To understand infertility and infertility in young we need to understand the process of conception. This article focuses on Infertility in young, its causes and treatments.
How do we conceive?
All of us start as 2 cells a sperm and an egg from our biological father and mother.
Normal conception requires a healthy male partner with a normal count, motility and morphology of sperms. During sexual intercourse sperms are ejaculated into the vagina. The sperms have to swim up through the vagina into the cervix, uterus and into the fallopian tube. This a long journey. A sperm which is about 4.4 microns and has to travel nearly 18cm. This is equal to a average car traveling a distance of 40km.
Normal conception also requires a healthy female partner who ovulates (produces an egg) every cycle. A healthy female has about 300,000 eggs in each ovary by the time they reach puberty. A women depletes these eggs over the next 25-30 years of her reproductive life. Doctors measure the remaining eggs in the ovary using ovarian reserve tests.
Once an egg is released, the egg needs a healthy fallopian tube to travel towards the sperm and the uterus. If a healthy egg meets a sperm, conception happens. This is a one in a million event where one out of 15-20 million sperms released during ejaculation fertilize an egg.
The fertilized egg now forms an embryo which is pushed from the fallopian tube into the uterus. The embryo implants itself into the lining of the uterus. Such an embryo grows to become a baby over time.
What is infertility? What is the meaning of subfertility?
Infertility is defined in young couples below the age of 35 as the inability to conceive after trying for one year of regular unprotected intercourse.
Infertility may be caused due to factors which result in subfertility in both the male and female partner. Subfertility is a technical term for factors that reduce fertility in an individual.
What are the common causes of infertility in young couples?
We identify and pinpoint the factors that may hamper the normal process of conception, resulting in infertility. This includes:
- Factors affecting normal sexual intercourse such as premature ejaculation or sexual dysfunction in males or pain during sex in females
- Low sperm counts, motility or morphology- male factor infertility
- A hostile vaginal or cervical environment that is bad of the sperms
- Problems with ovulation such as irregular ovulation in women with PCOS
- Blocked tubes due to past surgeries or pelvic inflammatory disease
- Problems with implantation due to fibroids or unhealthy uterine lining
- Medical disorders such as diabetes, autoimmune disease, obesity or thyroid disorders that may impact conception.
Are there any infertility warning signs in young couples? What are the signs of infertility at a young age?
Some of the problems described above may present with signs or symptoms. Such signs and symptoms include
- Irregular periods
- Painful periods- endometriosis
- Sexual dysfunction such as erectile dysfunction, premature ejaculation, low libido etc
- Pain during sex- Pelvic inflammatory disease
- Inability to conceive after one year or regular, unprotected intercourse
- History of infertility with another partner
- Exposure to chemotherapy or radiation
What are the options for fertility treatment and assisted conception techniques for Infertility in young couples?
Infertility in young couples below the age of 35 years usually require milder forms of treatment. This often involves
a.Evaluation of the cause of infertilityin both the male and female partner to understand the underlying cause
b. Lifestyle modifications like fertility diet and exercise to improve the chances of conception
c. Advice on tips and techniques to help with conception
d. Ovulation induction- stimulating the ovaries to produce eggs with tablets or injections
e. Timed intercourse- Timing sexual intercourse at the time of ovulation as directed by the doctor. The doctor or fertility specialist can track ovulation with ultrasound scans
f.Intrauterine insemination (IUI): A simple assisted reproduction technique that involves placing washed healthy sperms from the male partner into the uterine cavity of the female partner
g.In-vitro fertilization and intracytoplasmic sperm injection (IVF-ICSI): We use this advanced technique in 15-20% patients with tubal factor infertility, severe male factor ,unexplained infertility or other causes
h. Donor or Surrogacy programs- Typically, we use donor or surrogacy programs only in patients with ovarian failure, severe uterine factor infertility, or severe male factor such as azoospermia. In donor programs, we obtain gametes from a male or a female donor and fertilize them with the other gamete from your partner. We then place the resulting embryo into your uterus. In a surrogacy program, we place an embryo formed from your gametes or donor gametes into the uterus of a gestational surrogate.
Visit a fertility specialist who can help guide you to the best options for assisted fertility techniques based on your underlying medical conditions and preference.
How is fertility evaluation done in young couples?
Fertility evaluation starts with a visit to the fertility specialist. A fertility specialist may ask you to do one or more of the following:
a. Take adetailed clinical historyto identify the cause of infertility in both you and your partner
b. Advise asemen analysisto test for male factor infertility
c. Advice blood tests such as AMH or day 2 FSH toassess the ovarian reserveof the female partner. The ovarian reserve is a measure of the ability of the ovaries to produce eggs
d. Adviceblood tests for other hormonessuch as thyroid function tests, prolactin andother metabolitesin the body in both you and your partner to evaluate for underlying health conditions
e. Perform anultrasound scanto evaluate pelvic anatomy, tubal patency, endometrial health and ovarian reserve
f. Ask you to undergo ahysteroscopyevaluation to visualize the uterine cavity from inside. This helps to detect abnormalities in the endometrium, polyps and conditions that may cause the walls of the uterus to stick to each other
g. Ask you to undergo alaparoscopy, a surgical technique to visualize your ovaries, uterus and other pelvic organs from the outer surface.
h. Ask you to undergo ahysterosalpingography, a technique to check the patency of your fallopian tubes with a simple x ray