What is Endometriosis

Detection of male and female infertility

What is Infertility?

Infertility, whether male or female, can be defined as ‘the inability of a couple to achieve conception or to bring a pregnancy to term after a year or more of regular, unprotected intercourse’.Infertility is often a multifactorial problem and in any given couple may be related to the female partner, the male partner or the combination of both.

The evaluation of infertility proceeds along simple and logical lines of a basic three-step infertility work-up.

  • Test for eggs
  • Test for sperm
  • Test to make sure they can get together

For the male the specific tests required may include:

  • A semen analysis
  • Blood tests
  • Referral to an andrologist if an abnormality is detected.

For the female the specific tests required may include:

  • Hormonal tests
  • An infectious diseases screen
  • Endometrial biopsy
  • X-ray to determine patency of the fallopian tubes (hysterosalpingogram)
  • Ultrasound, possibly with saline infusion (Saline Infusion Sonography)
  • Hysteroscopy, a procedure in which a small telescope is placed in the uterus to check for abnormalities
  • Laparoscopy, a surgical procedure in which a small telescope is placed through the navel, to check for abnormalities of the tubes, ovaries and pelvis. This is the only way to diagnose mild forms of endometriosis

Causes that leads to infertility

Infertility can be due to problems with sperm production, transportation through the male reproductive tract and delivery into the female reproductive tract. On the female side, infertility may be caused by a lack of ovulation (anovulation), blocked fallopian tubes, or inability of an embryo to implant and establish a pregnancy in the uterus. Infertility often results from combinations of several problems on both the male and female sides.

What treatment options do infertile couples have?

Several options are offered to couples depending on the type of infertility that has been diagnosed. The vast majority of female patients are successfully treated with the administration of drugs such as clomiphene citrate, cabergoline, metformin or gonadotropins. Surgery can also be a means to repair damage to the reproductive organs, such as those caused by endometriosis and infectious diseases. Treatment options for male infertility also include the administration of drugs, surgery and assisted reproductive technologies, such as intracytoplasmic sperm injection (ICSI). Drug therapy and surgery have proved very successful for specific types of male infertility. However, in a great number of cases, the reason why men have fertility problems remains unexplained and the treatment methods applied are empirical. Some patients nevertheless require more complex medical intervention. Assisted reproductive technologies (ART) refer to several different methods designed to overcome barriers to natural fertilization such as anatomical problems (eg blocked fallopian tubes). One of these techniques, in-vitro fertilization (IVF), has now been practiced for more than 15 years. Overall, the estimated number of infertile patients currently treated by ART is around 20%.

What is the incidence of infertility worldwide?

The World Health Organization (WHO) estimates that approximately 8-10% of couples experience some form of infertility problem. On a worldwide scale, this means that 50-80 million people suffer from infertility. However, the incidence of infertility may vary from region to region. In France, 18% of couples of childbearing age said that they had difficulties in conceiving.

How important is counseling to the patient undergoing infertility treatment?

The physician helps the infertile couple find the most appropriate therapeutic path to overcome barriers to conception, but, before a treatment is started, patients need to be aware of all its aspects, including its constraints. Beyond the medical expertise, infertile couples are also looking for counseling and support. From a psychological point of view, infertility is often a hard condition to cope with. During treatment and before a pregnancy is achieved, feelings of frustration or loss of control usually experienced by the infertile couple are likely to be exacerbated. Management of infertility includes both the physical and emotional care of the couple. Therefore, support from physicians, nurses and all people involved in treating the infertile couple is essential to help them cope with the various aspects of their condition. Offering counseling and contact with other infertile couples and patient associations can provide help outside the medical environment.

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