- Infertility is defined as 1 year of unprotected intercourse without Conception.
- Primary infertility :- In which no previous conception have occurred.
- Secondary infertility :- In which a prior pregnancy, although not necessary a live birth has occurred.
- Fecundability is the probability of achieving pregnancy with in a single menstrual cycle.
- Fecundity :- is the probability of achieving of live birth with in single cycle.
- Approximately 90% of couple conceive after 12 month.
- Infertility affect:-
- 10% - 15% of reproductive age couple
- Prevalence of infertility depend on Demographic - variable. Includes
- Socioeconomic status
- Racial & Ethnic group
- Incidence of infertility has remained unchanged during last 3 decades, though evaluation and treatment have changed widely.
- Three major developments have had the greatest impact.
- Firstly, introduction of ART.
- Secondly, changes in population demographics have resulted in greater number of women attempting pregnancy at older ages when they are inherently less biologically fertile.
- Third, greater media attention and raised public awareness for infertility and modern treatments.
INFERTILITY AND FEMALE AGE
- Decline in Fecundability in females begins in early thirties and accelerates in late thirties and early forties.
- Peak fertility between ages of 20 and 24 years.
- Fertility rates are:
- 4-8% lower in women aged 25-29years,
- 15-19% lower in those aged 30-34 years,
- 26-46% lower in women aged 35-39 years, &
- Male fertility peaks at about 35 year and decline sharply after 45 yr of age as much as 95% lower in women aged 40-45 years.
FIGURE -CAUSES OF INFERTILITY
Treatment of infertility by assisted conception is one of the most progressive area of modern medicine, since birth of the world’s first test tube baby in 1978 (LOUISE BROWN, born in Great Britain under care Edwards & Steptoe). There has been a tremendous advancement in the investigation , diagnosis & treatment.
DIAGNOSIS OF INFERTILITY
3)Tubal factors-HSG, SSG ,Laparoscopy
4)Uterine factors- Hysteroscopy
TREATMENT OPTIONS- Early and timely investigations helps us to detect few conditions like Tuberculosis of uterus and tubes and endometriosis at early stages which if not treated keep on advancing. Moreover increasing age of female drastically reduces the probabilities of pregnancy.
- Laparoscopy to diagnose the causes in the female partner
- Treatment of infertility with medications
- Ovulation induction
- Intra Uterine Insemination
- Microsurgery of fallopian tubes when involved
- IVF .
- -Assisted reproductive techniques like
In vitro fertilization
ICSI – Intracytoplasmic sperm Injection
TESE – Testicular sperm extraction & percutaneous epididymal sperm aspiration
MESA – Microsurgical Epididymal sperm aspiration
- Third party reproduction like ovum donation, sperm donation & surrogacy