There are two types of infertility:
1. Primary infertility: when there is infertility without any previous pregnancy and
2. Secondary infertility: when there has been a previous pregnancy and woman is unable to conceive for the second time.
Common causes of infertility are:
1. Ovulation problems: – The main problem is anovulation which means absence of ovulation. It happens in a disease called PCOS or polycystic ovarian syndrome in which ovaries do not release egg regularly. The main sign of PCOS is irregular menstrual cycle. This is the main cause of infertility in today’s woman. It may also happen that in some women, ovaries are not able to produce egg at all. Such women do not bleed and pregnancy is impossible in them.
2. Tubal causes:- The fallopian tube may be blocked or damaged, preventing the egg from moving from the ovary to the uterus to be implanted. Causes of tubal blockages includes pelvic infections such as pelvic inflammatory disease, also known as PID, use of an intrauterine device, ruptured appendix, mis-located or ectopic pregnancy in tubes etc.
3. Sperm causes:- About 25% of all infertility is caused by a sperm defect and 40-50% of infertility cases have a sperm defect as the main cause, or a contributing cause. The odds of conception are reduced when sperm concentrations are lower than normal which is termed as oligospermia and if sperms have poor swimming ability (asthenozoospermia) or are misshapen (teratozoospermia), the sperm’s ability to fertilize the egg is compromised.
4. Unexplained infertility:- Between 10% and 20% of couples experiencing fertility problems are having unexplained infertility that is the reason for their infertility is not known. Although it is hard for a couple to learn why they are infertile, learning that there doesn’t seem to be any reason for infertility can be even more frustrating. 5.
Age-related factors:- Female age is very important in consideration of probability for getting pregnant. Many couples have problems in conceiving due to a decline in egg quality, and due to other factors that are more common in older women. Chances of pregnancy go on decreasing in women after 30 years of her age.
Some rare causes of infertility may also be one of the following:
1. Uterine problems: – Some women who have problems in their uterus may have no problems in conceiving, but they may have difficulty in maintaining a healthy pregnancy as they always have the tendency for miscarriages. Most women have no symptoms, whereas some women will have scanty periods, some patients may also complain of heavy periods (due to fibroids). Nearly 2.5% of women face infertility due to uterine problems. Causes may be fibroids or small polyps which remain silent otherwise.
2. Endometriosis:- It is a gynecological medical condition in females in which endometrial-like cells appear and flourish in areas outside the uterine cavity, most commonly on the ovaries. The most common symptom is pelvic pain which worsens during menstrual cycle. Endometriosis is quite common in reproductive years of a woman’s life. Other symptoms related to endometriosis include lower abdominal pain, diarrhea and/or constipation, low back pain, irregular or heavy bleeding during menstruation or may be blood in the urine sometimes.
3. Previous tubal Ligation:- It is a form of female sterilization, in which the fallopian tubes are severed and sealed or “pinched shut”, in order to prevent fertilization. Generally tubal ligation procedures are done with the intention to be permanent, but incase a patient wants a tubal reversal; it can also be done although pregnancy after reversal is not sure.
4. Cervical Factors:- Cervical factors usually have identifiable problems. They are physical problems or mucus related problems. The physical problems of the cervix can cause recurrent miscarriages. The mucus related problems usually occurs when there is not enough mucus for the sperm to survive or the mucus is too thick for sperm to survive or the mucus contains sperm antibodies.
Evaluation of Infertility: First step is often a sperm test. For women, doctors run tests to see if their ovaries work properly. A woman’s chances of having a baby drop rapidly every year after age 30.The tests help find whether the problem is with the man, the woman, or both. Tests usually include a physical examination, semen analysis, blood tests, and special procedures.
Living with Infertility: Being infertile can be stressful. The infertile patients who get pregnant move on to their obstetrician and then their pediatrician – but the ones who don’t get pregnant suffer. Living through infertility is really hard, but the experience can be life-changing. While some couples become bitter and unhappy because of all the struggle and stress they have to face during their life, and complain that life has been unfair to them, others become much kinder, nicer better people, who are much more empathetic, because they have been through pain and suffering themselves. Similarly, while some marriages results one stressed couple again, others become much stronger and bold. Life shows unusual ways to teach lessons to everyone – and for many infertile couples, the lessons, infertility can teach can be priceless.