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Investigating infertility
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This article was originally published by Medknow Publications & Media Pvt Ltd and was migrated to Scientific Scholar after the change of Publisher.
This book is part of the ‘Infertility Management Series’ focusing on investigating infertility. Infertility is a common disorder of the reproductive system caused by the failure to achieve a clinical pregnancy after 12 months or more of regular unprotected sexual intercourse as described by the World Health Organization. Around 25 per cent of individuals may be conservatively estimated to be attempting parenthood at any given time, and approximately 13-19 million couples are likely to be infertile in India at any time. Almost one-third of the gynaecological outpatient department attendance is due to inability to bear a child, after a varying duration of married sexually active life. Many couples still seek medical help quite late even as long as 15-20 years later, after exhausting all primitive methods.
In recent years, there have been advances in the understanding of management of infertility, making it a speciality in its own. However, to manage appropriately, it is important to identify the reason for the same. The causes of infertility are wide ranging such as ovulatory disorders, tubal disease, endometriosis, chromosomal abnormalities, sperm factors, and unexplained infertility. Among other factors thought to affect human fertility are the physical, behavioural, genetic, socio-economic as well as environmental or occupational contaminants. Lifestyle factors, such as psychological stress, advanced age to start a family, nutrition, weight, physical exercise and occupational exposures, can also have substantial effects on fertility and outcome. Further, other personal lifestyle factors, such as tobacco smoking and chewing, illicit drug use, alcohol and excessive caffeine consumption, can also have negative influence on fertility.
Many specialized infertility and in vitro fertilization centres are only focusing on management of infertility, oxidative stress reported to have significant role in infertility; thus, this handbook will be a handy tool for those focusing on how to investigate an infertile couple.
The book is divided into 12 chapters, highlighting different factors contributing towards failure to conceive. The first chapter focuses on understanding the basics of human reproduction including the anatomy of the reproductive system both in men and women, the physiology of fertilization and implantation and the basics of the roles of neuroendocribology, genetics and immunology in reproduction. The second chapter highlights the importance of history taking and clinical examination in an infertile couple. Preconception care is important; all high-risk factors are evaluated and treated as far as possible so that the couple is able to carry the pregnancy until the term safely. The third chapter highlights evidence-based preconception care and appropriate timing for the same.
Fourth and fifth chapters focus on evaluating ovulatory function and tubal patency, the two most common causes for failure to conceive in a woman. The sixth chapter highlights the mechanical issues of infertility in both female and male partners. These are emerging as important contributors for failure to conceive.
Once fertilization has occurred either in vivo or in vitro, the uterine endometrium has to be receptive for implantation to take place and let the embryo develop to its full potential, thus rightly the seventh chapter of the book focuses on endometrial receptivity, how to evaluate and improve it with an individualized approach. Several peritoneal and pelvic factors such as endometriosis, adhesions, fluid in peritoneal or uterine cavity and blockage also interfere infertility, and the eighth chapter provides information on evaluation of all these with clear-cut take-home messages.
Male partner contributes to almost 30-40 per cent of infertility, thus chapters nine and ten focus on the assessment of male partner and understanding of semen analysis and sperm function tests. Advanced genetics of infertility is discussed in chapter eleven. Last but not the least, the last chapter highlights when to stop investigating and start treating.
This is a multi-author book; thus, there is overlap between different chapters, such as. chapter 11 on genetics of fertility, also discussed under chapter one; approach to the evaluation of male factor also finds a place in other chapters besides the two dedicated chapters. The authors have approached the topic with their own perspective, and no uniform pattern has been followed. Some chapters end with a conclusion, some with summary and/or take home messages. Treatment options and modalities are also described in some chapters although the book focuses mainly on investigating infertility. It is hoped that these flaws will be taken care of during the editing and updating for the second edition.
Overall, those practicing infertility as well as medical postgraduates will find it a useful handbook.
