INFERTLITY

What is infertility and why is it a concern?

Infertility is the inability of a sexually active couple, not using any contraception, to conceive during one year, the time in which about 90 percent of couples succeed. Over their lifetimes, approximately one in every ten to eleven couples in Singapore seek infertility care. Just over half of all infertility is attributable to the female partner.

What causes female infertility?

For pregnancy to occur, several things must happen: an egg must develop and ovulate properly each month, and a sperm must fertilize the ovulated egg. The resulting embryo must be transported to the uterus and implanted.

If any of these events does not occur or is disrupted, infertility will result. Some women are unable to produce eggs. Others produce eggs, but do not ovulate. In others, conception cannot occur due to blockage of the fallopian tubes, scarring of the uterus, or the inability to produce cervical mucous of sufficient quantity or quality. These problems account for just over half of all infertility.

How is female infertility treated?

Many treatments are available, depending on the cause of the infertility, and it is always important to investigate both partners. Fertility drugs such as clomiphene citrate or human menopausal gonadotropins may bring about ovulation in women. Insemination directly into the uterus can manage infertility related to problems in the cervical mucous. Blocked fallopian tubes can sometimes be surgically repaired. In-vitro fertilization, also called "test-tube baby" procedures, and related assisted reproductive technologies are the most dramatic treatments for female infertility. Although these techniques may be time-consuming and costly, they offer hope to many women who previously were unable to conceive.

What is the role of endocrinology?

Endocrine research has been crucial in helping thousands of childless couples have children by determining the precise hormonal imbalance and treating it. However, many of the intricate hormonal changes that determine the successful completion of the reproductive cycle are not yet fully understood and further research is aimed at providing a greater understanding of these processes. It is expected that improved understanding of the reproductive process help to refine the existing treatments, by reducing any associated risks and providing information on which patients will benefit most from a specific treatment approach. In addition, current research is expected to lead to new types of treatment, particularly for those in whom current treatments are ineffective.

MALE INFERTILITY

About half of infertility is because of male infertility. Despite the relative importance of infertility due to the male, infertility evaluations have traditionally focused on women, because women tend to seek gynecological care and because men often are reluctant to seek advice.

What causes male infertility?

The causes are known in less than half of these cases of male infertility. Known causes include:

1 Genetic or inherited disease

2 Alcohol and illegal drugs, including anabolic steroids

3 Physical injury to the testicles

4 Varicose veins in the scrotum (varicocele)

5 Blockage of the ducts that carry sperm

6 Sexually transmitted diseases

7 Hypothalamic or pituitary hormone deficiency

8 Adverse effects of medical or surgical treatments

9 Specific abnormalities in the Y chromosome

Is male infertility treatable?

In many cases, no treatment is available. Current research has found that replacement of hypothalamic or pituitary hormones achieves excellent results in the rare condition of hypothalamic or pituitary deficiency, while only variable results have occurred following the removal of a varicocele or the surgical correction of blocked ducts. Two other effective treatment approaches are to correct the underlying illness or to stop the use of medication causing the infertility. A final option is in vitro fertilization, also called the "test tube baby" procedure. This approach, which often requires sophisticated treatment of the egg using microsurgery, has become increasingly effective in recent years. It is frequently used due to the lack of more specific treatments for male infertility. The main reason that efforts to treat male infertility have had only limited success is that once the testicle loses its ability to produce sperm, it is impossible to restore it. This aspect of male infertility is similar to the cessation of egg production at menopause for women. However, many men are able to produce sperm, but are still infertile due to the poor quality of the sperm.

What is the role of endocrinology?

Endocrine research has produced increased knowledge in two main areas: 1.how hypothalamic and pituitary hormones regulate both sperm and the production of male hormones 2.how factors within the testicle promote the development of sperm. To improve treatment for male infertility, research is needed on the factors that reduce the production or fertilizing power of sperm. Research is also needed in several areas: less toxic treatments for serious illnesses, environmental toxins that cause infertility, sexually transmitted diseases, voluntary sterilization, and education regarding reproduction and sexual issues.