Infertility is a common problem, occurring in approximately 10-15% of couples worldwide. Infertility is defined as the inability to conceive a pregnancy after two years of unprotected intercourse. It can be either primary – when the female has never conceived or secondary – when there has been a previous documented pregnancy – either a live birth a even a failed pregnancy e.g. miscarriage or ectopic pregnancy.

Causes of Infertility

Male factor 40%
Female factor – Tubal problem 20%
Female factor – Ovulatory problem 20%
Unexplained 15%
Others 5%

Investigation

  • Semen analysis of husband.
  • Basic blood investigation of female.
  • Harmone analysis.
  • Ultrasound – pelvis.
  • Hysterosalpingography – to see tube patency.

Treatment

  • Laparoscopy
    Diagnostic laparoscopy is gold standard to detect tubal and peritoneal causes. Any abnormality including endometriosis and pelvic adhesions which are not detected by ultrasound and hysterosalpingography are readily seen and also rectified. Dye can also be injected inside the uterus and patency of fallopian tubes confirmed. Treatment can be modified according to the problem present:

    If ovulatory disorder – medicines are given.
    If polycystic ovaries are present – ovarian drilling is done.
    If fibroids are present – myomectomy done.
    If tubes are blocked – the site of blockage is determined and reanastomosis done.
    If tubo ovarian adhesions present – Adhesiolysis done.
    Tubal recanalisation can be done if there is history of tubectomy.
    If Hydrosalpinx is present – Neosalpingostomy is done.

  • Hysteroscopy
    In this procedure a telescope is introduced inside the uterus & uterine cavity visualized.

    If polyps are present – Polypectomy done.
    If septate uterus – septum is cut.
    If ashermans syndrome present – Adhesiolysis done.
    Endometrical biopsy can be taken for sent for histopathological examination.