Pregnancy is a state of carrying a growing foetus for about 42 weeks, measured from the date of the pregnant mother’s last menstrual period (LMP). Pregnancy is indicated by an urine test and confirmed clinically through a blood test, ultrasound or detection of foetal heartbeat. Pregnancy period is divided into three trimesters of three months each.
Fertilization of the female egg by the male sperm marks the beginning of pregnancy. On conception, the zygote travels down from the fallopian tube to attach itself to the inner wall of the uterus. A cluster of attached cells later forms the foetus and the placenta. By 12 weeks, the placenta starts to transmit nutrients from the mother to the foetus through the umbilical cord.
Ultrasound scans to detect birth defects can be done by 18 weeks. Foetal movements can be felt by 20 weeks. Foetal hand and foot prints appear at 24 weeks. Foetus develops regular patterns of sleep and being active. Babies born at 28 weeks have a 92% survival rate though there may be complications.
At 28 weeks, the foetus starts to open and close its eyes. A 29 weeks old foetus can kick, stretch and grasp. By 30 weeks, organs are all formed and foetus starts gaining weight rapidly. The foetus starts practise to breath from 32 weeks. By 34 weeks, the foetus has hardened bones, nails and smooth skin. At 36 weeks, the baby occupies most of the amniotic space. The baby starts to turn head down and in to the pelvis at 37 weeks. The chest becomes prominent and baby stores fat to keep itself warm after delivery. At 39 to 40 weeks, baby achieves its height and weight. Babies born at this time are considered full term.
Infertility is defined as the inability to conceive after 12 months of unprotected sexual intercourse. 8 to 12 % of couples worldwide suffer infertility. The ratio of male to female infertility is 50:50. Couples experiencing infertility have to be screened for contributing factors from both the partners. Initial advise from doctors would be to increase the frequency of sexual intercourse few days before and during Ovulation. This increases the chances of natural conception. Beyond this, treatment for infertility aims at addressing the root cause.
Infertility treatments also include Assisted Reproductive Techniques (ARTs) such as IUI, IVF and ICSI.
There are reasons with either of the partners or a combination of factors that may lead to infertility in a couple. Problems in Ovulation, egg quality, sperm production, structural abnormalities, genetic factors, trauma, age, infections or too much exposure to certain toxins have been various reasons for causing infertility. Some of the more common reasons inclined to infertility are:
Risk factors that may reason the possibilities of infertility in Men and Women alike in present day life style are:
In recent years, largest group of infertility is associated with “Idiopathic infertility” in other words, unexplained infertility. Female Idiopathic Infertility refers to conditions where clinical findings do not reveal any pathological mechanism to explain infertility. Male Idiopathic Infertility does not imply absolute infertility but the chances of achieving fatherhood naturally may be reduced or prolonged. Rational treatment for Idiopathic Infertility cannot be applied because there is no pathological findings behind the problem. However advanced research has enabled specialists to identify certain pathological existence that were earlier thought to be Idiopathic in reasoning. Evidence based medicine remains to be the need for treating Idiopathic Infertility.
Determination of infertility treatment involves individualised evaluation, clinical implications and possible applications. Time, commitment and cost are the limiting factors a couple may undergo during the course of the treatment procedure. Infertility treatment procedure generally includes the following steps:
Lifestyle modifications that aid weight loss, counselling on sexual habits, usage of Ovulation calculator and other remedies to increase chances of natural conception are the first line management goals
Medications to control the pathological cause of the problem in either male/ female forms the baseline treatment for infertility. Predisposing health conditions such as Diabetes, heart problems, vascular diseases and metabolic disorders are to be brought under control before starting infertility treatment. Some of the common therapeutic options include:
Couples who do not achieve pregnancy through medications or surgeries may need Assisted Reproductive Techniques(ARTs) such as Intra Uterine Insemination, In Vitro Fertilisation or Intra Cytoplasmic Sperm Injections (ICSI). These procedures may also involve cryopreservation of gametes or embryo, embryo transfer and surrogacy.
Infertility evaluation is a tool not just for diagnosis but also to monitor treatment progress. There are several tests that either or both of the partners may have to take up in order to record clinical findings from time to time. Tests are necessary to ensure that the male is producing enough active sperms that get ejaculated effectively in to the vagina and successfully travel to reach and penetrate the egg. In women, tests evaluate the efficacy of the ovaries to release the egg, ability of the reproductive tract to allow fertilisation and the capability of the reproductive system to facilitate implantation.
A hysterectomy is the partial or total removal of the womb. This is considered for treating extremely large fibroids or excessive bleeding.A total hysterectomy can prevent the return of fibroids but also causes side effects like reduced libido and early menopause. Total hysterectomy also means no child bearing.
Infertility, classified as male and female are attributed to specific disorders or abnormalities as underlying causative factors with respective symptoms.
Low sperm count, low sperm motility and abnormal sperm morphology contribute to major cause of male infertility. Symptoms that are indicative of insufficient sperm parameters are:
Male sexual disorders that may interfere with delivery of sperms in to the Vagina for successful fertilization are:
Unlike in men, women experience infertility mostly due to endocrine disorders or structural deformities.
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