecting eggs or oocyte from a donor possessing normal functioning ovaries. Using the receiving couple’s sperm, the egg undergoes fertilization through IVF. The embryos are fertilized in a laboratory for 3-5 days and then implanted into the uterus of the woman who volunteers to carry the baby.

Sometimes the specialists may choose to freeze all or some of the embryos for future use or implantation in other women.

Egg donation can benefit women who are not able to use their own eggs due to several reasons like advanced age, ovarian failure, or congenital anomalies in the fetus.

Back in 2014, a journal called Fertility and Sterility noted that about 93% of fertility clinics in the United States offered egg donation. It also indicated that this procedure led to a success rate of 49.4 – 50%

This article will talk about the criteria for selecting an egg donor, legal ramifications, and the procedure.

What to Expect

The specialists working at the fertility clinic will find a suitable donor after an intensive selection process. They will also look into all the legal procedures.

Before undergoing the procedure, donors will be required to take medications to stop the menstrual cycle. Taking this medication can cause some side effects, such as:

• Hot flashes
• Body aches
• Fatigue
• Headache

More fertility drugs will be prescribed to induce hyperstimulation, whereby the ovaries produce several eggs at once. This medication will be self-administered by the donors themselves by injecting it into a muscle or under the skin.

Although not common, some mild side effects include tender breasts, mood swings, and bruising at the injected area. In some rare cases, too many eggs may develop inside the ovaries and lead to a severe case of Ovarian Hyper-stimulation Syndrome (OHSS). This may require hospitalization.

It is also possible for donors to get pregnant before retrieving the eggs, so it is recommended to abstain from sexual intercourse or use contraceptive barriers like a condom.

The donor will have to go through frequent ultrasound examinations and blood tests throughout the cycle of donation to closely monitor how their body reacts to the medications.

Extraction Process

The donor will receive one last injection before the eggs are retrieved.

The eggs will be removed from the donor’s ovaries through trans-vaginal ovarian aspiration. In this process, an ultrasound probe will be inserted into the vagina, and then the egg will be removed with the help of a needle.

The procedure lasts about 30 minutes, and the donor may be given an anaesthetic, sedatives, or painkillers. Since the procedure is quite minor, there is no need to stay overnight at the hospital.

After the Donation

Recovery depends on person to person. While some can resume their normal activities the very next day, some need several days of rest.

Some programs also offer after-care services to donors. Egg donation may affect some women psychologically, requiring psychotherapy following the procedure.

Complications and Side Effects

There are very little chances of complications in egg donation. The medications and procedures are the same as women who use their own eggs and comes with the same risk level.

Using anesthesia during egg retrieval comes with some risks, but it is quite rare to cause serious issues.

In some cases, it may cause minor bleeding when the needle is inserted into the ovary. Although very rare, there is also the chance of causing damage to the bladder, bowel, surrounding blood vessels. Severe bleeding or damage is very unlikely.

There is also the chance of infection even after retrieving the eggs. This can be prevented with the help of antibiotics.

Sometimes, OHSS can also be triggered by the medication to induce ovulation, which can range from mild to severe. In any case, consult a doctor.

Severe symptoms that may require hospitalization include:

• Fast weight gain
• Difficulty in breathing
• Vomiting
• Stomach ache

Donor Criteria

There are several factors that affect the ability of a woman to donate her eggs.

These are the factors that reduce the chances of congenital anomalies and increase the success rate of pregnancy.

Donors are generally between the age of 21 to 35 years as women at this age respond more readily to fertility drugs and also often have better quality and higher quantity of eggs.

Women diagnosed with Hepatitis C and HIV or with a high risk of inherited diseases (e.g., cystic fibrosis gene) are not qualified to be egg donors.

Women who are exposed to high risks of contracting HIV or other infections are also not eligible for egg donation. Similarly, if a woman is not able to provide her family medical history in detail, she cannot donate her eggs.

Certain programs give higher preference to women who have already donated eggs before or have given birth.

Screening Process for Egg Donor

In order to avoid as much congenital anomalies and other complications as possible, reputed egg donor programs are rigorous with their screening process.

The screening process by a program may include all or several of these steps:

• Interview in person or by telephone
• Application
• Physical screening
• Drug tests
• Blood tests
• Examining the reproductive organs through ultrasound
• Donor’s personal and family psychological and medical history
• Screening for infectious disease
• Inherited disease screening

Psychological Screening

Donating one’s own egg can be an emotional experience, not just for the donor but also for the recipient. Reputed programs provide psychological screening for both individuals involved.

It is important to evaluate the mental health of the donor to make sure she is making an informed decision and also to make sure the resulting children are healthy.

Legal Implications

The laws regarding egg donation vary from country to country. In a country like the United States, it is legally allowed for a woman to donate her eggs both anonymously and otherwise, and it is also legal to be financially compensated for it.

Donors are required to sign a contract stating that they do not bear any legal rights or responsibilities to the resulting embryos or children.

The egg recipient is recorded as birth mother although she may not be a genetic relation to the child.

Identity of the Donor

Most programs prefer to keep the identity of the donor confidential. There are also cases where the recipients receive all the information on the donor except meet them in person or know their name.

Some egg donation programs may make arrangements for the recipient and donor to meet in person if both the parties are willing. In certain cases, the recipients may also allow the donor to contact the child after they have reached a certain age.

There are also cases where the egg donor already has a relationship with the recipients. This is mostly when the donor is a family member or a friend. In such cases, the program recommends making direct contact in order to arrange for the transfer process, screening, and treatment.

Costs of Egg Donation

An international non-profit organization called Parents Via Egg Donation has estimated that the overall cost of a fresh cycle of egg donation is between $35,000 to $50,000 in the U.S. In this case, recipients will not share the eggs with others in the program.

Generally, the cost for a shared egg cycle starts at approximately $18,000. If the eggs are already frozen at the donor bank, it will typically start from $16,000 and go all the way up to $20,000 in the U.S. while the rates are cheaper in countries like Thailand or even in the European countries.

Usually, egg donors are compensated for their effort and time, and the outcome doesn’t determine the payment.

Compensation depends on a lot of things and varies with each donation program. According to the American Society on Reproductive Medicine, it is ethical to pay women who donate their eggs.

The society has also found that the amount of money that is paid to the donor varies and depends on several factors like the egg donation program, region, etc.

Outlook

Egg donation is a simple and short procedure with a high success rate. The doctor will extract the egg from the donor after careful screening of the candidate.

The egg donor will first take medication to stimulate the ovaries by stopping the normal menstrual cycle. The doctor will administer painkillers, anaesthesia, or sedative for the procedure. Recovery may take a day to a few days, depending on the individual.

There are psychological and physical side effects associated with donating and implanting eggs, but overall, this is a well-tolerated and safe procedure. The level of confidentiality of this procedure will depend on both the donor and the recipient, whether they want to get to know each other or decide to keep it a secret. Many egg donors are financially compensated for their eggs and effort.

In order to minimize any possibility of congenital anomalies and genetic diseases, the screening process is rigorous and thorough. It is also the responsibility of the facility to clarify all legal implications to the recipient and donor of the eggs.

Can I Prevent Female Infertility?

Usually, there is nothing you can do to prevent female infertility that is caused by illness or genetic issues.

There are, however, many things you can do to decrease the chances of infertility:

• Take caution to prevent the possibility of contracting sexually transmitted diseases
• Avoid frequent or heavy alcohol consumption
• Avoid illegal drugs
• Practice good health practices and personal hygiene
• If you are sexually active, have checkups with a GYN at least once a year

Outlook

For couples who are struggling to conceive naturally or wish to have children past the reproductive age, there are so many effective options available. Many couples explore over-the-counter and traditional solutions before exploring other infertility procedures.

The first IVF baby was born in 1978, and by 2015, more than 5 million IVF babies were born.

With more advanced science and technology, fertility solutions are accessible to more people and with a high success rate.

Depending on the type of treatment, fertility procedures can be costly. However, there are different programs that can help with this.

References:

https://www.mayoclinic.org/diseases-conditions/female-infertility/symptoms-causes/syc-20354308

https://www.womenshealth.gov/a-z-topics/infertility

https://share.upmc.com/2018/09/common-causes-of-infertility/

https://my.clevelandclinic.org/health/treatments/4819-female-pelvic-laparoscopy/when-to-call-the-doctor

https://www.glowm.com/section_view/heading/Hysteroscopy%20and%20Infertility/item/89

https://www.cdc.gov/reproductivehealth/infertility/

https://www.medicalnewstoday.com/articles/178635.php

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3859121/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4416474/

https://www.asrm.org/uploadedFiles/ASRM_Content/News_and_Publications/Ethics_Committee_Reports_and_Statements/financial_incentives.pdf

https://www.theguardian.com/society/2014/nov/23/whats-next-for-worlds-5-million-ivf-babies

https://www.reproductivefacts.org/globalassets/rf/news-and-publications/bookletsfact-sheets/english-fact-sheets-and-info-booklets/booklet_medications_for_inducing_ovulation.pdf/

https://www.ncbi.nlm.nih.gov/pubmed/25006718

https://www.merckmanuals.com/professional/gynecology-and-obstetrics/infertility/overview-of-infertility

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What Is Infertility?

Infertility is clinically interpreted as the inability to conceive after 12 months of regular unprotected sex. It is not affected by the patient’s gender and prevails both in female as well as male patients. Studies suggest that an estimated 15 percent of couples fall under this criterion (approximately 35% due to male factors).

Types of Infertility

1. Primary infertility: Refers to those unable to conceive after at least 12 months of having regular intercourse without any contraceptives.
2. Secondary infertility: Refers to those who had conceived once but are now unable.

Male Infertility Tests

• General physical and medical history: This involves a thorough evaluation of your medical history; infertility duration, previous tests, and procedures, inherited medical conditions, sexual habits, drug usage, illnesses and examining your genitals.
• Semen analysis: Here, a sample of your semen is obtained in a special container which is then examined by the lab technician to evaluate the shape, sperm count, and look for any abnormalities. If the sperm count is low, blood and hormone tests are conducted. The lab will also check for any possible signs of infection.

If the tests are found to be normal, the female partner will be given attention before performing any further laboratory test on the male.

Additional tests involved to determinants of fertility problems in men are as follows:

• Testicular biopsy: This involves the removal of a small tissue from the testicles. It helps to determine if a block is affecting semen formulation.
• Scrotal ultrasound: Images of the scrotum are generated using high-frequency sound waves. It helps doctors in finding any signs of injury and varicocele.
• Urinalysis: This test examines urine to detect any presence of semen; indicating signs of ejaculatory problems (retrograde ejaculation).
• Ultrasonography: Blockages in the male reproductive system and prostate are detected using ultrasonography.
• Specialized-sperm function tests: Rarely performed, it involves multiple tests to determine if your sperm can survive after ejaculation, if it can enter an egg or if there’s any problem with the egg.

Nearly 70% of conditions that causes infertility in men can be diagnosed with such tests alone.

Causes of Male Infertility

Male infertility is caused by multiple factors such as health, medical, environmental, and lifestyle issues.

1. Retrograde Ejaculation

Semen is normally released from the penis during ejaculation. Retrograde ejaculation can make the semen travel back to the bladder.

During normal ejaculation, the semen (aka ejaculate) is forced out of a man’s penis through the urethra. The semen is able to come out of the penis due to a muscle called bladder sphincter, which closes the bladder’s opening and prevents the semen from going back into the bladder.

If the bladder sphincter fails to work correctly, the bladder may fail to close, causing the semen to go back into the bladder instead of exiting the penis.

What Is Retrograde Ejaculation?

Retrograde ejaculation happens when semen flows back into the bladder, rather than ejaculating. This occurs due to the lack of nerve contractions and open bladder neck during ejaculation. It can be caused due to various health issues like diabetes, bladder or prostate surgeries, spinal injury, and medications.

It is also known as a dry orgasm. Retrograde ejaculation patients can still experience an orgasm but ejaculate fewer fluids than what they normally do. When very few or no semen exits from a man’s body, it often causes infertility(0.3-2%) in men as the chances of impregnating is greatly reduced from low to 0.

Most men with this condition don’t even realize that they have it as it doesn’t cause any physical pain. Although some men have reported signs of cloudy urine post-orgasm, this occurs when semen mixes with the urine.

Some Facts on Retrograde Ejaculation

• Men commonly ejaculate over 1.5 milliliters (ml) of semen
• Men suffering from retrograde ejaculation may not ejaculate any semen at all
• Retrograde ejaculation is not a diagnosis, it’s a symptom
• Unless a man is trying for a baby, it is not necessary to treat retrograde ejaculation

What Causes Retrograde Ejaculation?

Retrograde ejaculation might arise due to various factors, such as:

• Diabetes: Most male diabetic patients have chances of suffering retrograde ejaculation due to faulty blood sugar control for a long time. This is because it damages the nerves of the bladder.
• Injuries: Spinal injury can cause damage to the nerves and sphincter of the bladder.
• Surgery: Prior-surgeries on the urethra or prostate, bladder, or surgery on the lower spine can induce retrograde ejaculation. About 10-15% of men who undergo prostate surgery have chances of suffering retrograde ejaculation.
• Medications: certain medications used for treating HBP, depression, enlarged prostate, and spinal injury can lead to retrograde ejaculation.

Treatment for Retrograde Ejaculation

Although retrograde ejaculation does not have any serious underlying cause, some men may seek treatment for the condition simply because it affects their experience of sex.

There are also options for men looking to get their partner pregnant. Usually, the treatment will begin by removing the sperm following ejaculation; It may involve separating the sperm from the bladder.

There are certain medications that attempt to trigger antegrade (forward) ejaculation. If it does not work, a doctor may attempt to extract the sperm without ejaculation. Following are some surgical procedures to remove the sperm:

• Testicular sperm aspiration (TESA): It is a procedure conducted under local anesthesia. The sperm is extracted from the testicles using a needle.
• Testicular sperm extraction (TESE): TESE is similar to TESA as it extracts the sperm directly from the testicles after sedating the patient. But unlike TESA, this procedure makes an incision right in the testicle.
• Percutaneous epididymal sperm aspiration (PESA): In this procedure, sperm is collected from the epididymis (duct connected to the testes) with the help of a needle. It is performed under local anesthesia.

Once the semen has been successfully collected, the doctor can help to get the patient’s partner pregnant through one of two ways:

• Intrauterine Insemination (IUI): The procedure involves directly injecting the semen into the uterus of the woman during ovulation.
• In Vitro Fertilization (IVF): In this procedure, an egg is removed from the woman and then fertilized in a petri dish. Once the embryo grows, the doctor then implants it inside the uterus of the woman.

There are different types of treating retrograde ejaculation, and it depends on what caused the problem in the first place. If it is due to medication, usually stopping the medication or changing it resolves the issue. When it is caused by nerve damage, it is usually not reversible.

Retrograde Ejaculation and Prostate Removal

A common cause of retrograde ejaculation is the surgical removal of a part of the prostate. Around 10 – 15% of men who have undergone this surgery is said to suffer from retrograde ejaculation due to the fact that surgery may cause nerve and muscle damage in the bladder.

It is also possible not to ejaculate at all after undergoing radical prostatectomy (prostate removal.)

When to consult a doctor?

Retrograde ejaculation does not cause any pain, neither is it dangerous, and hence, treatment is not always necessary. However, it can be triggered by certain medical conditions.

You can consult a doctor regarding the condition when:

• You have a dry orgasm
• You ejaculate less semen consistently
• When you can’t impregnate your partner even after trying for a year.

A study conducted in 2017 showed a case where retrograde ejaculation showed to be the only and first symptom experienced by men suffering from type 1 diabetes. So if you are experiencing retrograde ejaculation, it is recommended to consult a doctor.

How to Prevent Retrograde Ejaculation

Retrograde ejaculation cannot always be prevented.

If you need medical treatment for your enlarged prostate, opt for less invasive surgeries like transurethral needle oblation aka TUNA or transurethral microwave thermotherapy aka TUMT. The possibility of causing muscle and nerve damage is less in these surgeries.

Prevention for retrograde ejaculation can also be done by simply keeping a check on the medical conditions that damage the nerve. If you have diabetes, regularly take your medications prescribed by your doctors and make healthy lifestyle changes.

Takeaway on retrograde ejaculation

In most cases, you cannot reverse the damage leading to retrograde ejaculation. However, you can treat the infertility that it causes. Even if you fail to ejaculate at all, you can get help from a fertility specialist.

If you have retrograde ejaculation, there is a chance you may have other symptoms as a result of diabetes, prostate surgery, or an enlarged prostate. It is recommended to report symptoms like erectile dysfunction, frequent urination, blood in semen or painful ejaculation to your doctor. These are symptoms that might be a result of another diagnosis.

Most men are under the assumption that ejaculation and orgasm are one and the same, but normal orgasm is possible even without ejaculation. Some men may find it uncomfortable to have dry orgasm, but it is not always a serious medical condition. Change your expectation so that you can lead a normal life with retrograde ejaculation.

2. Varicoceles causing Male Infertility

Varicoceles are like varicose veins only, it appears around the testicles instead of the legs. These may not cause serious issues, but it can cause male infertility.

Varicoceles occur as a result of enlargement of veins in the scrotum as a result of malfunctions in some blood pumping blood valves. It is a condition that affects around 15% of the male population and has a tendency to occur in men between 15 – 25 years of age.

Normally, varicoceles only affect the left side of the testicles.

Some Facts on Varicoceles

• Varicoceles are just like varicose veins but occurring in the area around the male testicles.
• It normally affects 15% of the male population, between 15-25 years.
• It is not exactly known as to what causes this but is thought to be similar to varicose veins.
• Usually does not cause any pain.
• Varicoceles are not a serious condition but may cause complications like infertility.
• If you face complications, surgery is an option.

What Is Varicoceles?

Varicoceles are one of the most treatable causes of male infertility and the most common cause of acquired infertility (75-85%). It is the swelling of the veins in the scrotum.

It leads to reduced sperm quality by impairing proper blood circulation and abnormal testicular temperature. It usually affects the left testicle, but it affects the production of sperm on both sides. Varicocele doesn’t usually cause pain.

Varicocele affects the pampiniform plexus, a type of nerve which is responsible for regulating( acts as a heat exchanger) the temperature of the testes and cooling the arterial blood. Varicocele interrupts the cooling system, which in turn stops the testes from producing good quality semen.

Treatment for varicoceles

Treatment for varicocele isn’t really required, but individuals must consult a doctor if they experience a reduced sperm count, pain, or feel uncomfortable or have been trying to conceive for more than a years with no success.

Your doctor might suggest having surgery in such cases.

Types of Varicocele Surgeries Available

There are three types of surgery available:

1. Percutaneous embolization: This procedure is minimally invasive, a tube is inserted through the groin or neck by a radiologist, and then instruments are allowed to pass through the tube. Next, the surgeon tries to block the veins by scaring it using chemicals or coils. The surgery can be performed as an outpatient procedure, and patients can expect a quick recovery.
2. Laparoscopic surgery: In this procedure, the surgeon inserts a laparoscope in the abdomen area by making a small incision.
3. Varicocelectomy: The surgeon performs an open surgery under general or local anesthesia. The goal is to enter the area either through the groin or the upper thigh or abdomen.

The surgeon then corrects the swollen veins using surgical microscopes or ultrasound. The affected veins are closed, and the blood flow is rerouted through healthier veins. Patients may feel minimal pain post surgery and can expect a short recovery time.

If the condition isn’t serious or doesn’t require surgery, wearing supportive briefs might prevent discomfort and ease the pain.

Surgery Risks

Although these surgeries are normally safe, there may be some risks involved:

• Damage to the artery
• Atrophy of the testicles
• Abdominal pain
• Infection, or
• Chances of swelling, bruising, or fluids building up in the treated area.

Although very rare, renal vein thrombosis may also develop affecting the kidney. There are also cases where even after surgery, the new veins also enlarge. More treatments are required to address the problem.

Symptoms of Varicoceles

It is very rare for men with varicoceles to experience pain. If pain occurs, it will probably:

• Worsen during physical exertion or in standing position
• Range from dull to sharp pain
• Ease when lying on back
• Increase as the day goes on

Varicoceles are often not noticed except by a physician during a medical examination.

It is recommended to see a physician if you notice:

• Changes in the appearance, size or shape of your testes
• Abnormal lump
• Fertility issues
• Swollen scrotum
• Twisted or unusually large veins

Possible Complications

Varicoceles can sometimes cause complications.

• Infertility

Possibly the most serious complication that may arise is infertility. It happens probably as a result of increased blood accumulation in the area, which causes a rise in the testicular temperature.

Studies show that 35 – 44% of men experiencing primary infertility are diagnosed with varicoceles. When a man fails to impregnate his partner for 12 months, it is called primary infertility.

Varicoceles are also found in 45 – 81% of men experiencing secondary infertility. Secondary infertility is when a man has been able to impregnate his partner at least once but is no longer successful.

According to a research that was published in 2016, 15.7% of 7,035 young, healthy men who were monitored between 1996 and 2010 had varicoceles. The same people also had lower quality semen.

Sperm production is shown to be more efficient when the temperature is said to be lower than the body.

• Shrinkage of Testicles

Varicoceles also cause testicular shrinkage or atrophy. Sperm-producing tubules form a major portion of the testicles. The testicles become softer or smaller when there is damage to the tubules.

• Hormonal imbalance

Changes in the hormones can occur when the cells are subjected to an increase in the pressure. It can lead to a higher level of the luteinizing hormone (LH.) It is a hormone found both in the male and female body. The testosterone levels may also vary between normal to subnormal.

Causes

Reports suggest that the swelling of the veins may be because the valves present in the spermatic cord stops functioning normally, it helps in carrying the blood to and from the testes. Although the precise cause for this is unknown, it is somehow similar to the varicose veins that occur in the legs.

The valves are responsible for the smooth flow of blood from the testicles towards the heart and ensure that the blood does not flow backward. But when the valves stop functioning correctly, the blood pools in the lower parts of the veins and forms a varicocele.

Classification of Varicoceles

1. Pressure type (grade I varicocele, which occurs when the blood fills up the spermatic vein).
2. Shunt type (a grade II/ III varicocele, which is caused by a severe build-up of blood that damages the spermatic vein).

When a patient with varicocele is above 40 years, it might be due to an obstruction in the larger veins in the abdomen area, which indicates the presence of a kidney tumor.

Risk Factors for varicoceles

There are no known risks involved with varicoceles. However, it commonly occurs during puberty. The risk of getting varicoceles is lower when an individual is overweight, while taller people have a higher risk.

Previously, it was considered that a man is less likely to become infertile once he has succeeded in fathering a child. However, a research conducted in 1993 has concluded that this is not the case. Instead, the research claims that the risk of a man becoming infertile increases with time.

If a man above 40 years of age develops varicoceles, it is most probably caused by larger vein blockage around the abdomen, possibly caused by a kidney tumor.

Natural Treatments for Varicoceles

If the condition is not serious enough, you can wear supportive underwear to reduce any pain.

You can find a wide variety of alternative therapies to treat low sperm count but always consult a physician first.

Diagnosis for Varicoceles

Varicoceles are present in 3 grades:

Grade I: It is very small and not visible. A physician can feel it using a Valsalva maneuver.

Grade II: This is also not visible but is big enough to be felt even without using a Valsalva maneuver.

Grade III: Here, the varicocele is visible. Large growths can feel soft to the touch, like a “bag of worms.”

“Subclinical Varicoceles” can be detected only with imaging tests. The tests used in this type of imaging can either be Doppler reflux test or scrotal thermography, which are both types of ultrasound.

By conducting an ultrasound test, your doctor will rule out any possibilities of a tumor near or on the spermatic vein.

Other test options include analysis of the semen and hormone tests for detecting low testosterone and high follicle stimulating hormone (FSH.) These tests may be recommended if your physician suspects a dysfunction in your testicles.

Typically, varicoceles do not pose any risk, but if you notice changes in the consistency, shape, or size of your genitals, it is recommended to consult a physician.

3. Drugs causing Male Infertility

Consuming certain drugs, both legal and illegal, can negatively affect male fertility (the ability of a man to impregnate his partner.) Men who want to father a child must first consult a physician before undergoing treatments or taking a new medication. Taking fertility supplements that are not FDA approved and scientifically evaluated may cause more harm than good.

Men who find it difficult to father a child should consult a physician about their medications and any possible tests for semen quality. Certain medications can cause side effects to some men, which can cause infertility problems. If your physicians tell you it could be the case, it is a good idea to try a different medication. Always discuss the issue with the physician who prescribed the medication for you.

Here are some common substances that cause infertility in men.

• Testosterone

Supplemental testosterone or replacement testosterone can negatively impact your sperm production. When you take testosterone supplements, it blocks the hormonal signals that trigger the testicles to produce sperm and testosterone. This leads to a sharp drop in the testosterone levels in the testicles. A common outcome is a considerable decrease in sperm concentration or a total absence of sperm in the semen.

In most cases, you can reverse this effect although it will take time – 6 to 12 months or more – to normalize the sperm production. It is safer to stay away from any kind of testosterone supplements if you are trying to impregnate your partner.

• Anabolic steroids

Anabolic androgenic steroids or anabolic steroids are drugs that can help in muscle mass enhancement and/or body fat elimination. Testosterone is also an anabolic steroid. It has become increasingly popular among non-athletes and non-competitive athletes to use this drug.

Low-quality muscle-building and fitness dietary supplements sometimes contain anabolic steroids. These steroids can provide the same level of harm to a man’s fertility as testosterone. Both disrupt the hormone signals required for sperm production.

The level of damage caused will depend on the dose, drug, and how long it was consumed. Typically, a man’s sperm production will increase in 3 to 13 months after stopping the medication. It is recommended to avoid taking drugs of this nature because the negative impact of taking anabolic steroids on male fertility is very high.

• Alcohol

Male fertility will not be affected by light to moderate alcohol consumption. The problem lies with heavy alcohol consumption (over 14 mixed drinks per week), which can decrease the testosterone production, rapidly clear the existing testosterone from the bloodstream and increase the estrogen levels. The resultant effect will be a decrease in the testosterone level, harming the production of sperm.

• Tobacco

Using or smoking tobacco causes serious health issues. Infants and toddlers living in households with adult smokers have a higher risk of developing serious respiratory conditions such as pneumonia, severe asthma, and frequent ear infection. SIDS (Sudden Infant Death Syndrome is also a condition frequently linked to households with smokers.

Children whose parents smoke are also more likely to smoke as they grow older. Regular smoking negatively impacts your sperm movement and sperm production. Couples trying to conceive are recommended to stop smoking.

• Marijuana

The active ingredient in marijuana is THC, and it is known to decrease the production or sperm and weaken a man’s sex drive by disrupting the testosterone production. THC also directly harms the sperm movement. Marijuana also contains heavy metals like lead, which increases its weight and other illicit addictive drugs like cocaine.

Due to the negative effects of using marijuana on the fertility of a man, couples trying to conceive should avoid using marijuana altogether.

• Opiates

Opiates or narcotics refer to both illegal street drugs and prescription medication. Long-term opiate consumption interferes with the signals that control the production of testosterone, which lowers testosterone and decreases the sperm quality and quantity. The level of impact will depend on what is used, how long and the dose.

If you have been prescribed opiates to treat your addiction, consult your addiction counsellor, and talk about your fertility concerns because some treatments can be less harmful than others.

Short-term opiate consumption does not have a negative impact on the fertility of a man. Therefore, it is safe to take opiates prescribed by your physician for a short time to control pain after a broken bone or surgery. If you are prescribed or is taking opiates for several weeks or months, consult your physician and ask for suggestion to cut back on your intake.

Recreational (illegal) opiate use is strongly discouraged.

• 5-alpha reductase inhibitors (Propecia, dustasteride, and finasteride)

These are medications for treating hair loss and prostate enlargement. Taking these medications has a very mild impact, and reverses once stopped. If you are taking these drugs for treating prostate enlargement, you will notice a decreased semen volume and the quantity of sperm in your semen, making it harder for you to impregnate your partner.

When this medication is taken to treat hair loss, the change in sperm quantity is negligible. However, about 5% of people consuming this medication for either of the reasons will see a visible reduction in their sperm count. It is recommended to stop taking the medication if you are struggling to impregnate your partner. Taking these medications will also decrease a man’s sex drive, although it will go back to normal once the medication is discontinued.

• Alpha-blockers (Alfuzosin, Tamsulosin, Silodosin, Cardura®, Hytrin®)

Alpha blockers are prescribed for treating urinary symptoms as a result of an enlarged prostate. Taking these medications can cause male infertility. Both Tamsulosin and Silodosin can either decrease the ejaculation volume or completely inhibit the ejaculation altogether.

If you have been prescribed an alpha-blocker and experiencing urinary symptoms, consult an urologist and ask about the possible impact it may have on your fertility and possible treatment alternatives.

• PDE5 inhibitors (Cialis®, Levitra®, and Viagra®)

PDE5 inhibitors are commonly used for treating erectile dysfunction. The medications, however, does not seem to negatively impact male fertility.

• Selective serotonin reuptake inhibitors(SSRIs)

It is commonly used for treating anxiety and depression, especially in the United States. Continued intake of the medication can harm the sperm or even inhibit sperm movement through the reproductive tract.

If you are taking SSRIs and is finding it difficult to impregnate your partner, consult an urologist, and have your semen tested. You can also discuss with your mental health provider for alternative medications.

• Ketoconazole

It is a medication for treating fungal infections. It is a topical treatment and is applied to the skin as powder, cream, or ointment. Topical application of Ketoconazole shows no evidence of harming male fertility. However, when taken as a pill, it decreases the production of sperm and hurts the production of testosterone.

• Chemotherapy

Any type of chemotherapy medication for treating cancer inhibits the production of sperm. Your sperm production will return in a matter of 2 years, depending on the type and duration of chemotherapy.

On rare occasions, the production of sperm may never return, leaving the man infertile. It is recommended to consult a doctor about sperm freezing before undergoing chemotherapy.

• Other medications

These medications can lead to male infertility issues: colchicines, sulfasalazine, nifedipine, cimetidine, spironolactone, and some antibiotics. If you are struggling to impregnate your partner while taking these medications, discuss your concerns with your doctor and consult an urologist to test your semen.

Male infertility is caused by multiple factors such as health, medical, environmental, and lifestyle issues.

4. Immunologic Male Infertility

Sometimes, antibodies or immune system cells produced in a man’s body can mistakenly identify his own sperm as harmful and try to remove it. Antibodies are often produced because of surgery, injury, or infections. They stop the sperm from swimming into the fallopian tube and entering the egg.

Patients with testicular cancer have higher chances of producing antibodies that might impair sperm motility.

Production of antisperm antibodies in men

Causes of immunologic infertility

Immunology infertility in men is triggered by an injury to their testicles or infection in their prostate. This kind of trauma can set off the immune response whenever the blood and sperm come in contact. It can also be caused by testicular surgeries like a vasectomy.

When to get tested?

If you are finding it difficult to impregnate your partner and your doctor has suggested some fertility tests, ask to get tested for antisperm antibodies as well.

An immunobead test can be conducted on the patient’s sperm. You need to provide a sample of your semen by masturbating. You can also opt for an antiglobulin reaction test which is done on the blood.

Treatment for immunologic infertility depends on its underlying cause.

Your doctor might suggest some of these treatments – IUI, IVF, or ICSI.

5. Chromosomes: Genetic Causes of Male Infertility

Changes in chromosomes or inherited disorders such as; Klinefelter’s syndrome (a male born with 2 X- chromosomes and 1Y-chromosome instead of one each) cause abnormality in sperm production and block the sperm flow and can lead to male infertility, Y-chromosome deletion (a condition where a genetic material which is essential for producing sperm is absent in the Y chromosome), down syndrome, and DNA mutations (in a single gene.)

6. Obstructions

Certain infections and prior surgeries, including vasectomy, prostate surgeries, testicular, and abdominal surgeries, can block the male reproductive tract. Such obstructions disrupt the sperm movements and in turn, stops it from leaving the body during an orgasm.

7. Environmental Causes of Male Infertility

Extended contact with certain environmental components can impair sperm production and cause infertility.

Overexposure to radiation or x-rays, industrial chemicals, harmful substances like lead can contribute to lower sperm count. In the same way, elevated temperatures affect sperm production. Sitting for long hours and wearing tight clothes also increases the temperature of the testes and can reduce sperm count.

8. Lifestyle, Health, and Other Causes

Male infertility can also be caused by certain health and lifestyle choices. Some of these are:

• Weight: Obesity causes hormonal changes and accelerates the chances of infertility.
• Depression: Study shows that the chances of pregnancy are reduced if a male partner suffers from depression.
• Smoking tobacco: Men who smoke have reduced sperm production compared to those who don’t.
• Drug use: Using steroids, cocaine, and other sorts of drugs can temporarily reduce the quality of your sperm.

All of these causes can be related to male infertility and impairing sperm production.

What Are The Treatments Available for Male Infertility?

Infertility treatments for men are divided into 3 categories:

Surgical therapy

Varicocele treatments: Varicoceles are swollen veins found in the scrotum. There are three surgical options for treating varicoceles:

• Laparoscopic surgery: To perform this surgery, the surgeon makes a small cut and inserts a laparoscope through the abdomen area.
• Varicocelectomy: An open surgery performed under local anesthetic. The surgeon enters the varicocele area through the groin and corrects the affected veins and allows the blood to pass through healthier vessels.
• Percutaneous embolization: A tube is inserted into the body through the neck by the radiologist, and instruments are passed into the tube. Then the surgeon uses a coil or chemicals to block the veins.

Microsurgical Vasovasostomy: It is used to reverse vasovasostomy. Microsurgical vasovasostomy is done to reattach the vas and allow the sperm to swim through the urethra.

Vasoepididymostomy: It is a common microsurgical procedure to treat epididymal obstruction. This surgery is done to attach the upper end of the vas to the epididymis.

Non-surgical therapy

Non-surgical therapy involves using antibiotics to cure infections of the reproductive tract, medications, and therapy to treat intercourse problems, hormone replacement or drugs in cases where hormone levels affect the semen formulation and lower sperm count.

Treatment for Unknown Causes

Intrauterine Insemination (IUI): The sperm is allowed to pass through a tube and into the uterus. IUI is used to treat lower sperm count, retrograde ejaculation, and other infertility problems.

In Vitro Fertilization (IVF): this method is the most effective among other ARTs. This method involves mixing a woman’s egg with the sperm in a lab dish for fertilization. The embryo is then inserted into the uterus. It is often used to treat blockages in the fallopian tubes and lower sperm count.

Testicular Sperm Extraction (TESE): This method is done to determine the cause of azoospermia. It extracts sperm directly from the testicular tissue.

Intracytoplasmic Sperm Injection (ICSI): In this method, the sperm is injected directly into the egg obtained from IVF. The embryo (fertilized egg) is then inserted into the uterus. It is used in cases of block or testicular failure (when there is no sperm in the semen).

Post-Treatment and Recovery Time

Male infertility is often treated using outpatient procedures. While pain after such treatments is usually mild, their recovery and follow-up may vary. To determine if the varicocele is completely treated, getting a physical evaluation and sperm analysis is recommended every three months for at least a year.

After vasectomy reversal surgery, the pain experienced is mild, but its recovery might take up to 4-7 days. Successful treatment depends on the year gap between your vasectomy and reversal and mostly on the age and fertility of the female partner.

Precautions

A rich diet high in antioxidants like vitamin E and C has been proposed to improve sperm quality by reducing free radicals that damage the membrane. Zinc, fish oil, and selenium are also known to be of benefit.

Limiting the use of abusive substances like cigarettes, marijuana, and steroids. Harmful environmental exposure should be reduced.

Outlook

As new technology is introduced, more options are available for couples experiencing infertility and those who wish to conceive at an older age. Infertility treatments are now accessible to more people, and the success rate and safety of such treatments have increased.

Infertility treatments can be costly, but there are certain programs that can help you financially.

References:

https://www.betterhealth.vic.gov.au/health/ConditionsAndTreatments/infertility-in-men

http://obgyn.ucla.edu/infertility

http://www.myfertility.ca/testing_and_diagnosis/male_diagnosis/immunological_infertility/

https://www.health.harvard.edu/a-to-z/retrograde-ejaculation-a-to-z

https://www.health.harvard.edu/mens-health/retrograde-ejaculation

http://www.sciencedirect.com/science/article/pii/S2214442016301759

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The post Male infertility: A Comprehensive Guide To Causes Of Infertility In Men appeared first on MedTravel Asia.

What Is Infertility?

Infertility means failure to conceive after trying for at least one year or 6 months if a woman is over 35. It is a condition that affects both genders equally. Overall around 15% of couples struggle to conceive. It is important to remember that infertility can arise from female factors (about 35%), male factors (about 35%), a combination of both (20%), or from unknown causes (about 10%).

Types Of Infertility In Women

• Primary infertility: The couple’s inability to conceive any child at all after having regular unprotected sex.
• Secondary infertility: Couples who have already conceived a first child but have great difficulty in adding to their family.

Female infertility can arise if any problems occur in any of these steps:

• Ovulation: The ovaries must produce an egg.
• Womb: The egg must swim through the fallopian tube and enter the uterus.
• Fertilization: A man’s sperm must fertilize the egg along the way.
• Implantation: The embryo must attach inside the uterus and grow.

What Causes Infertility In Women?

A number of factors can cause female infertility. Some of these are:

1. Ovulation Disorders

Ovulation disorders account for 1/3rd of female infertility and the most common problem for unsuccessful pregnancy. The pituitary gland or the hypothalamus produces reproductive hormones, any abnormality in its regulation or complications in the ovary can cause ovulation disorders.

Symptoms

The inability to conceive is the main symptom of infertility. If your menstrual cycle is too short (under 21 days), too long (more than 35 days), irregular or altogether absent, it could mean you are not ovulating.

When to See a Doctor

Determining when to see a doctor will depend on your age.

• Up to 35 years: Most times, your doctor will suggest you to try at least 1 year before seeking treatment.
• 35 – 40 years: Consult a doctor after trying to conceive for 6 months.
• Above 40 years: Your doctor might start treatment or tests right away.

It is also possible for your doctor to suggest treatment and tests right away if either you or your partner has a history of infertility or if you have a history of endometriosis, prior cancer treatment, frequent miscarriages, pelvic inflammatory disease, painful or irregular periods.

Some causes of ovulation disorders are as follows:

Primary ovarian insufficiency (POI)

POI or premature ovarian failure causes ovulation problems. This disorder is caused when the ovary stops releasing eggs and lowers its estrogen production before she turns 40.

POI is also referred to as premature menopause, but they are both different. Women with POI  have chances of conceiving even after irregular periods for years, but those with early menopause will stop having periods nor get pregnant.

Patients with POI have deficient estrogen and as a result, cause osteoporosis. It can be improved by increasing the estrogen level. Age, family history, and ovarian surgeries can also be associated with POI.

Some symptoms of POI include; night sweats, irregular menstrual cycle, inability to conceive, hot flashes, dry vagina, low sex drive, etc. Women should see a doctor if they experience these symptoms.

What Causes POI?

A healthy ovary produces mature eggs each month for fertilization along with two essential hormones, estrogen and progesterone, to facilitate pregnancy. On the other hand, POI  prevents the ovary from working normally.

The causes of POI are:

• Genetic disorders: POI may arise due to specific genetic conditions or flaws in the chromosomes such as mosaic Turner’s syndrome, where a woman has only one X chromosome while the other one is either inactive or missing.
• Antibodies: In this case, the female’s immune system releases antibodies that affect the ovarian tissue, harm the follicles(or the sac that contains eggs) and damage the eggs.
• Toxins: Cancer treatments( chemotherapy and radiation ) are associated with toxin-induced POI. Such treatments damage the DNA in cells. Other toxic substances like pesticides, cigarette smoke, and viruses might also cause POI.

Treatment

Restoring estrogen levels is the main focus when treating POI. Some of these treatments include:

• Estrogen therapy: Such therapy can inhibit osteoporosis and can help in treating estrogen deficiency. Your doctor will prescribe estrogen with progesterone as it prevents precancerous changes induced by taking estrogen alone.
• Supplements: Vitamin D and calcium supplements can prevent osteoporosis. Your doctor will recommend a bone density testing before prescribing the supplements.

It is recommended to take 1000mg of calcium per day for females aged 19-50 while 1200mg for those above 50 years. The ideal dosage of vitamin D is not known yet, but  600-800 IU a day is a good start for adults.

Higher doses may be recommended in cases of low vitamin D.

Hypothalamic dysfunction

This refers to the malfunction of the pituitary gland. The pituitary gland releases two hormones; FSH and LH, that stimulates ovulation. If excess or too less of these hormones are produced, the ovary won’t ovulate normally. This can be due to a tumor, physical injury, or an abnormality in the pituitary gland.

What Causes Hypothalamic dysfunction?

There are various causes of hypothalamic dysfunction. Some of the common causes include; head injury, surgery, radiation, and tumor. It can also be associated with Prader-Willi syndrome, a genetic condition where a person is missing some chromosomes.

Excessive bleeding, malnutrition, eating disorders, and infections are some other causes of hypothalamic dysfunction.

Polycystic Ovarian Syndrome (PCOS)

Common among women, PCOS is a hormonal imbalance that causes infrequent or longer periods of menstruation and infertility in women.

If not diagnosed and treated early, it can cause type-2 diabetes and heart disease. Some symptoms of PCOS include; Irregular menstrual cycle, polycystic ovaries, increase in androgen.

Causes Polycystic Ovarian Syndrome (PCOS)

The root cause of PCOS is not known yet, but some of these factors might be associated with it:

• Genes: report shows that PCOS might be caused due to certain genes.
• Low-grade inflammation: White blood cells release substances that fight infections. Some reports suggest women with PCOS are linked with low-grade inflammation.
• Excess androgen: High levels of male hormone(androgen) is released by the ovaries which cause hirsutism and acne
• Excess insulin: The pancreas produces a hormone known as insulin, which is used by the cells as a primary energy supply for your body. When cells become resistant to it, the sugar level in your body increases and lead to excess insulin. This might lead to the production of more androgen and cause ovulation problems.
• Hyperprolactinemia: It is a condition where a person has excess prolactin in their blood. The pituitary gland releases excess prolactin, which leads to lower production of estrogen and causes infertility. Like other pituitary gland problems, it can also be caused by certain medications used for treating another disease.

What Causes Hyperprolactinemia?

• Tumor: One major cause of hyperprolactinemia is prolactinoma( pituitary gland tumor). These tumors are more common in women than men; it produces excess prolactin and is not cancerous. Larger tumors can even cause headache and blurry vision.
• Medications: Certain drugs can also lead to excess production of prolactin. Some of these drugs are methyldopa, SSRI antidepressants, opiates, Risperdal, etc.

Hypothyroidism, chest- wall injuries, kidney and liver problems, radiation treatments are some other causes.

Treatment

The treatment for hyperprolactinemia depends on its cause. If the patient has the condition but shows no signs or symptoms, then treatment isn’t required. However, there are some options  for treating the tumor:

• Medicines: Prescription drugs such as bromocriptine and cabergoline are used to reduce the production of excess prolactin.
• Surgery: If such medicines are not effective, surgery is needed to remove the tumor.
• Radiation: In rare cases, if both the above options are not found to be ineffective, then radiation is preferred to reduce the size of the tumor.

Synthetic thyroid hormone is also used to remedy hypothyroidism and reduce excess production of prolactin.

2. Damage to Fallopian Tube

Damaged fallopian tubes are another possible cause of infertility. It keeps the embryo from entering the uterus. Main causes of fallopian tube damage include:

• Pelvic inflammatory disease: Bacteria, viruses, and STDs like Chlamydia and gonorrhea infects the fallopian tube. Sometimes women with PID don’t know that they have the condition as it rarely shows any symptoms. It is later detected when they can’t conceive or suffer from chronic pelvic pain.

Some of the symptoms are; serious pelvic pain, foul vaginal discharge, high fever(>38.3 C). It is better to consult a doctor if you experience such symptoms.

The chances of having PID is increased if a woman:

• is sexually active before 25 years
• has many sexual partners
• is sexually active with someone with multiple partners
• has unprotected intercourse
• Prior-surgeries: Pelvic or abdominal surgery can result in adhesion that stops the egg from passing through the fallopian tube. Surgery for ectopic pregnancy can also cause the embryo to implant and develop in the tubes and not the uterus.

3. Endometriosis

A painful disorder that occurs when the tissue grows elsewhere instead of the uterus(endometrium). About 10% of partners who experience infertility are related to endometriosis.

The excision of the extra tissue causes scarring, which can lead to fallopian tube blockage and stop the sperm from interacting with the egg. Recent studies reveal that treating minimal endometriosis does not accelerate the rate of a successful pregnancy.

4. Uterine Or Cervical Causes

Most uterine causes can affect fertility by interfering with the implantation of the sperm and accelerating the chances of miscarriage. Some of these causes include:

• Fibroids and polyps tumors in the uterus can cause an obstruction in the womb or the fallopian tubes.
• An estimated 3% of couples who experience infertility are related to cervix mucus problems.
• Congenital abnormalities can cause repeated miscarriages and unsuccessful pregnancy.
• An inherited abnormality or damaged cervix can cause cervical stenosis ( narrowing of the cervix)

5. Unidentified Infertility

Sometimes, the exact cause of infertility can be hard to identify. Both male and female factors combined can cause unexplained infertility. Although the exact reason for infertility is hard to identify, it is not recommended to delay its diagnosis and treatment.

Risk Factors

Certain personal and lifestyle choices affect health; most of these factors also limit the couple’s ability to conceive.

• Diet and exercise: Both overweight and underweight women may have difficulty conceiving, which is why a proper diet and training is recommended for optimum reproductive functioning.
• Smoking: It reduces sperm counts and reduces sperm growth and increases the risks of miscarriage and premature birth for women.
• Alcohol and drugs: Consumption of both alcohol and drugs significantly raises the chances of infertility in women.

Prevention of female infertility

If you want to get pregnant soon or in the near future, here are some ways to increase your normal fertility:

• Maintain a healthy weight: If you are underweight or overweight, it will increase your chance of ovulation disorders. Exercise moderately if you want to lose weight. Intense, strenuous exercise lasting for over 5 hours is also associated with a decrease in ovulation.
• Quit smoking: Besides affecting your general health, tobacco also affects the fertility of a woman in many ways, including the health of the fetus. If you are a smoker and is looking to conceive, quit immediately.
• No alcohol: Excessive alcohol consumption leads to decreased fertility. Drinking alcohol while pregnant will also negatively affect the developing fetus. It is important to avoid alcohol if you are trying to conceive.
• Reduce stress: Studies show that couples that experience psychological stress have a lower chance of getting successful outcomes in their fertility treatment. Before trying to conceive, find a way to create a stress-free environment.
• Lower caffeine intake: Research has suggested that your ability to conceive will increase when you limit your caffeine intake by 200 milligrams per day. This is about 1-2 cups of 6-8 ounce coffee cups per day.

Environmental And Occupational Factors of female infertility

Overexposure to harmful toxins or chemicals present in the workplace and the surrounding can cause infertility.

• Lead: Lead can negatively impact human fertility. It can lead to abortion.
• Medical treatments and materials: Frequent exposure to radiation (x-ray, chemotherapy) alters sperm production and contributes to ovarian problems.
• Ethylene oxide: Using ethylene oxide (a chemical used in sterilization) causes complications in the early stage of pregnancy and can even cause a miscarriage.
• Dibromocholoropropane (DBCP): Handling DBCP (chemicals found in pesticide) can cause ovarian disorders and directly impact fertility.

Age as a cause of female infertility

Age is a major cause of fertility problems. About 1/3rd  partners in which the women are over 35 experience infertility. Age reduces a woman’s chance of getting pregnant because of the following reasons:

• As the female ages, her ovaries release fewer eggs
• The quality of her eggs decreases with age
• Health problems may occur leading to fertility issues
• More likely to experience a miscarriage

Diagnosis For Infertility In Women

Usually, doctors recommend getting an infertility checkup; a physical exam, questions about your medical and sexual history. Sometimes an infertility checkup can identify the cause. However, doctors will need to perform tests to find the cause. Some of these tests include:

Hysterosalpingography

This is an x-ray of the uterus and fallopian tubes. A special dye is inserted into the uterus through the vagina. This helps the doctors to see if the dye can move freely into the uterus and also the fallopian tube.

It helps in detecting physical blockage that can cause infertility. These blocks keep the eggs from passing through the fallopian tubes and into the uterus. It can also stop the sperm from swimming towards the egg.

Laparoscopy

A minor surgery which involves a small incision to see inside the abdomen and inserts a small tool (laparoscope) to examine the ovaries, fallopian tubes, and uterus for any signs of disease or physical problems. A laparoscopy usually detects scarring, endometriosis, and blocks in the fallopian tubes.

Ovulation Tests And Ovarian Reserve Testing

This can be done at home using an ovulation test kit. It can detect a sudden increase in Luteinizing Hormone (LH). Blood tests can also show signs of ovulation problems. Ovarian reserve testing helps in determining the condition of the eggs available.

Treatments Available For Female Infertility

Infertility can be corrected with a combination of medicines, surgery, artificial reproductive technology, or ARTs. Doctors suggest treatments based on:

• Laboratory test results
• How long the couples have been struggling to conceive
• Age of both genders
• The health of both partners
• Personal preferences

Medications (Fertility Drugs)

Fertility drugs are fundamental treatments for females who have fertility problems due to ovulation disorders. Such drugs improve ovulation by helping to produce natural hormones ( FSH and LH).  Some of these fertility drugs are:

Clomiphene

Clomiphene (or Clomid) is very effective in treating fertility problems. It should be taken orally, like tablets and pills (50mg) every day for 5 days and then observe the result. These drugs make the pituitary gland to release more LH and FSH and thereby stimulates ovulation.

Some side effects include drying of the vagina, irritation, vomiting, and nausea.

Gonadotropins

These treatments are injected to stimulate the ovary directly to release more eggs. Gonadotropin medications include HMG (Menopur), FSH ( Bravelle, Gonal-F, Follistim AQ) and human chorionic gonadotropin (Pregnyl, Ovidrel).

However, gonadotropin usage can increase the risks of having multiples and premature births.

Bromocriptine

Bromocriptine ( Cycloset) is used when the pituitary gland produces excess prolactin.

Letrozole (Ferama)

An aromatase inhibitor (similar to clomiphene) that is used to stimulate ovulation. However, it isn’t used much like the others since the effects it has on early pregnancy is not known.

Metformin

It is used by patients diagnosed with PCOS or when the problem is due to insulin resistance.

Risks of Using Fertility Drugs

• Increases the risks of conceiving twins.
• It can cause Ovarian Hyperstimulation Syndrome (OHS), swollen and painful ovaries.
• Long-term risks of tumors

Surgical Treatments

There are several surgical procedures available to treat infertility problems and restore fertility. The success rates of other treatments are higher, so surgical treatments are rarely preferred nowadays.

Tubal Surgeries

Laparoscopic surgery is done to remove adhesions, create new tubal openings, and remove blocks or fluids in the fallopian tubes. As IVF produce better results, laparoscopic surgery is rarely done.

Laparoscopic or Hysteroscopic Surgery

These surgeries improve the chances of conceiving. Surgery involves removing polyps and fibroids that causes abnormality in the uterus, uterine adhesion removal.

Reproductive Assistance

Common methods used in reproductive assistance technology (ART) include:

Intrauterine Insemination (IUI)

This treatment involves the transfer of healthy sperm inside the uterus. IUI accelerate the chances of ovulation. IUI treatments are cheaper compared to IVF.

Assisted Reproductive Technology

The sperm cell and the egg cell are kept together in a lab dish for fertilization. After fertilization, the embryo is transferred to the uterus for implantation. IVF is one major and effective method of assisted reproductive technology. It requires multiple blood tests and hormone injections and can take several weeks.

Preparing Before The Appointment

These are some of the steps you can follow before your infertility tests:

1. Note down your menstrual cycles and related symptoms, days you have sex with your partner, etc.
2. List the number of medications, supplements you take, its doses, and mention how often you consume them.
3. Document your medical history and carry it along with you during your appointment.
4. Carry a notepad to note down relevant pieces of information at your visit.
5. Make a list of the important questions you’ll ask.

References:

https://www.mayoclinic.org/diseases-conditions/female-infertility/symptoms-causes/syc-20354308

https://web.stanford.edu/class/siw198q/websites/reprotech/New%20Ways%20of%20Making%20Babies/Causefem.htm

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