female infertility treatment in chennai

FACTORS THAT AFFECT INTRAUTERINE INSEMINATION(IUI pregnancy)SUCCESS?

INTRODUCTION

The main aim of infertile couples is to conceive and have a healthy child. Infertility could be due to problems in men, women, or both in 20% of infertile couples all investigations may be normal and they may yet be infertile which is called unexplained infertility. One common treatment option for infertility is intrauterine insemination (IUI Pregnancy), which involves directly inserting sperm into a woman’s uterus to increase the chances of fertilization.

Abnormalities in women are not the only cause of infertility. The important causes of infertility are:

Evaluation of physical factors in a couple

FEMALE ORIENTED:

1) Problem in the development of eggs in the ovary.

2) Obstruction in the fallopian tubes prevents egg and sperm from meeting.

3) Anomalies in the uterus

MALE ORIENTED PROBLEMS:

1) Problem in the production of sperms.

2) Mental stress or anxiety and other reasons

TEST RELATED TO THE WOMEN:

FOLLICULAR STUDY: Follicular study is a vital component of egg assessment and timing of release of the egg. It basically employs a simple technique for assessing ovarian follicles at regular intervals (from the 12th day of period 18th to the 20th day) and documenting the pathway to ovulation (mature egg is released from the ovary).

HORMONE ANALYSIS:

The level of hormones in the blood plays an important role in conception. T4, TSH (Thyroid stimulating hormone), and prolactin levels are tested routinely. FH and LH levels are also.

LAPAROSCOPY:

Laparoscopic surgery, also called minimally invasive surgery (MIS), or keyhole surgery, is a modern surgical technique. It is used to visualize ovaries, uterus, and fallopian tubes. Endometriosis can also be diagnosed. PCOD can be diagnosed. It is both diagnostic and therapeutic.

DIAGNOSTIC:

By directly visualizing the uterus, Ovaries, and tubes, and checking tubal potency, couples can be reassured.

THERAPEUTIC:

Therapeutic procedures like ovarian drilling, ovarian cyst removal, adhesion, and myomectomy can be done through laparoscopy. Hysteroscopy will enable to visualization inner side of the uterus and tubal opening.

TEST RELATED TO MEN

Semen analysis and hormone analysis are performed. In some cases, a urologist's opinion is also taken. Treatment would be easier after the preliminary tests are done in the male along with his spouse Hormone tests like T4, TSH, Prolactin, FSH, LH, and testosterone are done.

INFERTILITY PROCESS:

In this modern era conceiving a child naturally seems difficult, due to the changes in the social structure and function, where the priority of the woman has shifted from marriage to education and career, squeezing pregnancy between career ladder and homemaking, reducing treatment of infertility a rate race. As the age of marriage is raised conception window is narrowed, and anxiety is built on attempts for early pregnancy.

Though reproductive medicine has stretched its wings far and wide and procreating children to many infertility couples, there are grey areas that don’t come under its preview. We are analyzing the other side of the coin – the functional aspect. The problem of infertility is like an iceberg – the visible part is the physical aspect. The tip of the iceberg – It is amenable to tests and treatment. The submerged invisible part is the functional aspects comprising of immune and hormone function not available for the scrutiny of the medical fraternity.

Intrauterine insemination (IUI) pregnancy is one of the advancements in reproductive medicine, where sperm is directly inserted into a woman’s uterus to increase the chances of fertilization. This procedure helps many couples achieve pregnancy despite the challenges posed by modern lifestyles.

 

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WHY SOME PEOPLE DOEN’T CONCEIVE, IN SPITE OF THE BEST MEDICAL TREATMENT AND ALL PHYSICAL FACTORS



CORRECTED?

The problem of fertility (conception) has physical, functional, social, and emotional aspects. The physical aspects (Egg, tube, Sperm, Hormone) are studied by tests, and problems are recognized and corrected by treatment. Medical treatment has advanced to a great extent in treating the physical aspects, medicines to improve the egg development, keyhole surgery for tubal, uterine, and peritoneal factors, ART (assisted reproductive techniques, Test tube baby IVF, ICSI as the ultimate resort). Intrauterine insemination (IUI) is another method, where sperm is directly inserted into the uterus to facilitate fertilization. IUI success rates can vary but generally range from 10% to 20% per cycle, depending on various factors like age and underlying fertility issues.

FUNCTIONAL ASPECTS:

Functional aspects comprise immunity and organ function. Diet (antioxidants vitamins) improves the structure whereas exercise improves the function by increasing the blood flow. Diet and exercise improve the quality of eggs and sperm.

IMMUNE FUNCTION:

These days nutritive values of food are comparatively low due to the low soil fertility. Protein content of the soil has gone down by 30-50% and levels of minerals like Iron, Calcium, Magnesium, and Zinc are also low. Anti-nutrients like GM (genetically modified) foods, pesticides, herbicides refined sugars, hydrogenated fats, water from plastic bottles, color preservatives, and junk food depletes the conception nutrients being absorbed. They damage eggs and sperm leading to infertility, abortion, congenital anomalies, etc.

Exercise is a good way of improving BMR and reducing weight. It is a good way of detoxing by way of sweating, breathing, and relieving constipation. It decreases insulin resistance and LDL Cholesterol and improves immune function and anti-oxidant levels. It also decreases stress hormones and food cravings. University of ADELAIDE conducted 6 months study on diet and exercise in 18 overweight women. There was a 71% increase in insulin sensitivity, a 39% decrease in LH levels, and an 11% decrease in central fat.

HORMONE FUNCTION:

Hormone balance is directly dependent on our emotions. Fertilization and implantation are dictated by hormonal interplay. They are so designed that when physical factors are ok when we don’t think about pregnancy, conception occurs naturally. The normal conception rate would be 10%-15% per month. When we are anxious about pregnancy and expect every month stress hormones are released and upset normal hormonal balance and confident happy hormones are released which enhance natural function.

EMOTIONAL ASPECTS OF THE INFERTILITY:

HOW EMOTIONS ARE INVOLVED IN CONCEPTION?

It has many dimensions. Self-esteem is directly affected by conception. Emotional trauma is more than physical suffering. This is due to the conflict between self, society, and family.

SOCIETY: Infertility is a pet subject of sarcasm to society, making infertility couples social outcasts.

FAMILY: In the past joint family system was there, which gave a lot of moral support to the couple. Now with a nuclear family, for a word of reassurance, we need to seek the help of counselors or psychologists. Interpersonal relationships between husband and wife also can suffer due to infertility. Both of them need to express their feelings, understand, and offer mutual support.

FACTORS THAT AFFECT INTRAUTERINE INSEMINATION SUCCESS

The success of intrauterine insemination (IUI) depends on several factors.

IN FEMALE:

Age plays a major role in the IUI success. There is a gradual decrease in getting pregnant after 30 years and the worst decrease after 35 years of female age. After 35 years of female age, the incident of infertility increased to 50% and the quality of the ova also deteriorated and the incidence of aneuploidies in the fetuses increased. Actually in human being natural fertility ends at the age of 41 years for females.

The recommendations are that in a couple with unexplained infertility, IUI should be limited to couples with females aged under 40 years. No routine ovarian reserve screening prior to starting IUI treatment is required. IUI may be advised with donor sperm for up to 42 years. Ovarian reserve testing is required only to exclude older women and for them, effective treatment is only ovum donation. So, ovarian reserve tests are not required in IUI practice. In women aged <=38 years, IUI should be considered as an option particularly in cases of female factor infertility due to ovulatory disorder, in cases of normal ovarian reserve, in cases of secondary infertility, or when postwash semen count in a male is >=1 million with progressive motility >90%. In all these cases, follicular development with ovulation induction improves the chance of pregnancy.

Female obesity is associated with lower oocyte yield with gonadotropin stimulation, lower pregnancy rate, and increased pregnancy loss in IUI. But, fecundity rates are higher in obese patients, particularly in polycystic ovary syndrome (PCOS). Weight loss improves obstetric outcomes and not fecundity. The optimal body mass index (BMI) for natural conception is between 20 and 24.

IN MALE:

As the male age increases there will be a decrease in the quality of sperm (Count, Motility, and morphology). These parameters start declining after 35 years of age also DNA damage at an older age may cause multiple genetic and chromosomal defects. The miscarriage rate is increased if the paternal age is more because of oxidative stress-induced mtDNA damage and nuclear DNA damage. This damage may put them at a higher risk of transmitting multiple genetic and chromosomal defects. After 40 years, it has a negative effect on IUI success rate. But, there is no absolute cut-off for the age as far as male infertility is concerned.

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