What is Infertility?
Most people will have the strong desire to conceive a child at some point during their lifetime. Understanding what defines normal fertility is crucial to helping a person, or couple, know when it is time to seek help. Most couples (approximately 85%) will achieve pregnancy within one year of trying, with the greatest likelihood of conception occurring during the earlier months. Only an additional 7% of couples will conceive in the second year. So if after 1 year of trying, a woman fails to get pregnant, it is time for the couple to meet the specialist but it is definitely not the time to get depressed or unduly worried. with the right approach and guidance from your doctor, things will fall in place for most of the times.
- Infrequent menstrual periods: If a woman has cycles at intervals of greater than 35 days, it may indicate that she is not ovulating an egg predictably, or even at all. Ovulation of the egg is essential for pregnancy.
- Female age of 35 years or older: For unclear reasons, egg numbers decrease at a rapid rate as women age. Furthermore, as aging occurs, egg quality, or the likelihood of an egg being genetically normal, decreases.
- A history of pelvic infections or sexually transmitted diseases: Sexually transmitted infections, such as chlamydia or gonorrhea, can cause inflammation and permanent scarring of the fallopian tubes.
What Causes Infertility?
1) Advancing maternal age: In our modern era, women are delaying childbirth until their thirties and forties. Advancing maternal age has an adverse effect on the egg function with the ovarian reserve going down. In fact, female age-related infertility is the most common cause of infertility today.
2) Ovulation disorders: Normal and regular ovulation, or release of a mature egg, is essential for women to conceive naturally. Ovulation often can be detected by keeping a menstrual calendar or using an ovulation predictor kit. polycystic ovarian syndrome or PCOS is one of the most common causes of ovulatory dysfunction, whereby either egg formation does not occur at all or is delayed. with PCOS it’s becoming more and more common in young girls and women. it is increasingly identified as causing infertility.
3) Malefactors affecting sperm function: Male factor infertility has been associated as a contributing factor causing infertility in 30%per cent of cases, and as the sole cause for infertility in 15-20% percent of cases. Physical examination and assessment of semen parameters of the male partner is very important when a couple is undergoing infertility work up.
4) Pelvic Infections and Sexually Transmitted Diseases:
With changing social norms more young women are sexually active at a younger age exposing them to risk of STDs and pelvic infections. this can cause inflammation of the tubes and tubal damage or blockage causing infertility. In our country pelvic tuberculosis is also one of the causes for female infertility.
Which infertile patients should have laparoscopy?
Generally, laparoscopy should be reserved for couples who have already completed a more basic infertility evaluation including assessing for ovulation, ovarian reserve, ultrasound and hysterosalpingogram for the female and semen analysis for the male. Some couples may elect to skip laparoscopy in favor of proceeding to fertility treatments with fertility medications which could be oral ovulation inducing medications or hormonal injections. If these medications do not work till 3-6 cycles, then depending upon women’s age, there can be infertility or any other associated medical problems. the couple should be counselled to go in for a laparoscopic/ hysteroscopic evaluation before proceeding further.
Laparoscopic evaluation will tell us whether the fallopian tubes are healthy enough to pick up the egg. Hysteroscopy is endoscopy of the uterus which helps the doctor to visualise the inside of the uterine cavity and helps in assessing if the uterus is healthy to carry a pregnancy.
There may be instances in which the doctor may have a high suspicion of pelivc pathology based on the patient’s medical history.
- History of tuberculosis in the past.
- History of previous ectopic pregnancy.
- History of severe pelvic infection
- History of previous surgeries like the appendix.
Laparoscopic evaluation in these women as part of the initial workup can be greatly beneficial.