Infertility

Nowadays, one out of ten couples has problem of infertility. Infertility is a condition when the body's most basic function for conceiving baby is impaired. Infertility is the inability of a couple to conceive after a year of regular unprotected intercourse. By definition, normal frequency of intercourse is twice a week.

In the olden days, infertility is a shameful topic and the blame is usually on the wife who is unable to conceive. The causes of infertility can be traced to the female in 30% of cases, the male in 30% and both female and male in another 30%. In the remaining 10%, the cause remains unknown despite all relevant tests to determine the cause of infertility have been performed. There is always hope for these couples, those with known cause as well as those with unknown causes.

There had been a lot of efforts done to Since the birth of world first IVF baby, Louise Brown, in July 1978, assisted reproductive techniques (ART) have improved dramatically. Assisted reproductive techniques (ART) are treatments designed for these infertile couples to help them to have babies of their own. There are various types of ART available; intrauterine insemination (IUI), in vitro fertilization (IVF), gamete intrafallopian transfer (GIFT) and intracytoplasmic sperm injection (ICSI). All of these treatments have one common purpose i.e. to give nature a helping hand by giving a better chance for the eggs and sperm to meet, fuse and fertilize to form embryos.

The first step in managing infertile couples at Metro IVF is investigation. Investigation is important to find out the reasons of having problem in conceiving. Meanwhile, our doctors will give medical treatment to the infertile couples and hope that the treatment will work for them. In fact, many infertile couples success to conceive after medical treatment. If medical treatment does not help, more advanced ART such as IUI, IVF, ICSI and blastocyst culture may be indicated. Please bear in mind that you may need 5 to 15 visits for the whole process of infertility investigations and treatments, depending on the treatment that you require.

 

Milestones of ART Developement

July 1978 The world's first IVF baby, Louise Brown, was born.
1980
Founded of the Bourn Hall Clinic, the first IVF centre in the world, by Patrick Steptoe and Robert Edwards.
1984 The world's first frozen embryo baby was born.
1991 The world's first PGD baby was born.
1992 The world's first ICSI baby was born.
The world's first blastocyst transfer baby was born.

However, IVF only came in Malaysia 15 years ago. Metro IVF, which was established in 1999, appears as the first IVF centre in Klang and achieved its first IVF baby in March 2000. Below is a video presentation showing the process of a normal IVf cycle. The IVF cycle is devided into five steps;

1. controlled ovarian hyperstimulation (COH)
2. oocyte pick-up (OPU),
3. insemination and embryo cultivation
4. embryo transfer (ET), and
5. luteal support.

 

Metro IVF First IVF Baby in 2000

This video presentation shows the whole process of IVF treatment done for our first IVF baby born in 2000. The mother was started with COH 28 June 1999. Later, OPU and ET were done on 26 and 28 July respectively and two embryos were transferred back. Gestational sac was deteced by ultrasound scan four weeks after ET. Eight months later, a baby girl was delivered by Caesarean Section.

 

The causes of fertility problem

Causes of women fertility problem :

1.Disturbance of the ripening of the egg.

The right hormonal balance is very important for conception. Hormonal imbalance can lead to the ripening of the egg being disturbed, to a lack of ovulation and to poor luteinisation (the process by which the ruptured follicle transform into the corpus luteum). Somewhat suprisingly, women produce small hormones of male hormones(androgens) in their bodies and sometimes increased amounts of these can disturb hormonal balance, often in combination with ovarian cyst (follicle like-structure).Hormonal balance can also be disturbed by being very underweight or overweight, large weight changes in a short period of time, extreme physical exertion, disturbance in the working of thyroid gland or in the secretion of the hormone prolactin, certain types of medication and stress. Hormonal assay will help to determine this cause.

2. Tube-related infertility.

Some of the childless women, the fallopian tubes are found to be partly or completely blocked. Most frequently, the fallopian tubes are damaged by infection (which might have happened many years before). Other possible causes are an earlier pregnancy in which embryo implanted in the fallopian tube instead of the womb (which is called an ectopic pregnancy) or adhesions following an operation or endometriosis. You can do HSG (Hysterosalpingogram) to determine this cause.

3. Endometriosis.

Endometriosis is the growth of endometrium (the lining of the womb) outside the womb itself. It is not known exactly how this occurs. It is probably due to very small amounts of the endometrium passing through the fallopian tubes to the abdominal cavity during menstruation. Here it may settle, causing adhesions between the abdominal organs and painful menstruation. Laparoscopy will help to determine this cause.

4. Antibodies against gamete.

These are an uncommon cause of fertility problems. In rare cases, the body does not recognize its own egg cells and the immune system forms antibodies against them. Antibodies against the man’s sperm in the cervical secretions are rather more frequent. As a result, sperm cannot enter the womb and fertilization does not take place.

5.Uterus Abnormalities.

A bicornuate uterus (a womb with two 'horns') is the most common. Instead of the womb being pear-shaped it is shaped like a heart, with a deep indentation at the top. This means that the baby has less space to grow than in a normally shaped womb. A uterine fibroid non-cancerous tumor that originates from the smooth muscle layer (myometrium) and the accompanying connective tissue of the uterus. Fibroids are the most common benign tumors in females and typically found during the middle and later reproductive years. They can grow and cause heavy and painful menstruation. Ultrasound scan will help to determine this cause.

Causes of men fertility problem :

1.Disturbance of sperm maturation.

The most frequent problem affecting the male fertility is insufficient production of normal, freely mobile sperm. Male semen (a mixture of sperm and nutrient fluids) is considered to be of normal quality if there more than 20 million sperm per milliliter (ml) (about half a teaspoon) of semen. Even in fertile men, most sperm are imperfect and many cannot swim properly, but at least 30% of them should be normally formed and 50% freely mobile. If these values are not reached, the man’s procreative capability can be reduced. However, even with normal sperm a functional problem may prevent sperm from penetrating the egg. The ability to produce healthy sperm may be reduced as are result of a mumps infection in childhood. Varicose veins in the testicles (varicocele) may also lead to poor sperm quality. Other causes are hormonal disturbances, stress, environmental factors, undescended testes or hereditary factors such as genetic damage. Infections such as flu may reduce sperm quality, but this is usually temporary. Semen analysis is requested to determine the cause.

2.Disturbance sperm transport.

In 4% of cases, sufficient semen is formed but cannot enter the woman’s body on ejaculation because the seminal duct is blocked. This situation is comparable with blockage of the fallopian tube in women. Possible causes are previous sterilization or sperm ducts which are underdeveloped or blocked by adhesions, usually as a result of a previous infection of the reproductive organs.