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Millions of individuals worldwide who are of reproductive age have infertility, which is a global health concern. Based on current data, one in six individuals worldwide may face infertility at some point in their lives. Infertility refers to a couple's incapacity to conceive and procreate. A woman is considered infertile if she is unable to create after a year of regular sexual activity without the use of contraception or if she is unable to carry a pregnancy to term. Male or female infertility can arise from a variety of factors and impact both genders. Infertility affects between 10% to 15% of the population or one in every ten couples.

Normal fertility is based upon the male producing an adequate quantity of healthy, motile sperm, delivering those cells into the vagina, the sperm successfully passing via the uterus and into the fallopian tubes, and one of the sperm penetrating a normal ovum (egg). For a pregnancy to be successful, the fertilized egg must be incorporated within the lining of the woman's uterus. A couple may become infertile due to issues at any one of these stages.

HOW COMMON IS INFERTILITY?

One in six couples will conceive with a regular menstrual cycle, yet many couples choose to postpone conception out of pure chance. It is estimated that approximately 3.5 million couples in the UK seek reproductive therapy, many of whom are unnecessary. A couple should consult a doctor if, after a year of frequent, unprotected sexual activity, they are unable to conceive. They should seek assistance sooner if there are other risk factors, such as age. Male factors, unidentified or mixed variables, ovulation delays, structural problems in the woman, or both might result in infertility. Forty to fifty percent of the reasons might be female, while around half could be male or combination.

Many infertile people have been able to conceive thanks to modern infertility therapies, but the increased chance of multiple births raises concerns. These newborns are often premature and underweight, which can cause neurological conditions like cerebral palsy as well as issues with their physical, mental, and developmental health. Medical treatments have made it possible for many infertile people to become parents despite these worries.

TYPES OF INFERTILITY:

1. Primary infertility: where someone who's never conceived a child in the past has difficulty conceiving.

2. Secondary infertility: where someone has had one or more pregnancies in the past but is having difficulty conceiving again.

CAUSES OF WOMEN INFERTILITY:

Both males and females cause infertility:

About 30 percent of infertility issues start with the female partner. Unusual ovulation, obstructions in the fallopian tubes, and uterine anomalies, including fibroids and endometriosis, are among the problems associated with female fertility.

1. Ovulation problems: Various glands and hormones collaborate to produce the menstrual cycle. Ovulation hormones are secreted by the pituitary gland in response to signals from the brain's hypothalamus, which may or may not occur.

Age has a significant influence on fertility; women over 40 have a 5% chance of getting pregnant. It is thought that aging eggs are accountable, and women over 40 are more likely to miscarry and have an unborn child with genetic abnormalities.

2. Polycystic ovary syndrome (PCOS): About one in seven women suffer from the common hormonal disorder known as polycystic ovarian syndrome, or PCOS. It makes pregnancy challenging and results in irregular menstruation. Hormonal abnormalities, not conditions relating to the ovaries, are the leading cause of PCOS.

3. Damage of fallopian tube: A blocked or scarred fallopian tube can prevent the egg from meeting up with sperm.

4. Cervical issues: Sperms that have been ejaculated must enter the uterus through the cervix, which is the opening at the top of the vagina. Cervical mucus helps sperm flow through since it is usually thin and fluid, while thick mucus may hinder sperm movement.

5. Endometriosis: In endometriosis, endometrial cells spread to other parts of the pelvis, damaging the ovaries and fallopian tubes and impairing the passage of eggs and sperm. Even without injury to these areas, it can still affect implantation, growth, and fertilization.

DIAGNOSIS AND TREATMENT:

Diagnosis:

Physical examination

Blood tests to check the ovulation hormones

Ultrasound scan to check for the presence of fibroids and other conditions.

Treatments:

1. Surgery: Female infertility can be caused by obstructions in reproductive organs, such as fibroids, polyps, endometriosis, uterine septum abnormalities, and ovarian cysts. Surgery can address these issues by draining or removing them. Most reproductive surgery is performed using keyhole surgery through a laparoscopy or hysteroscopy, but open surgery may be necessary for specific reasons. Surgical treatments can help to address these issues and improve fertility.

2. Ovulation induction: One can use injectable or tablet drugs to promote irregular or absent ovulation, which is due to the result of irregular or absent periods. Oral medicines, such as clomiphene citrate, encourage ovulation and increase hormone release from the brain. Hormone injectables stimulate ovaries to develop and release an egg. Ultrasound and blood testing closely evaluate the body's reaction to these hormones.

3. In vitro fertilization (IVF): IVF involves fertilizing an egg outside the body and then implanting it in a woman’s uterus.

CAUSES OF MALE INFERTILITY:

Male fertility problems happen due to poor-quality sperm, low sperm count, or blockages in the tubes of the reproductive system.

1. Difficulty in passage of sperm: The testicles create sperm, which develop in the epididymis and then leave the body through the vas deferens. Sperm are subsequently released from the vas deferens into the ejaculatory duct, where they combine with seminal fluid from the prostate gland and seminal vesicles. Menstrual contractions drive the semen from the penis and into the urethra. Around 1 in 3 cases of male infertility, which can be hereditary, result from a vasectomy or an accident that causes blockages or absences of tubes, including the vas deferens.

2. Sperm issues: Sperm problems in men are believed to be caused by genetic factors. Some men may have missing male chromosome fragments, leading to absent sperm, low sperm count, abnormal shape, and poor mobility, which can affect the sperm's ability to penetrate the egg surface.

3. Impotence: the inability to get or maintain an erection sufficient for sexual intercourse.

4. Prostatectomy: side effects of the surgical removal of the prostate gland, including infertility, impotence, and incontinence.

DIAGNOSIS AND TREATMENT:

Physical examination

Semen analysis

Blood test to assess hormone levels

Testicular biopsy

Ultrasound scan

Treatments:

1. Surgery: Surgery is one option for treating the fertility-affecting disorder varicocele. It is possible to remove and fix obstructions in the male reproductive system tubes that prevent sperm from moving. Percutaneous epididymal sperm aspiration (PESA) is an option in the case that surgery is unsuccessful. After inserting a needle into the epididymis, sperm is extracted and preserved for later use or utilized right away for ICSI.

In vitro fertilization (IVF): IVF involves removing a man's sperm and putting it in a specialized incubator. The lady receives hormone injections to activate her ovaries, and after they are fully developed, eggs are extracted under ultrasound guidance. Through a tiny tube, the fertilized eggs mature into embryos inserted into the woman's uterus.

3. Intracytoplasmic sperm injection (ICSI): In cases where semen lacks sufficient sperm for IVF, Intracytoplasmic sperm injection (ICSI) can be employed. This involves injecting each egg with a single sperm using a microscopic needle, resulting in fertilized embryos that are transferred to the uterus.

4. Hormone therapy: The pituitary gland releases hormones called gonadotropins, stimulating the testicles to produce sperm. Insufficient levels can cause male infertility, and medication may boost sperm production in some cases.

PREVENTION:

To improve fertility, avoid:

Smoking

Consumption of alcohol

Drugs

Sexually transmissible infections

Anabolic steroids

CONCLUSION:

In conclusion, Infertility refers to a couple's incapacity to conceive and procreate. A woman is considered infertile if she is unable to create after a year of regular sexual activity without the use of contraception or if she is unable to carry a pregnancy to term. Both males and females cause infertility. Rather than going for an infertility treatment, it is better to prevent it from happening. Avoiding smoking, alcohol usage, drugs, and anabolic steroids and monitoring sexually transmissible infections can prevent infertility.

WHY MMC IVF A BETTER OPTION FOR TREATING INFERTILITY?

The MMC IVF Team has been providing fertility solutions to over 9000 babies in 30 countries and six continents since 1990. They ensure consistent, high-quality care with a dedicated team of ART Clinicians and embryologists, including a 27-year-experienced IVF Consultant and a 20-year-experienced Laboratory Director. The center offers cutting-edge technology, including Time Lapse Imaging of embryos and PGT-A and PGT-M, and tailor-made fertility solutions based on a thorough understanding of infertility issues. For further details, please visit our website info@mmcivf.com or contact us at +971 56 404 5330