- Ovulation Disorders: These are the cause of infertility in around 25% of couples having trouble conceiving. When a woman is not ovulating regularly, her menstrual periods are irregular or the periods are heavy and prolonged. Some women’s periods may be absent completely. Where ovulation is impaired, a woman’s chance of becoming pregnant naturally can be drastically reduced.
- Maternal Age: As a woman gets older, the number of eggs and their quality are reduced. Chances of miscarriages also increase due to unintended chromosomal abnormalities. Pregnant woman at age 35 and above are at an increased risk of complications in pregnancy compared to younger women.
- Tubal Occlusion: A tubal occlusion is when the fallopian tube is blocked. This prevents the sperm from fertilizing the egg. Some women have bilateral tubal occlusion which means both the fallopian tubes are blocked.
- Endometriosis: Endometriosis is when the tissue lining the uterine wall is present on other organs in your body. It can be found in around 3 to 10% of reproductive aged women. It causes infertility in 2 ways. First, by causing distortion of fallopian tubes so that they are unable to pick up the egg after ovulation. Second, by causing inflammation that can adversely affect the function of ovary, egg, fallopian tubes or uterus.
- Uterine fibroids: These are non-cancerous growth in the uterus. However, not all of them lead to infertility. If present in the uterine cavity, it can prevent implantation of the embryo. These should be removed surgically.On the other hand, if they are present elsewhere, they need not be removed.
- Endometrial polyps: These are growths found in the uterine cavity. Large or multiple numbers of polyps can affect fertility by hindering implantation of the embryo. These should be removed surgically. Small of single polyps may not be affecting fertility.
- Unexplained: Sometimes, even after all the fertility tests, the cause remains unknown. This does not mean that there is no explanation but that the tests performed are normal. In Vitro Fertilization (IVF) can reveal abnormalities in egg quality, sperm function or embryo development that could not be determined from standard testing. However, even when the cause is unknown, fertility treatments can in due course lead to the delivery of a healthy baby.
Role of Laparoscopy in Infertility
Laparoscopy is a surgical procedure conducted by inserting a laparoscope (to visualize internal organs) usually via bellybutton and identifying problems which may interfere with fertility. These problems may not be immediately obvious otherwise.
The most common problems identified are endometriosis, uterine cysts, pelvic adhesions and ovarian cysts.
If abnormalities are identified, the doctor can introduce additional instruments through tiny insertions which can help treat some of the problems.
This procedure is helpful in women who may have a past history of pelvic problems or unexplained reason of infertility (other preliminary tests are normal).
Role of Hysteroscopy in Infertility
Hysteroscopy is used to identify and treat problems of the uterus and fallopian tubes. A hysteroscope is inserted through the vagina to see the inside of the uterus and the fallopian tubes for any abnormalities.
This procedure is mainly used for women, who might have irregular periods, adhesions and fibroids in the uterus which might result in infertility. It can also be used to identify any blockage in fallopian tubes. This procedure can then be modified to treat the identified problem if possible.
Couples who have had previously unsuccessful cycles of IVF may benefit from this additional procedure.
Hysteroscopy can be done after some abnormalities are already identified by previous hysterosonography or hysterosalpingography. This procedure is up to the discretion of your fertility doctor after reviewing your medical history.