Infertility

Infertility refers to an inability to conceive after having regular unprotected sex. Infertility can also refer to the biological inability of an individual to contribute to conception, or to a female who cannot carry a pregnancy to full term. In many countries, infertility refers to a couple that has failed to conceive after 12 months of regular sexual intercourse without the use of contraception.
Studies indicate that slightly over half of all cases of infertility are a result of female conditions, while the rest are caused by either sperm disorders or unidentified factors.

Causes of female infertility

  • Causes of female infertility may include: Ovulation disorders, which affect the release of eggs from the ovaries. These include hormonal disorders such as polycystic ovary syndrome. Hyperprolactinemia, a condition in which you have too much prolactin — the hormone that stimulates breast milk production — may also interfere with ovulation. Either too much thyroid hormone (hyperthyroidism) or too little (hypothyroidism) can affect the menstrual cycle or cause infertility. Other underlying causes may include excessive exercise, eating disorders, injury or tumors.
  • Uterine or cervical abnormalities, including abnormalities with the opening of the cervix, polyps in the uterus or the shape of the uterus. Noncancerous (benign) tumors in the uterine wall (uterine fibroids) may rarely cause infertility by blocking the fallopian tubes. More often, fibroids interfere with implantation of the fertilized egg.
  • Fallopian tube damage or blockage, often caused by inflammation of the fallopian tube (salpingitis). This can result from pelvic inflammatory disease, which is usually caused by a sexually transmitted infection, endometriosis or adhesions.
  • Endometriosis, which occurs when endometrial tissue grows outside of the uterus, may affect the function of the ovaries, uterus and fallopian tubes.
  • Primary ovarian insufficiency (early menopause), when the ovaries stop working and menstruation ends before age 40. Although the cause is often unknown, certain factors are associated with early menopause, including immune system diseases, certain genetic conditions such as Turner syndrome or carriers of Fragile X syndrome, radiation or chemotherapy treatment, and smoking.
  • Pelvic adhesions, bands of scar tissue that bind organs after pelvic infection, appendicitis, or abdominal or pelvic surgery.

Other causes in women include:

  • Cancer and its treatment: Certain cancers — particularly female reproductive cancers — often severely impair female fertility. Both radiation and chemotherapy may affect fertility.
  • Other conditions: Medical conditions associated with delayed puberty or the absence of menstruation (amenorrhea), such as celiac disease, poorly controlled diabetes and some autoimmune diseases such as lupus, can affect a woman’s fertility. Genetic abnormalities also can make conception and pregnancy less likely.

Causes of male infertility

  • Abnormal sperm production or function due to undescended testicles, genetic defects, health problems such as diabetes or infections such as chlamydia, gonorrhea, mumps or HIV. Enlarged veins in the testes (varicocele) can also affect the quality of sperm.
  • Problems with the delivery of sperm due to sexual problems, such as anejaculation , erectile dysfunction; certain genetic diseases, such as cystic fibrosis; structural problems, such as a blockage in the testicle; or damage or injury to the reproductive organs.
  • Overexposure to certain environmental factors, such as pesticides and other chemicals, and radiation. Cigarette smoking, alcohol, marijuana or taking certain medications, such as certain antibiotics, antihypertensives, anabolic steroids or others, can also affect fertility. Frequent exposure to heat, such as in saunas or hot tubs, can raise the core body temperature and may affect sperm production.
  • Damage related to cancer and its treatment, including radiation or chemotherapy. Treatment for cancer can impair sperm production, sometimes severely.

When to see a doctor

You probably don’t need to see a doctor about infertility, unless you have tried regularly to conceive for at least one year. Talk with your doctor earlier, however, if you’re a woman and:

  • You’re age 35 to 40 and have been trying to conceive for six months or longer
  • You’re over age 40
  •  You menstruate irregularly or not at all
  • Your periods are very painful
  • You have known fertility problems
  • You’ve been diagnosed with endometriosis or pelvic inflammatory disease
  • You’ve had multiple miscarriages
  • You’ve undergone treatment for cancer

Talk with your doctor if you’re a man and:

  • You have a low sperm count or other problems with sperm
  • You have a history of testicular, prostate or sexual problems
  • You’ve undergone treatment for cancer
  • You have testicles that are small in size or swelling in the scrotum known as a varicocele
  • You have others in your family with infertility problems

Laparoscopy

Laparoscopy is a surgical procedure that has been used widely in medicine over 30 years.faster recovery time, the minimizing of pain, hospitalization and better aesthetic result are some of the advantages which made laparoscopy very popular among patients and surgeons. Also, some technical parameters such as the magnification offered by the endoscope during the procedure and the small risk of complications resulted in the wide use of laparoscopic surgery in gynecology. Laparoscopy has gained a leading role and appears to be the gold standard method for a quiet wide range of gynecologic procedures such as tubal ligation, removal of ovarian cyst or adnexa, treatment of ectopic pregnancy, hemorrhagic rupture of a cyst, exploration of chronic pelvic pain, sterility, treatment of endometriosis, removal of fibromyomata , hysterectomy, and lately for treatment of pelvic organ prolapses, urinary incontinence and even in gynecologic cancers.

What is a laparoscopy?

Laparoscopy is a type of surgical procedure in which a small cut is made through the navel (tummy button) through which a viewing tube (laparoscope) is inserted. The laparoscope has a small camera on the eyepiece which allows the doctor to examine the abdominal and pelvic organs on a video monitor. Other small cuts can be made to insert instruments to perform procedures (keyhole surgery). Laparoscopy can be carried out to diagnose conditions or to perform certain types of operations.

Diagnostic procedure

As a diagnostic procedure, a laparoscopy is done to find out the cause of pelvic pain, fertility problems, or gynecological) symptoms that cannot be confirmed by a physical examination or ultrasound. For example, a laparoscopic examination can identify ovarian cysts, endometriosis, adhesions (scarring), ectopic pregnancy or blocked fallopian tubes. It is carried out as a day- case procedure. Laparoscopy can also be used to examine the appendix, bowel, gallbladder, or liver.

Operative procedure

As an operative procedure, laparoscopy is used for female sterilization, treating an ectopic pregnancy, treating endometriosis and/or adhesions, removal of ovarian cysts or abnormal ovaries, and opening or removing damaged tubes. Most of the fibroids in the uterus can be removed by laparoscopy. Laparoscopy can also be used to perform a hysterectomy.

While many of these procedures can be carried out using regular open surgery, laparoscopy usually involves:

  • less pain
  • less scarring on the outside and inside
  • faster recovery.

Because laparoscopy is so much less invasive than traditional abdominal surgery, patients can leave the hospital sooner, usually within 12 – 24 hours.

Some common reasons for having a Diagnostic Laparoscopy

  • Infertility
    A laparoscopy can determine if there is any abnormal anatomy, endometriosis, blocked fallopian tubes, or some other reason for infertility. A dye may be injected through the neck of the womb via the vagina to see if the fallopian tubes are open. If the tubes are open, the dye will be seen spilling out of the ends.
  • Pelvic pain
    There are many possible causes of pelvic pain that can be diagnosed with laparoscopy. These include endometriosis, adhesions (scar tissue), ovarian cysts, ectopic pregnancy, pelvic inflammatory disease (PID), and abnormalities of the uterus.
  • Sterilization
    In this operation the fallopian tubes are sealed with a clip to reduce the risk of
    pregnancy.
  • Ectopic pregnancy
    If a fertilized egg becomes embedded outside the uterus, usually in the fallopian tube, an operation can be performed to remove the developing embryo. This is preferably done with laparoscopy. Usually the affected tube is removed, though sometimes an attempt can be made to remove the pregnancy whilst leaving the tube in place.
  • Endometriosis
    This is a condition in which tissue from inside the uterus is found outside the uterus in other parts of (or on organs within) the pelvic cavity. This can cause cysts to form in an ovary. Endometriosis is diagnosed with laparoscopy, and in some cases the cysts and other tissue can be removed during the procedure.
  • Ovarian cysts
    Cysts in the ovaries can be removed using laparoscopy, or the whole ovary can be removed.
  • Adhesiolysis
    Adhesions (scarring) between organs within the abdomen or pelvis can be associated with pain and/or infertility. The adhesions may result from previous surgery, infections, or endometriosis. Cutting these adhesions, known as adhesiolysis, may improve symptoms.
  • Fibroids
    Fibroids in the uterus can be successfully removed using laparoscopy. The fibroid is ‘shelled-out’ from the lining of the uterus and then a special instrument (morcellator) is used to cut the fibroid into pieces for removal. The defect in the uterine wall is then stitched using laparoscopy.
  • Hysterectomy
    This procedure to remove the uterus can be performed using laparoscopy. The uterus is cut away with the aid of the laparoscopic instruments and then the uterus is removed either through the vagina or through the laparoscopic keyholes in case of very large uterine size.

What happens during a laparoscopy?

Laparoscopy is a surgical procedure performed in the hospital under general anaesthesia. Before starting the procedure, the bladder is emptied with a small catheter and the skin of the abdomen is cleaned.

After you are anaesthetized, a hollow needle is inserted into the abdomen through a small cut through or just above the navel (tummy button), and carbon dioxide gas is pumped through the needle to expand the abdomen. This allows the surgeon to get a better view of the internal organs. The laparoscope is then inserted through this cut to look at the internal organs on the video monitor.

Usually one or two additional small cuts are made along the ‘bikini line’ to insert other instruments which are used to lift the tubes and ovaries for examination or to perform surgical procedures.

Preparation for the procedure

You should not eat or drink for about 6 hours before the procedure.Doctor may prescribe some medications on the previous night to swallow and to put in the vagina, so as to ascertain an empty bowel and clean aseptic lower genital tract, during the surgery. An enema may be given 2 hours prior to the procedure.

Aftercare

Nurses will check your vital signs (blood pressure, pulse, temperature and rate of breathing) after the operation. If there are no complications, you may leave the hospital within four to six hours of a diagnostic procedure. If you have had an operative laparoscopic procedure, you may need to stay in hospital for one night or so. (Traditional abdominal surgery requires a hospital stay of four days or more.)
There may be a some slight pain or throbbing in the first day or two after the procedure at the sites where the cuts were made. The gas that is used to expand the abdomen may cause discomfort under the ribs or in the shoulders for a few days.
Depending on the reason for the laparoscopy in operative procedures, some women may experience vaginal bleeding.
Many patients can return to work within a week of surgery and most are back to work within two weeks.

Antenatal care

The objective of antenatal care is to ensure the supervision of maternal and fatal well being during pregnancy, identify and treat conditions that may threaten the health of the fetus/newborn and mother. Also making available all appropriate choices to fulfill optimal potential, and providing all necessary support and preparation for a high quality life after birth. Another objective of antenatal-care is to help a women approach pregnancy and birth as positive experiences.

Main objectives of antenatal-care are:

  • Maintenance of health of mother during pregnancy
  • Promote physical, mental and social well being of mother and child.
  • Ensure delivery of a full term healthy baby.
  • Early detection of high risk cases and minimize risks by taking appropriate
    management.
  • Prevent development of complications through health education, adequate
    nutrition, exercise, vitamin intake and appropriate medical and pharmaceutical
    intervention.
  • Screening for conditions and diseases such as anemia, STIs, HIV infection, mental
    health problems, and domestic violence.
  • Teach the mother about child care, nutrition, sanitation and hygiene.
  • Decrease maternal and infant mortality and morbidity.
  • Remove the stress and worries of the mother regarding the delivery process.
  • Provide safe delivery for mother and educate mother about the physiology of
    pregnancy and labor by demonstrations, charts and diagrams so that fear is removed and physiology improved.
  • Advice family planning and motive the couple about the need of family planning.
  • Predict possible problems during pregnancy and provide an appropriate treatment.
  • Provide information on pregnancy and birth and discuss with the couple about the place, time and mode of the delivery provisionally and care of the newborn.
  • Ensure continued medical surveillance and prophylaxis.
  • Advice the mother about breast feeding, post natal care and immunization.
  • Advice and support to the women and her family for developing healthy home behaviours.