Q 1 – Can my husband also be responsible for me not having a baby?
Not being able to have a baby is called infertility and it is as much a responsibility of the husband as the wife. In fact, one third of the cases infertility are due to problems in you, the female partner, and in one third only your husband is responsible. In the rest of the one third there may be problems in both the partners. The husband should have his semen analysed where the number, movement, quality and appearance of his sperms are tested. This should be done early so that invasive and expensive testing of the wife can be prevented. Further testing may also be required. Remember that any medicines given to the husband will improve the sperms 3 months later since the immature sperms spend that time in those tortuous tubules before ejaculation.
Problems in the sperms may be due to infections like sexually transmitted diseases or blocks in the tubes carrying the semen. Sometimes the semen may not come out but reverses back to enter the urinary bladder resulting in infertility. This is known as Retrograde Ejaculation and caused by diabetes, certain medicines or injury to the genital-urinary system. Sexual problems or impotence can cause infertility and maybe due to anxiety, stress; diseases like diabetes, high blood pressure, obesity; or medicines like anti-depressants. Varicocoeles are enlarged veins in the scrotum; found commonly in 15-40% of men with infertility. They prevent proper flow of blood, cause heating of the sperms resulting in decreased sperm production. Some of these issues can be treated with lifestyle changes with respect to weight, drugs, alcohol, stress or by addition of medicines or hormones and some cases may require surgery, which may not be successful always. Artificial intra-uterine insemination (IUI) after preparing and nourishing the sperms in the laboratory and placing them directly inside the uterus via a tube is a simple way of overcoming many problems. Some cases may require Assisted Reproductive Techniques (ART) like IVF aka ‘test tube baby’. Even a single sperm present in a man’s testes can be retrieved to be injected directly into an egg to fertilize it in the laboratory in an amazing method called ICSI (Intra Cytoplamic Sperm Injection). So there is always hope…..
Q 2 – Is there any specific medicine or treatment for infertility?
Yes, there are specific medicines to help a patient with infertility to conceive. In women who have improper or no egg formation, their main use is to cause formation and growth of the egg. These are generally taken for about 5 days soon after the start of the menstrual cycle. They are started at low doses and then increased in strength till the egg formation is happening well. They may be combined with Artificial Insemination (IUI) to increase the chances of conceiving. There may be multiple pregnancy, most commonly twins, in about 10% of women who conceive on these medicines. Triplets may happen too, but are rarer. In about 10% of the patients the eggs may get over-stimulated, grow uncontrollably large and cause problems which may get serious. Therefore it is wiser to start with lower doses to check your sensitivity to these medicines. It may be wise to limit usage of these medicines to not more than 12 cycles as they may be associated with long term problems in the ovaries at an older age. If you do not conceive within one year, it may be best not to drag on with these medicines but to shift to hormonal treatments of infertility.
There are other medicines used in the treatment of infertility too. Sometimes the hormone Prolactin may be high. High Prolactin does not allow you to conceive but medicines used to decrease these levels help fertility. Medicines that change your metabolism and your sugar levels also improve your chances of becoming pregnant.
Surgical treatment of infertility has a very important role to play. Conditions like fibroids, endometriosis, poly cystic ovaries, ovarian cysts, blocked tubes may require laparoscopic treatment before you can conceive. In case of problems inside the uterus like fibroids, polyps, septum, adhesions, foreign bodies, tubes blocked at attachment to the uterus may require expert hysteroscopic surgery for you to be able to conceive. Combined Hysteroscopy-Laparoscopy is established management of all cases of infertility especially when no cause can be found.
Q 3 – What is hormone therapy. How can it treat infertility?
In cases where there are problems of egg formation and release, and simpler medicines by mouth do not work, you may require hormone injections. There are many schedules of these hormones – long, short and ultrashort depending upon the duration of injection treatment. They are used to suppress the natural abnormal hormones which cause no or haphazard, incomplete egg release, so that a new, controlled cycle of egg formation is stimulated. Egg formation thus occurs in a predictable fashion; the number of eggs formed is controlled by the dose of injectible hormones given. When about 1-2 eggs are formed, one can do artificial insemination (IUI). When more eggs are stimulated, eggs can be picked up for fertilization in a dish with the sperms (IVF). Once the eggs are fertilized 1-2 of these are placed inside the womb where they grow into a baby or twin babies. Once these hormones are used, then usually the egg is not released by itself and requires another hormone injection. In this way, problems of egg release, blocks in the tubes or problems in the husband’s semen are overcome. These methods of hormone treatments of infertility work well even in those cases where no reason for the infertility can be identified. These are known as ‘Unexplained Infertility’. Natural intercourse, where both you and your husband are healthy and normal, and when you meet during your fertile period (generally day 8 to day 18 of a 28 day cycle) results in a pregnancy in 60% of the cases. Assisted Reproductive Technologies, like those described, including IUI and IVF, have success rates of 30-40% in achieving a pregnancy. For a couple in despair because they are unable to conceive naturally each success is the world for them and a matter of great joy.