WHAT IS INFERTILITY?

• Infertility means failure to conceive after one year of frequent unprotected intercourse during the fertile period.

FERTILE PERIOD:

• Means Days of Menstrual Period During Which If You Have Sexual Relationship Chances of Conception Are High.
• Usually If Female Has Regular Cycle 0f 28-30 Days then Fertile Period is Between 10^th To 20^th Day of The Menstrual Cycle.
• One must remember that, majority of infertile couple can have a baby with the help of assisted reproductive technology.
• So, positive attitude of patient gives better result.

• OVER ALL 15 % COUPLE REQUIRE MEDICAL ATTENTION TO CONCEIVE.
• FEMALE PARTNER IS RESPONSIBLE IN 30%
• MALE PARTNER IS RESPONSIBLE IN 30%
• BOTH ARE RESPONSIBLE IN 20%
• IN REMAINING 20% WE DO NOT FIND ANY CAUSE.

TYPES OF INFERTILITY

PRIMARY INFERTILTIY: A COUPLE THAT HAS NEVER CONCEIVED

SECONDARY INFERTILTY: INFERTILITY THAT OCCURS AFTER PREVIOUS

PREGNANCY REGARDLESS OF OUTCOME.

CAUSES OF INFERTILITY

THE CAUSES OF INFERTILITY CAN BE GROUPED UNDER FOUR MAIN FACTORS:

• FEMALE FACTORS: 30%
• MALE FACTORS: 30%
• BOTH MALE AND FEMALE FACTORS: 20%
• UNEXPLAINED FACTORS; 20 %

ALL OVER THE WORLD, THERE IS INCREASING TREND FOR MALE AND FEMALE INFERTILTIY.

THE MOST COMMON LIFESTYLE FACTORS CAUSING INFERTILITY ARE AS FOLLOWS:-

• STRESS
• FOOD HABBITS LIKE CONSUMPTION OF JUNK FOODS, FROZEN FOOD,
• LATE NIGHT SLEEP, POOR PHYSICAL ACTIVITIES.
• LATE AGE MARRAIGES
• PRESERVATIVES IN FOOD
• POLLUTION
• MOBILE PHONE RADIATION
• HABBIT OF PUTTING LAPTOP ON LAP
• INCREASE IN DAIBETIC AND OBESE POPULATION

FLORA FERTILITY CENTER IS ONE OF THE BEST INFERTILITY SPECIALISTS IN AHMEDABAD, HERE YOU ATTAIN THE COMPLETE INFERTILITY SOLUTION BY OUR SPECIALIST

MALE INFERTILITY

• 50 % MALE HAVE INFERTILTIY PROBLEM.
• OUT OF THAT 30% ARE SOLELY RESPONSIBLE FOR INFERTILTY
• 20% BOTH PARTNERS HAVE PROBLEMS.

ANATOMY AND FUNCTIONS OF REPRODUCTIVEORGANS

• TESTIES: SPERMS PRODUCTION
• EPIDYDEMIS: STORAGE AND MATURATION OF SPERMS.
• VAS DEFFERENCE: TRANSPORTATION OF SPERMS
• SEMINAL VESICAL: SUPPLEMENTATION OF ENERGY FLUID
• PENIS: EXPULSION OF SEMEN CONTAING SPERMS

CAUSES OF MALE INFERTILITY:

APART FROM LIFESTYLE FACTORS

MOST COMMON CAUSES FOR MALE IINFERTILTITY:

• VARICOCELE: MEANS DILATED VEINS OF SCROTUM
• MUMPS INFECTION IN CHILD HOOD
• DIABETES AND OBESITY
• H/O TRAUMA, INFECTION, TORSION AND TUMOURS OF TESTIES AND SURGERY OF SCROTAL AREA
• CHRONIC MEDICAL ILLNESSES: DM, HYPERTENSIVE, HYPOTHYRODISM, PSYCHIATRIC DISORDERS,
• ON MEDICATIONS: CIMETIDINE, SPIRENOLACTON, CHEMOTHERAY
• SMOKING, ALCOHOL AND TOBACCO CONSUMPTION
• DRUG ADDICTION
• H/O RADIATIONS
• OCCUPATIONAL: WORKING IN HOT CONDITION LIKE NEAR FURNACE

LESS COMMON CAUSES ARE

• HYPOTHALEMIC PITUITORY DISORDERS LIKE:
  • PITUATORY FOSSA TUMOURS
  • KALLMAN SYNDROME

• GENETIC DISORDERS LIKE:
  • KLINEFELTER SYNDROME
  • Y CHROMOSOME MICRO DELETION

HOW TO EVALUATE THE MALE INFERTILITY:

• FIRST IMPORTANT PART IS THE PROPER HISTORY TAKING AND PHYSICAL EXAMINATION.
• SEMEN ANALYSIS: SIMPLE, NONIVASIVE AND MOST IMPORTANT
  • SEMEN WILL BE COLLECTED BETWEEN 3-5 DAYS OF ABSTENENCE.
  • IF SEMEN IS NORMAL USUALLY THERE IS NO NEED FOR FURTHER INVESTIGATION OF MALE PARTNER.
  • TERMINOLOGY USED IN SEMEN ANALYSIS

• USG & DOPPLER OF SCROTUM (MOST COMMON TEST) TO RULE OUT
  • VARICOCELE: GRADE III AND IV REQUIRES MINOR SURGERY
  • TESTICULAR DISORDER
• HORMONAL ANALYSIS: IN SEVERE OLIGOASTHENOSPERMIA
• TESTICULAR BIOPSY: IN AZOOSPERMIA
• GENETIC TESTS (CHROMOSOMAL ANALYSIS)
• Y CHROMOSOME DELETION

FOLLOWING CATOGARIES OF SEMEN ANALYSIS.ALL OTHER TESTS HELP IN DECIDING THE MODE OF TREATMENT.

• There are lots of variations in semen analysis between two sample taken few days apart.
• So, if first sample is abnormal then semen analysis should be repeated after 15 days.

HOW TO TREAT MALE INFERTILITY?

• Mode of infertility treatment is only decided after investigations of both male and female partners.
• Most common treatments are as follows depending on cause and abnormality of semen analysis.
• TREATMENT OF OBVIOUS CAUSE:
  • SURGICAL TREATMENT OF GRADE III AND IV VARICOCELE
  • CONTROL OF CHRONIC MEDICAL CONDITIONS
  • CONTROL OF CHRONIC MEDICAL CONDITIONS E.G. DM, HYPERTENSION
  • AVOIDING MEDICATIONS THAT AFFECT SPERMATOGENESIS
  • STOPPING DRUGS, TOBACCO, LIMITING ALCOHOL CONSUMPTION

NUTRIONAL SUPPLEMENTS WITH LIFE STYLE CHANGES

• VITAMIN SUPLEMENTATION
• ANTIOXYDANTS: COQ/ LYCOPIN/ARGININE
• AYURVEDIC MEDICATIONS CAN BE TRIED

MEDICATIONS

• • CLOMIPHEN CITRATE / LETROZOLE:FOR OLIGOSPERMIA
  • PENTOXYPHYLINE:FOR ASTHENOSPERMIA
  • INJECTABLE HORMONS:FOR SEVERE OLIGOASTHENOSPERMIA AND TRAILS IN NON-OBSTRUCTIVE AZOOSPERMIA

ART (ASSISTED REPRODUCTIVE TECHNOLOGY)

• • SIMPLE PROCEDURES
    • OVULATION INDUCTION WITH INTERCOURSE AROUND

OVULATION

• OVULATION INDUCTION WITH IUI

• IVF:
  • CONVENTIONAL IVF
  • ICSI
  • TESA / PESA
  • IMSI
• SPERM DONATION
• RESEARCH LEVEL TREATMENT:
  • PRP: PLASMA RICH PLATLETS INJECTION
  • STEM CELL THERAPY

FEMALE INFERTILITY

PICTURE OF FEMALE REPRODUCTIVE ORGANS

FUNCTIONS OF FEMALE ORGANS

• OVARY: PRODUCTION OF OVUM
• FALLOPIAN TUBES:
  • PICK UP OF OVUM
  • TRANSPORT OF OVUM AND FERTILE EGG
  • PROVIDING PROPER ENVIRONMENT FOR FERTILISATION
• UTERUS:
  • IMPLANTATION
  • SUPPORT EMBRYO GROWTH.

FEMALE FACTORS CHART

EVALUATION OF FEMALE FACTORS

• PROPER HISTORY AND EXAMINATION
• GENERAL BLOOD INVESTIGATIONS TO RULE OUT MEDICAL DISEASES
• BASELINE SONOGRAPHY TO RULE OUT
  • UTERINE FACTORS
  • OVARIAN RESERVE
  • ENDOMETRIAL PROBLEM

• HORMONAL TESTS IF NECESSARY
  • TSH
  • PROLACTIN
  • AMH
  • FSH
  • LH
  • TESTOSTERON
  • DHEAS

• TUBAL PATENCY TEST
  • HYSTEROSALPINGOGRAPHY
  • LAPAROHYSTEROSCOPY: DIAGNOSTIC AND THERAPEUTIC

• GENETIC TEST: IF NECESSARY
  • KARYOTYPE
  • EXON SEQUENCING

TREATMENT:

• CONTROL OF MEDICAL DISORDERS
• NUTRITIONAL SUPPLEMENTS
• CORRECTION OF FEMALE FACTORS RESPONSIBLE FOR INFERTILTIY LIKE:
• MYOMECTOMY: REQUIRED BIG OR DISTORTING ENDOMETRIUM.
• METROPLASTY
• ADHESOLYSIS
• OVARIAN TUMOUR REMOVAL
• SUGERY FOR ENDOMETRIOSIS: IN GRADE III AND IV
• SEPTUM RESECTION:
• TUBAL CANNULATION
• POLYPECTOMY

MOST OF ABOVE TREATMENTS ARE DONE BY THERAPEUTIC LAPAROHYSTEROSCOPY

• ET DEVELOPMENT TREATMENT
• TREATMENT OF PROLACTINEMIA, GENITAL TB
• ART (ASSISTED REPRODUCTIVE TECHNOLOGY)
  • SIMPLE PROCEDURES
    • OVULATION INDUCTION WITH INTERCOURSE AROUND OVULATION
    • OVULATION INDUCTION WITH IUI
    • PRP INJECTION
  • IVF:
    • CONVENTIONAL IVF
    • ICSI
  • OVUM DONATION
  • EMBRO DONATION
  • STEM CELL THERAPY
  • SUROGACY