Author Name: Dr. Punita Kumari Mentor Name: Dr. Nagadeepti Naik on April 08, 2020

Infertility is the inability to conceive after 12 months of regular intercourse without use of contraception in women less than 35 years of age and after 6 months of regular intercourse in women of age 35 years and above.

Cause of infertility may be present in male, female or both. Therefore, it is always advisable to evaluate both the partners simultaneously at right time because delay in evaluation and treatment may diminish the success rate of pregnancy. The timing of initial evaluation depends upon the age of the female partner as well as the risk factors of couples. There is decline in fecundity as ovarian aging increases especially after age of 30.

Evaluation can also start prior if female partner has a history of any pelvic surgery, exposure to cytotoxic drugs or pelvic radiation therapy due to cancer, autoimmune disease, family history of early menopause, endometriosis or any suspected uterine/tubal disease. In male, treatment can start earlier if any prior surgical history to the testis /scrotal region, erection or ejaculatory dysfunction, prior chemotherapy or radiotherapy due to cancer or any testicular trauma. Fertility treatment methods include use of medications like ovulation induction. drugs, gonadotropins and timed relation, intrauterine insemination (IUI) and finally includes use of assisted reproductive technology like invitro fertilization (IVF)

IVF is a procedure in which a female receives gonadotropin injections for 10-12 days, followed by retrieval of the eggs under anaesthesia. These eggs are then mixed with the sperms in the embryology lab to form embryos. These are then transferred back into the uterus by embryo transfer technique. Over the decades, with increased advance techniques, success rates have tremendously increased with IVF.

Candidates for IVF include :

Tubal factor : The function of the fallopian tube is to help in fertilization of the egg. It is considered as the meeting zone of the egg and the sperm. In cases of damaged/ blocked tubes due to prior surgery, infection like Chlamydia or tuberculosis which is common in India or absent fallopian tubes, IVF is the appropriate treatment of choice. Tubal surgery has been helpful in certain conditions but the pregnancy rates are considerably low.

Ovulatory dysfunction: Polycystic ovarian syndrome(PCOS) is a disorder due to hormonal imbalance resulting in anovulation, menstrual irregularities , excess of male hormones and infertility. Lifestyle changes, use of medications like metformin and surgery (laproscopic drilling) have been helpful in few cases, but ivf is better alternative in severe cases and in failure of the above methods.

Endometriosis: It is a condition in which the uterine lining called the endometrium grows outside the uterus such as in ovaries and other organs. It has a negative impact on the egg quality, can affect the tubal function and also the endometrial lining. Surgery and medications have proven to be helpful for few in the initial stages of disease but ivf treatment is considered as the best alternative in endometriosis.

Male factor infertility: IVF becomes the treatment of choice in men with low/nil sperm count and low motility.
Unexplained infertility: IVF has proven to be helpful for many couples, in whom the age of women is less than 35 years with no identifiable cause.

Recurrent abortions: In cases of recurrent abortions , ivf with pregentic diagnosis (PGD)can help the couples to achieve successful pregnancies.

Genetic diseases in the family: IVF with PGD has proven to be a boon for many couples where certain diseases are inheritable.

IVF is also the treatment of choice in cases where egg/ sperm /embryo adoption is considered.
Timely evaluation with appropriate treatment has helped in acheiving better success rates in IVF.

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