 Infertility is the inability of a sexually active, non-contracepting couple to achieve

pregnancy in one year.

 There are 2 types of Infertility:
1. Primary Infertility: When a woman is unable to ever bear a child, either due
to the inability to become pregnant or the inability to carry a pregnancy
to a live birth she would be classified as having primary infertility. Thus,
women whose pregnancy spontaneously miscarries, or whose pregnancy
results in a still born child, without ever having had a live birth would present
with primarily infertility. 

: denotes couples who have never been able to conceive.

2. Secondary Infertility: When a woman is unable to bear a child, either due to

the inability to become pregnant or the inability to carry a pregnancy to a
live birth following either a previous pregnancy or a previous ability to
carry a pregnancy to a live birth, she would be classified as having
secondary infertility. Thus, those who repeatedly spontaneously miscarry or
whose pregnancy results in a stillbirth, or following a previous pregnancy or a
previous ability to do so, are then not unable to carry a pregnancy to a live
birth would present with secondarily infertile.

: indicates difficulty in conceiving after already having conceived.

Reference/s:

http://www.who.int/reproductivehealth/topics/infertility/definitions/en/?
utm_source=blog&utm_campaign=rc_blogpost#:~:text=Infertility%20is
%20%E2%80%9Ca%20disease%20of,regular%20unprotected%20sexual
%20intercourse.%E2%80%9D%E2%80%A6&text=%E2%80%9CInfertility%20is%20the
%20inability%20of,achieve%20pregnancy%20in%20one%20year.
 Infertility can be caused by many different things. For 1 in 4 couples, a cause
cannot be identified.

 Infertility in women

 Infertility is commonly caused by problems with ovulation (the monthly

release of an egg from the ovaries).
 Some problems stop an egg being released at all, while others prevent an
egg being released during some cycles but not others.

 Ovulation problems can be a result of: 

 polycystic ovary syndrome (PCOS)

 thyroid problems – both an overactive thyroid gland and an underactive

thyroid gland can prevent ovulation

 premature ovarian failure – where the ovaries stop working before the age
of 40

 Scarring from surgery

 Pelvic surgery can damage and scar the fallopian tubes, which link the
ovaries to the womb.
 Cervical surgery can also sometimes cause scarring or shorten the neck
of the womb (the cervix).

 Cervical mucus problems 

 When you're ovulating, mucus in your cervix becomes thinner so sperm

can swim through it more easily. If there's a problem with the mucus, it can
make it harder to conceive.
 Fibroids

 Non-cancerous growths called fibroids in or around the womb can affect

fertility. In some cases, they may prevent a fertilised egg attaching itself in
the womb, or they may block a fallopian tube.

 Endometriosis

 Endometriosis is a condition where small pieces of the womb lining (the

endometrium) start growing in other places, such as the ovaries.
 This can damage the ovaries or fallopian tubes and cause fertility
problems.

 Pelvic inflammatory disease

 Pelvic inflammatory disease (PID) is an infection of the upper female

genital tract, which includes the womb, fallopian tubes and ovaries.
 It's often caused by a sexually transmitted infection (STI). PID can
damage and scar the fallopian tubes, making it virtually impossible for an
egg to travel down into the womb.

 Sterilisation

 Some women choose to be sterilised if they do not want to have any more
children.
 Sterilisation involves blocking the fallopian tubes to make it impossible for
an egg to travel to the womb.
 It's rarely reversible – if you do have a sterilisation reversed, you will not
necessarily be able to have a child.
  Medicines and drugs 

The side effects of some types of medicines and drugs can affect your fertility. These
include:

 non-steroidal anti-inflammatory drugs (NSAIDs) – the long-term use or a

high dosage of NSAIDs, such as ibuprofen or aspirin, can make it more
difficult to conceive

 chemotherapy – medicines used for chemotherapy can sometimes cause

ovarian failure, which means your ovaries will no longer be able to function
properly

 neuroleptic medicines – antipsychotic medicines, often used to

treat psychosis, can sometimes cause missed periods or infertility

 spironolactone – a type of medicine used to treat fluid retention (oedema);

fertility should recover around 2 months after you stop taking
spironolactone
 Illegal drugs, such as marijuana and cocaine, can seriously affect fertility
and make ovulation more difficult.

Reference/s:

https://www.nhs.uk/conditions/infertility/causes/#:~:text=Infertility%20is%20commonly
%20caused%20by,polycystic%20ovary%20syndrome%20(PCOS)

If you've been unable to conceive within a reasonable period of time, seek help from
your doctor for evaluation and treatment of infertility.

Fertility tests may include:

 Ovulation testing

 Hysterosalpingography
  Ovarian reserve testing

 Other hormone testing

 Imaging tests

Depending on your situation, rarely your testing may include:

 Other imaging tests

 Laparoscopy

 Genetic testing

Female Infertility Treatment

Infertility treatment depends on the cause, your age, how long you've been infertile and
personal preferences. Because infertility is a complex disorder, treatment involves
significant financial, physical, psychological and time commitments.

Although some women need just one or two therapies to restore fertility, it's possible
that several different types of treatment may be needed.

Treatments can either attempt to restore fertility through medication or surgery, or help
you get pregnant with sophisticated techniques.

 Fertility restoration: Stimulating ovulation with fertility drugs

Fertility drugs regulate or stimulate ovulation. Fertility drugs are the main treatment for
women who are infertile due to ovulation disorders.

Fertility drugs generally work like the natural hormones — follicle-stimulating hormone
(FSH) and luteinizing hormone (LH) — to trigger ovulation. They're also used in women
who ovulate to try to stimulate a better egg or an extra egg or eggs. Fertility drugs may
include:
  Clomiphene citrate.

 Gonadotropins. 

 Metformin. 

 Letrozole. 

 Bromocriptine. 

Risks of fertility drugs

Using fertility drugs carries some risks, such as:

 Pregnancy with multiples. 

 Ovarian hyperstimulation syndrome (OHSS). 
 Long-term risks of ovarian tumors. 

 Fertility restoration: Surgery

Several surgical procedures can correct problems or otherwise improve female fertility.
However, surgical treatments for fertility are rare these days due to the success of other
treatments. They include:

 Laparoscopic or hysteroscopic surgery.

 Tubal surgeries.

 Reproductive assistance

The most commonly used methods of reproductive assistance include:

 Intrauterine insemination (IUI). 

 Assisted reproductive technology.

Reference/s:
https://www.mayoclinic.org/diseases-conditions/female-infertility/diagnosis-treatment/
drc-20354313

 Infertility in men
 Semen and sperm

 A common cause of infertility in men is poor-quality semen, the fluid

containing sperm that's ejaculated during sex.

Possible reasons for abnormal semen include:

 a lack of sperm – you may have a very low sperm count or no sperm at all

 sperm that are not moving properly – this will make it harder for sperm to swim to
the egg

 abnormal sperm – sperm can sometimes be an abnormal shape, making it

harder for them to move and fertilise an egg
Many cases of abnormal semen are unexplained.

There's a link between increased temperature of the scrotum and reduced semen
quality, but it's uncertain whether wearing loose-fitting underwear improves fertility. 

 Testicles

The testicles produce and store sperm. If they're damaged, it can seriously affect the
quality of your semen.

This can happen as a result of:

 an infection of your testicles

 testicular cancer
  testicular surgery

 a problem with your testicles you were born with (a congenital defect)

 when 1 or both testicles has not descended into the scrotum (the loose sac of
skin that contains your testicles (undescended testicles))

 injury to your testicles

 Sterilisation

 Some men choose to have a vasectomy if they do not want children or

any more children. 
 It involves cutting and sealing off the tubes that carry sperm out of your
testicles (the vas deferens) so your semen will no longer contain any
sperm.
 A vasectomy can be reversed, but reversals are not usually successful.

 Ejaculation disorders

 Some men experience ejaculation problems that can make it difficult for

them to release semen during sex (ejaculate).

 Hypogonadism

 Hypogonadism is an abnormally low level of testosterone, the male sex

hormone involved in making sperm.
 It could be caused by a tumour, taking illegal drugs, or Klinefelter
syndrome (a rare syndrome involving an extra female chromosome).

 Medicines and drugs

Certain types of medicines can sometimes cause infertility problems. These include:
  sulfasalazine – an anti-inflammatory medicine used to treat conditions such
as Crohn's disease and rheumatoid arthritis; sulfasalazine can decrease the
number of sperm, but its effects are temporary and your sperm count should
return to normal when you stop taking it

 anabolic steroids – are often used illegally to build muscle and improve athletic
performance; long-term abuse of anabolic steroids can reduce sperm count and
sperm mobility

 chemotherapy – medicines used in chemotherapy can sometimes severely

reduce sperm production

 herbal remedies – some herbal remedies, such as root extracts of the Chinese
herb Tripterygium wilfordii, can affect the production of sperm or reduce the size
of your testicles
 Illegal drugs, such as marijuana and cocaine, can also affect semen quality.

Reference/s:

https://www.nhs.uk/conditions/infertility/causes/#:~:text=Infertility%20is%20commonly
%20caused%20by,polycystic%20ovary%20syndrome%20(PCOS)

Diagnosing male infertility problems usually involves:

 General physical examination and medical history.

 Semen analysis.

Your semen is then sent to a laboratory to measure the number of sperm present and
look for any abnormalities in the shape (morphology) and movement (motility) of the
sperm. The lab will also check your semen for signs of problems such as infections.

Often sperm counts fluctuate significantly from one specimen to the next. In most cases,
several semen analysis tests are done over a period of time to ensure accurate results.
If your sperm analysis is normal, your doctor will likely recommend thorough testing of
your female partner before conducting any more male infertility tests.

Your doctor might recommend additional tests to help identify the cause of your
infertility. These can include:

 Scrotal ultrasound. 

 Transrectal ultrasound. 

 Hormone testing. 

 Post-ejaculation urinalysis.

 Genetic tests. 

 Testicular biopsy. 

 Specialized sperm function tests.

Reference/s:

https://www.mayoclinic.org/diseases-conditions/male-infertility/diagnosis-treatment/drc-
20374780

Male Infertility Treatment

The ultimate goal of male infertility treatment is to create a pregnancy. Ideally, the cause of
the infertility is reversible and then conception can result from natural sex. Here are some
common male infertility treatments.

 Varicoceles are repaired with surgery to block off the abnormal veins. This seems to
result in a significant improvement in fertility, although some studies disagree.
 Hormonal abnormalities can sometimes be treated with medicine or surgery.
 Obstructions in the sperm transport plumbing can sometimes be surgically
corrected.
In the past, if the above methods didn’t work, it often meant lifelong male infertility. Today,
assisted reproductive techniques (ARTs) offer powerful new options.

These high-tech and expensive male infertility treatments give sperm an artificial boost to
get into an egg. ARTs have made conception possible even for men with very low or
abnormal sperm.

First, sperm are collected either from ejaculated semen or by a needle from the testicle.
They are then processed and introduced to eggs by different methods.

 Intrauterine insemination (IUI.)At the time of ovulation, sperm are injected directly up
into the uterus. Medicines are usually given to the women first to increase the
number of eggs they release.
 In-vitro fertilization (IVF.)Sperm are mixed with multiple eggs collected from the
woman in a “test tube” (actually just a plastic dish.). Fertilized eggs are then placed
in the uterus. IVF requires at least some viable sperm.
 Intracytoplasmic sperm injection (ICSI.)A single sperm is injected through a tiny
needle into an egg. The fertilized egg is then implanted in the uterus. ICSI can be
performed when sperm counts are extremely low or abnormal.

Shaban says that by using some combination of ARTs for several months, “most couples
can expect a pregnancy between 40 to 50% of the time.”

Reference/s:

https://www.webmd.com/men/features/male-infertility-treatments