Friday, October 24, 2008

Infertility in Man and Women

What Is Infertility?

If a couple is infertile, this means that they have been unable to conceive a child after 12 months of regular sexual intercourse without birth control.

· Primary infertility means they have never had a child.
· Secondary infertility means that the infertile person has had one or more children in the past, but a medical problem is impairing fertility.
Many people may be infertile during their reproductive years. They may be unaware of this because they are not seeking to create a pregnancy. On any one occasion, the chance of pregnancy is just one percent.
Age, lifestyle and physical problems can all contribute to infertility.
Reproduction In A Woman
Five important hormones stimulate the reproductive system of a woman:
· gonadotropin-releasing hormone
· luteinizing hormone
· follicle stimulating hormone
· estrogen
· progesterone

Here is how the hormones work:
· The hypothalmus, a region in the brain, first releases a hormone called gonadotropin-releasing hormone (GnRH).
· GnRH causes the pituitary gland to produce two more hormones--luteinizing hormone and follicle stimulating hormone.
· These hormones, in turn, tell the ovaries, to release estrogen and progesterone.

How hormones regulate a woman's fertility
A woman's ovaries contain 200,000 to 400,000 egg follicles--small sacs that contain the ingredients needed to form ripened eggs.

· Over a two-week period in a woman's monthly cycle, FSH causes several follicles in the ovaries to ripen and mature.
· FSH also orders the ovaries to produce estrogen, which in turn, launches the manufacture of large amounts of LH hormone.
· LH hormone stimulates the release of an egg from the largest follicle into the fallopian tubes - a process called ovulation.
· LH hormone also stimulates the follicle to produce corpeus luteum - a collection of yellow tissue that manufactures progesterone.
· Progesterone and estrogen work together to thicken and prepare the lining of the uterus for a fertilized egg.
· Together, these hormones swell the lining of the uterus with blood, making it easier for a fertilized egg to implant itself there

How the egg is fertilized

An egg is usually fertilized by sperm within the fallopian tubes - but only if the woman has sex with a man around the time the egg is released. The sperm must penetrate the egg to fertilize it.
Sperm can survive for six days after entering a woman's vagina and can fertilize the egg at any time during this period. However, research shows that fertilization is most likely to occur two days before or on the day the egg is released. The fertilized egg then moves on to the uterus, where it implants and grows into an embryo, and pregnancy results.
The Unfertilized Egg If the egg is not penetrated by sperm, it lives for 12 to 24 hours. The egg and the bloody lining of the uterus then slough off, traveling out of the uterus, the cervix and vagina - a process called the woman's menstrual period

Reproduction In A Man
Men have four primary hormones involved in reproduction. They are:
· gonadotropin-releasing hormone (GnRH).
· follicle stimulating hormone (FSH)
· luteinizing hormone (LH).
· testosterone

Here is how the hormones work:
· In a man, the brain's hypothalmus first releases gonadotropin-releasing hormone (GnRH).
· GnRH stimulates the pituitary gland to produce two hormones - follicle stimulating hormone (FSH) and luteinizing hormone (LH).
· These hormones regulate the production of sperm and the release of the male hormone testosterone, all of which takes place in the male testes, located in the scrotal sac.

The Production of sperm
Sperm begin life in the testes in cells called Sertoli cells.
· At the beginning of a sperm's life cycle, hormones develop its head and tail.
· The sperm then escapes from the Sertoli cell into the epididymis, located behind the testes.
· For three weeks, a sperm travels through the epididymis in an energizing fluid containing fructose. As the sperm swims through this fluid, it matures and acquires the ability to swim and move back and forth.
· A mature sperm has a head that contains the man's DNA - his genetic material - and a tail that rapidly moves from side to side, propelling it forward.
When a man ejaculates during sex, muscular contractions push the sperm out of the epididymis to channels called the vas deferens. The sperm then move to the ejaculatory ducts and out the urethra, (the passage through which urine and semen are passed from the body).
· Just before ejaculation, the sperm in the ejaculatory ducts mix with fluids that come from the prostate gland, and from glands called the seminal vesicles, creating semen.
· During orgasm, the seminal vesicles push the semen forcefully out into the urethra.
· A muscle in the bladder also locks shut to prevent the semen from traveling backward into the bladder and mixing with urine.
· The semen moves from the urethra to a holding area at the bottom of the penis, where muscles propel it out of the penis.

How a sperm fertilizes the egg
Of the 100 to 300 million sperm released when a man ejaculates, only about 40 survive the trip through the acidic environment of the vagina and cervix. The woman's thick cervical mucous can also be a barrier. But during ovulation, the woman's mucous thins and allows the sperm to travel more freely.
After it bores through the cervical mucous, the sperm trigger the acrosome (a special membrane located on their heads), and it dissolves and releases special enzymes. These enzymes allow the sperm to penetrate the tough coating surrounding the egg in the fallopian tubes. Only one sperm ultimately fertilizes the woman's egg.

Nice To Know:

What should I do if I think I am infertile?
If you've had more than a year of regular sex without birth control and you haven't achieved a pregnancy, it may be time to see a doctor.
If a year hasn't passed yet, a good strategy is to plan to have sex during the days the woman is ovulating. To find the days when she ovulates, a woman can take her temperature by mouth or in the vagina with special thermometers available in drugstores. Her temperature will rise slightly on the days she ovulates.

Facts About Infertility:
· It's a myth that infertility is always a "woman's problem." Half of all cases of infertility result from problems with the man's reproductive system.
· The best protection against infertility is using a condom while you are not attempting to conceive a child. Condoms protect against sexually transmitted diseases, a major cause of infertility.
· Of couples that seek medical treatment for infertility, 20 percent conceive before the treatment actually begins. One reason may be that anxiety about infertility may have contributed to the fertility problem, and contacting a doctor provides emotional relief.
· Fifty percent of infertile couples conceive within two years of starting treatment.
· A woman's temperature rises about 1 degree Fahrenheit during the days she is ovulating (producing eggs). By taking her temperature every morning with a special thermometer, a woman and her partner can chart the rises and falls in her morning temperature. They can then plan intercourse for the days she is ovulating--her most fertile time.

Hot water in bath tube can lead to infertility

What Causes Infertility?

Most infertility results from physical problems in a man or woman's reproductive system.
· About 35 percent of all cases of infertility arise from problems in the man's system.
· About 35 percent arise from abnormalities in the woman's system.
· About 20 percent of the time, the man and woman both have fertility problems.
· In 10 percent of cases, no cause can be found.
· Age often increases the risk of infertility.
Infertility can be caused by poor sexual or lifestyle habits that are easily remedied. For example, the couple may be using a sexual lubricant that interferes with the survival of the man's sperm. Or, they may not be having sex often enough. Other easily treated illnesses or lifestyle habits that may contribute to infertility are:
· Heavy use of alcohol, tobacco or drugs.
· Starvation diets or anorexia in the woman.
· Tight underwear or pants in the man, which raises the crotch temperature and reduces sperm count.
· Stress. In a woman, this may cause her periods to be irregular. In a man, stress may reduce his sperm count.
Most of these problems can be resolved with medical treatment or lifestyle changes, such as wearing boxer shorts, avoiding a sexual lubricant, or trying some simple stress reduction methods such as physical exercise or relaxation techniques.
Changing the timing of sex and the couple's sexual techniques may also increase the chance of pregnancy. Sometimes the semen from the man fails to reach the woman's cervix. Placing a pillow under the woman's hips after intercourse may help prevent spillage of semen.

Nice to Know:
Does limiting sex boost the man's sperm count?

It may. However, research shows that having sex every day or even several times each day both before and during ovulation is the best way to achieve pregnancy. The sperm count may be lower when sex is this frequent, but the constant release of semen may be more likely to fertilize the egg.
Why Does A Woman Become Infertile?
Infertility in a woman may stem from many causes, such as hormonal deficiencies, problems in the reproductive organs, and some illnesses. Complications from surgery and certain medications may also impair fertility.

The most likely causes for female infertility are:

Pelvic Inflammatory Disease (PID) - PID is the most common cause of infertility worldwide. It's an infection of the pelvis or one or more of the reproductive organs, including the ovaries, the fallopian tubes, the cervix or the uterus. Sometimes PID spreads to the appendix or to the entire pelvic area.
PID usually stems from the same bacteria that cause sexually transmitted diseases, such as gonorrhea or chlamydia. Chlamydia, in fact, causes 75 percent of fallopian tube infections.
PID may also develop from bacteria that reach the reproductive organs through abortion, hysterectomy, childbirth, sexual intercourse, use of an intrauterine (IUD) contraceptive device or a ruptured appendix.
Not only does PID cause infertility, but it may also lead to ectopic pregnancy and blood poisoning, a potentially fatal complication.

Polycystic ovary syndrome (PCO) - This condition affects 5 million American women and is another major cause of infertility. In PCO, the ovaries produce high amounts of male hormones, especially testosterone. LH levels also remain abnormally high while FSH levels are abnormally low; thus, the follicles do not produce eggs. Instead they form fluid-filled cysts that eventually cover the ovaries.
Recent research indicates that PCO is caused by the failure of muscle, fat and liver cells to accept glucose (the cellular fuel made from the food that humans eat). As a result, the pancreas, begins churning out large amounts of insulin, a hormone that usually ushers glucose from the blood to the body's cells. This extra insulin plays havoc with the ovaries, as well as other parts of a woman's body.
PCO not only causes infertility, but also increases the risk of diabetes, cancer and even heart disease.
The symptoms include:

o Excessive facial hair
o Thinning hair
o Acne
o Depression
o Unexplained weight gain
o Irregular or no periods
o High insulin or cholesterol readings

1. Endometriosis - This disease is another common cause of female infertility. Endometriosis refers to a condition in which sections of the uterine lining implant in the vagina, ovaries, fallopian tubes or pelvis. These implants eventually form cysts that grow with each menstrual cycle, and may eventually turn into blisters and scars. The scars can then block the passage of the egg.
2. Other sexually transmitted diseases such as genital herpes can decrease fertility.
3. Ovary Problems - Decreased production of any one of the five hormones that regulate a woman's reproductive cycle may result in infertility. Problems within the ovaries may inhibit reproduction as well. Instead of releasing an egg, the ovarian follicle remains empty, fails to rupture or traps the egg.
4. Hormonal Problems - Adrenal or thyroid deficiencies may cause hormonal and ovarian problems. Some women produce excess amounts of prolactin, a hormone that normally stimulates the production of breast milk. Prolactin can also prevent ovulation. High levels of prolactin in a woman who is not nursing may indicate a pituitary tumor. It can also result from the use of oral contraceptives.
5. Immune System Problems - Women may develop antibodies or immune cells that attack the man's sperm, mistaking it for a toxic invader. Certain autoimmune diseases, in which the woman's immune cells attack normal cells in her own body, may also contribute to ovarian problems.
6. Luteal Phase Defect - In a luteal phase defect, a woman's corpus luteum - the mound of yellow tissue produced from the egg follicle - may fail to produce enough progesterone to thicken the uterine lining. Then the fertilized egg may be unable to implant.
7. Fibroids - Fibroids, or benign growths, may form in the uterus near the fallopian tubes or cervix. As a result, the sperm or fertilized egg cannot reach the uterus or implant there. Fibroids in the uterus are very common in women over age 30.
8. Other Uterine Problems - Abnormal reproductive organs or endometritis (an abnormal swelling of the uterine lining) may make it difficult for the fertilized egg to implant.
9. Surgical Complications - Scar tissue left after abdominal surgery can cause problems in the movement of the ovaries, fallopian tubes, and uterus, resulting in infertility. Frequent abortions may also produce infertility by weakening the cervix or by leaving scar tissue that obstructs the uterus.
10. Uterine muscle problems - Some women may produce weak, infrequent or abnormal contractions in the uterus. During ovulation, these contractions usually push the sperm up to the fallopian tubes.
11. Poor quality cervical mucous - Sometimes a woman's mucous fails to thin around the time of ovulation, and consequently it prevents the sperm from traveling through it. A cervical infection may also be the cause.
12. Illness - Certain diseases, such as diabetes, kidney disease or high blood pressure may cause infertility. Ectopic pregnancy and some urinary tract infections may also elevate the risk of infertility.
13. Medications - Many medicines, such as hormones, antibiotics, antidepressants, and pain killers may bring on temporary infertility. Commonly used medications such as aspirin and ibuprofen can also impair fertility if taken mid-cycle. Acetaminophen (Tylenol) pills can reduce the amount of estrogen and luteinizing hormones in the body, impairing fertility.
14. Premature Menopause - Some women may experience premature menopause, when their ovaries stop producing eggs. Often the cause is excessive exercise or anorexia.
15. Other causes: some other contributors to infertility include excessive exercise, stress or anorexia.

Why Does A Man Become Infertile?
The most common cause for male infertility is a problem with the sperm - either low sperm count or sperm with poor quality. Sperm with poor quality cannot move rapidly enough or in the right direction, or may be abnormally shaped. Some conditions that may contribute to sperm problems include:
· Under-developed testes-usually arising after a mumps (viral infection to parotid glands), a hernia surgery, an injury or birth defect.
· Swollen veins in the scrotum.
· Undescended testes-a problem often present from birth in which the testes remain in the body cavity. Normally they descend into the scrotum before birth.
· Infections, such as gonorrhea or tuberculosis, that block the ducts through which the sperm travel.
· Exposure to metals such as leads, or chemicals such as pesticides.
· Certain medications, such as Tagamet (cimetidine), Dilantin (phenytoin), Folex (methotrexate), Axulfidine (sulfasalazine), corticosteroids and chemotherapy drugs such as Cytoxan and Neosar (cyclophosphamide).
· Injury to the testicles
· Chronic prostate infections

Other common causes of male infertility are:
· Autoimmunity, in which antibodies or cells of the man's immune system attack sperm cells, mistaking them for toxic invaders. The antibodies attach themselves to the sperm and may cause them to stick together, or may stop them from penetrating the cervical mucous or the egg.
Nice To Know:
What causes male autoimmunity?

Male autoimmunity often develops after vasectomy. Sperm actually are produced after a vasectomy, but may leak out into the body where immune cells target them as invaders.
Even when a vasectomy is reversed through surgery, this autoimmunity may continue.
Antibodies to sperm have also been located in men without vasectomies-in about 10 percent of infertile men. In these cases, the reason for the existence of these antibodies is often unknown.
· Retrograde ejaculation. In retrograde ejaculation the muscles of the urethra do not force the sperm out. Instead, the sperm travel backward into the bladder.
Causes of retrograde ejaculation include:

· Drugs such as tranquilizers or high blood pressure medicines.
· Diseases such as diabetes or multiple sclerosis.
· Neck, bladder or prostate surgery.
· Spinal cord injury.

In a small percentage of cases, male infertility is caused by:

· Sexual difficulties such as impotence, premature ejaculation, or painful intercourse. These problems can often be easily treated.
· Genetic defects or structural problems. In germ-cell aplasia, for instance, the sperm-producing germ cells do not develop correctly. Defects in the Y chromosome or in certain genes may also play a part in infertility.
· Rarely, a hormonal difficulty that decreases or stops the man's production of sperm. Hormonal problems may be present from birth or can develop from brain or pituitary gland tumors or radiation treatment. Sometimes, hormonal difficulties are induced by excessive exercise, malnutrition or other illnesses.
How Is Infertility Diagnosed?
A complete medical history and a physical exam are the first steps in diagnosing a fertility problem. Both partners need to be evaluated. The couple may also need blood tests, semen specimens from the man, and ultrasound exams or exploratory surgery for the woman.

Need To Know:
Your Doctor Will Want to Know
During the initial medical exam and history, the doctor will need information about the couple's sexual and medical history. They should prepare for these questions:

· What medical conditions have you had?
· What medications do you take?
· Have you had any past surgeries?
· How often do you have intercourse?
· When do you have intercourse?
· Do you use a lubricant?
· Is there any discomfort during intercourse?
· Do you feel anxious or depressed about being unable to conceive?
For the woman:
· When did your periods begin?
· How regularly do your periods occur, and how long do they last?
For the man:
· Do you experience any erection or other sexual problems during intercourse

How Is Infertility Diagnosed In A Woman?
If a woman has an infertility problem, she will be referred to a doctor who specializes in reproductive endocrinology. Her diagnostic tests may include:
· Blood tests and urine tests to check hormone levels.
· A Pap smear to study the health of the cervix.
· Urine tests to evaluate LH surges.
· A basal body temperature test, which checks whether the woman is releasing eggs from her ovaries. A woman's temperature rises slightly during the days she ovulates. The woman will chart her basal body temperature every day for a few months on a graph. She will take her temperature orally or may take her temperature vaginally with a special ultra-sensitive thermometer available at most drugstores.
· An endometrial biopsy, in which the doctor removes a piece of tissue in the uterine lining. Examining this tissue will tell the physician whether eggs have been released and whether the corpeus luteum is producing enough progesterone. This test is often done if the results from the woman's basal body temperature chart are unclear.
· An ultrasound to look for fibroids and cysts in the uterus and ovaries. This test uses sound waves to picture the uterus and ovaries, causes little discomfort, and is very effective.
· A postcoital test, in which the doctor takes a sample of mucous from the woman's vagina. She must have the test during her fertile days and within 12 hours after she and her partner have sex. The test will tell the doctor if the man's sperm can survive in the woman's cervical mucous.

More complex tests include:
· A laparoscopy: If the doctor suspects ovarian or fallopian tube scarring or endometriosis, a woman may undergo a laparoscopy. The doctor makes two small incisions at the pubic bone and navel, and carbon dioxide gas is injected into the stomach to enlarge it. Then the doctor inserts a laparoscope, a long tube with lenses and a fiberoptic light, into one incision and a long probe through the other opening in the skin. With the probe, the doctor can view the ovaries, fallopian tubes and uterus to check for scar tissue. In some cases, he may cut away scar tissue discovered during this operation.The woman usually has to undergo general anesthesia for the procedure, but the risks of bleeding, infection and reaction to the anesthesia are slight.

· A hysterosalpingogram: This test checks the condition of the woman's fallopian tubes. The doctor clamps the cervix and injects a needle filled with dye into the woman's uterus. An X-ray is taken to determine whether the dye passes through the open ends of the fallopian tubes. If the dye emerges from the end of the tubes, they are not blocked. The test may also reveal other fertility problems, such as fibroid tumors, structural abnormalities and endometrial polyps. In some cases, the dye actually clears away blockages in the fallopian tubes, and restores the woman's fertility. The dye is harmless and is absorbed by the woman's body after going through her tubes. The test may be uncomfortable, but is rarely painful. Unfortunately, it is noted for both false positive and false negative diagnoses.

How Is Infertility Diagnosed In A Man?
The tests for male infertility are fairly simple and easy. After a medical history and an examination, the man's sperm are tested. He'll be asked to ejaculate into a cup in a private place in the doctor's office or at home, and this specimen will be evaluated. The man should not ejaculate for several days before he takes the test, because each ejaculation may reduce the sperm count.

Health workers will check the man's semen for several factors:
Try to conceive for 2 years with no result and there is nothing wrong with the woman. Low sperm counts, or high concentrations of abnormally shaped sperm, & slow motility. In approx. 40 percent of infertility cases, sperm abnormalities are either a factor or the factor.
Male Infertility is assessed on the following:

· Sperm Count (less than 10 million per milliliter)
· Volume (more than 2 ml per ejaculate)
· Sperm motility (over 50% should be motile and show forward movement)
Sperm morphology (more than 5% should be of normal shape) The average ejaculate has about 200 million sperm. Only a few sperm actually reach the egg.

This shows how the odds are played against a man with poor sperm quality. Although, there are ways to imporve sperm count, motility, and morphology.

· sperm count (20 to 100 million sperm is the normal number)
· movement
· maturity and shape of the sperm (which reveal its quality)
· the amount of sperm produced (one teaspoon is sufficient)
· acidity (the semen should be slightly acidic)

Diagnosis of Male InfertilityMedical history will be taken; childhood disease, undescended testes, mumps, sexual disease.

· Structural abnormalities will be examined; varicocele (swelling of the scrotum), size and shape of testes.

· Secondary sex characteristics will be evaluated.

· Hypothyroidism, hypopituitarism, adrenal disorders, hypogonadism, diabetes, and other endocrine disorders will be checked for.
2-3 specimens of sperm will be needed for a proper evaluation. Volume and other characteristics vary from time to time. The semen should look somewhat viscous and opaque. The volume should be around 0ne full tea spoon, There should be over 20 million sperm per ml of semen.

Sperm is evaluated into the following categorie
· adequate
· aspermia (absence of ejaculate)
· azoospermia (absence of sperm in semen)
· oligospermia (lowered sperm density)
· poor motility and forward movement
· high percent of abnormal sperm morphology
· antisperm antibodies

The man may be asked to undergo this test twice, because some illnesses such as infections or viruses can affect the sperm. If a man has abnormal sperm, he'll be referred to a fertility specialist, where he'll experience more tests, such as:

· Hormonal blood tests.
· Imaging tests that check for swollen veins or reproductive system blockages.
· A testicular biopsy. This is a procedure done in the office. The doctor takes bits of tissue from the testes, and this tissue is examined to see whether the cells that produce the sperm are working properly.
· Anti-sperm antibody tests, which check whether the woman's mucous rejects the man's sperm. These tests also show whether the man produces antibodies to reject his own sperm.
· A hamster egg test, which studies the sperm's ability to penetrate a hamster egg. The outer covering of the egg is removed to allow the sperm to more easily penetrate. This test cannot result in a living embryo. It's expensive, however, and sometimes unreliable.
· A human zona penetration test, which tests whether the man's sperm can fertilize dead human eggs. Again, this test cannot result in a living embryo, and is thought to be more reliable than the hamster egg test.
· A bovine cervical mucous test, which checks whether the sperm can penetrate cervical mucous taken from a cow.

How Is Infertility In A Woman Treated?
After the physician has determined possible causes of the infertility, a course of treatment can then be planned. Sometimes simple instructions, like knowing when having sex is most likely to produce a pregnancy, are all that is needed. In many cases, medications are indicated, while in other cases, the woman may require surgery or other forms of treatment.
If medications are unhelpful or surgery is not appropriate, other specialized techniques will be offered.
Medications can help solve hormonal problems and ease infections in women with fertility problems. Surgery to repair reproductive organs may also resolve a woman's infertility.

What Medicines Treat Female Infertility?

If the woman isn't producing eggs, often she can be helped with fertility drugs. Fertility drugs are fairly safe, although some researchers have voiced concern that they may increase the risk for ovarian cancer. Several of the most recent studies, however, have found no increased risk of ovarian cancer and suggest that the drugs may even protect against cervical cancer. Fertility drugs include:
Clomiphene: This drug triggers the release of FSH and LH, boosting egg growth and helping the ovaries release a monthly egg. The drug is considered safe, is fairly inexpensive, and carries less risk of multiple births than other drugs. Women who have polycystic ovary syndrome or menstruate irregularly apparently benefit most from this drug. Sixty percent of women on clomiphene successfully ovulate, and about 30 percent of women become pregnant in the first three months of being on the drug. Side effects may include nausea, insomnia, breast tenderness and headaches.
Bromocriptine: This drug suppresses a hormone called prolactin, which, if released in excessive amounts, may cause a woman to stop ovulating. Ninety percent of women on bromocriptine release eggs while on the drug. It's considered fairly safe, but side effects may include nausea, dizziness, headaches and low blood pressure.
Human Menopausal Gonadotropins (HMG): If other drugs don't work, the doctor may prescribe HMG. This drug is comprised of hormones extracted from the urine of postmenopausal women and contains large amounts of LH or FSH. Women who have trouble ovulating, endometriosis, infertility caused by cervical problems or unexplained infertility are good candidates for this drug. To monitor the woman's progress, the doctor will order regular ultrasounds to check the quality and number of eggs being released.

Nice To Know:

· Seventy five percent of women release eggs while on HMGs.
· But the chance of pregnancy varies widely, ranging from 20-80 percent.
· HMGs are also fairly expensive, and carry considerable risks- including an increased chance of spontaneous abortion and ovarian enlargement, which can lead to ovarian cysts.
· A woman on this drug will face an increased chance of multiple and premature births. Possible side effects include weight gain and swelling in the stomach area.

Luteinizing Hormone-Releasing Hormones (LH-RH): LH-RH drugs are used when the pituitary or hypothalamus gland is not producing hormones. They are also used to treat endometriosis. Most women must administer these drugs themselves with a portable pump, and the equipment is unwieldy and expensive. Risks include an increased chance of infections and clotting, and multiple births.
Human Chorionic Gonadoptropin (hCG). Chorionic gonadoptropins are often prescribed with HMGs, and sometimes with clomipheme, to stimulate the release of the egg. They may also be used to treat endometriosis. One of these drugs, Humegon, has resulted in pregnancy in more than 26 percent of cases in clinical trials. Possible side effects are ovarian enlargement, ovarian cysts and multiple births.
Urofollitropin (FSH): This drug is made up of FSH taken from the urine of postmenopausal women. It can be used with hCG to bring on the release of an egg. It's an effective drug for women with polycystic ovary syndrome, for whom clomiphene has been ineffective.
Other medications that may cure fertility problems include:
· Antibiotics - They may cure infections in the reproductive system, such as in the cervix or lining of the uterus, and some sexually transmitted diseases.
· The hormone progesterone - This hormone develops the lining of the uterus and helps a fertilized egg implant.
· Corticosteroids -These may be prescribed for the treatment of endometriosis.
· Oral contraceptives, antiandrogens, and drugs to reduce insulin levels - These drugs are used in women with polycystic ovary syndrome to restore regular periods and ovulation and to reduce symptoms stemming from an oversupply of male hormones.
· Drugs to treat thyroid disease, benign tumors or to improve poor quality cervical mucous.

What Surgeries Treat Female Infertility?
If investigations suggest that surgery may cure infertility, then depending on the cause, surgery may be used to deal with:
· Fibroids or defects in the woman's uterus.
· Endometriosis in the woman. In these surgeries, the doctor removes the uterine tissue that has grown outside the uterus.
· A scarred fallopian tube in the woman. In surgeries for this problem, the scarred tissue is removed or the entire scarred section of the tube may be cut out. The tube is then rejoined and reattached to the uterus.

How Is Infertility In A Man Treated?
Illnesses and problems in the male reproductive organs can often be resolved with medicines and surgery.

What Medicines Treat Male Infertility?
A number of drugs can be prescribed to ease male fertility problems, but their effectiveness varies widely. Here's a look at some of them:

· Hormones - Though hormones can be quite successful in women, they are only occasionally effective in men. Hormone drugs for men include testosterone, menotropins, GnRH medications, bromocriptine, clomiphene citrate and human chorionic gonadotropin (hCG). Many of these drugs are quite expensive, however.
· Antibiotics - These may help treat sexually transmitted diseases and other infections.
· Corticosteroids - These drugs can aid men who make antibodies to reject their own sperm, but they may also have serious side-effects after long use.
· Viagra - This is a newly developed medicine for male impotence. The man takes Viagra an hour before having sex. The medication improves blood flow to the penis, resulting in an erection. Studies have revealed that 70 percent of men who used Viagra improved their ability to maintain an erection. The drug can have severe side effects for certain men, however, especially those with heart disease. Men with heart disease, who have had a heart attack, or those with low blood pressure should not take the drug.

What Surgeries Treat Male Infertility?
If investigations suggest that surgery may help with male infertility, then depending on the cause, surgery may be used to deal with:

· Varicose (or swollen) veins in the man's scrotum, helping to restore proper sperm movement.
· An obstruction in the man's reproductive organs, including the epididymis, vas deferens and ejaculatory duct. These blockages can halt the sperm's passage or prevent it from
Coping With The Emotions Of Infertility
If your doctor tells you that you are infertile, you may experience a wealth of emotions.
Couples often feel frustrated, angry or guilty after such a diagnosis. Women may feel unfeminine and men may feel powerless and unmasculine.

Women are more likely to discuss their feelings, while men often sublimate their anger in sports or other activities. Women may feel angry when they see pregnant women or women with infants.

Treatment for infertility is also likely to be stressful, not only because some treatments may be painful, but more likely because of the concern and fear that the treatment will not work. The side effects of the medications, and the necessity of going through procedures several times, can test a couple's patience and create a strain on their relationship.

It's important that you don't become isolated as a couple after a diagnosis of infertility. In organizations like Resolve, a national support group made up of infertile couples, you can discuss your feelings and learn about other people's solutions to infertility. Resolve has chapters in many cities in the United States.

A diagnosis of infertility does not mean you are a failure. There are many medical treatments that may improve your fertility. Even if you can't achieve a pregnancy, there are other options that may leave you fulfilled, such as adoption or deciding to remain childless.

Frequently Asked Questions
Here are some frequently asked questions related to infertility.

Q: What should I do if I think I am infertile?

A: If you've had more than a year of regular sex without birth control and you haven't achieved a pregnancy, it may be time to see a doctor. If a year hasn't passed yet, a good strategy is to plan to have sex during the days the woman is ovulating. To find the days when she ovulates, a woman can take her temperature by mouth or in the vagina with special thermometers available in drugstores. Her temperature will rise slightly on the days she ovulates.
Q: My husband and I are having trouble conceiving a child. Should he try wearing loose underwear?

A: Tight fitting underwear as well as hot tubs and saunas decrease a man's sperm count because they raise the temperature of the testes. It might be wise to try loose underwear, and refrain from using hot tubs and saunas.

Q: If I'm over 40, can I have children?

A: A woman's fertility declines markedly at age 40, but in many cases, she may still have children. Men's sperm begins to decrease after age 25, but they can stay fertile into their 60s and 70s.

Q: Can marijuana cause infertility?

A: Marijuana, as well as nicotine and other legal and illegal drugs, can be a cause of infertility. If you smoke marijuana and you're trying to have a child, it's best to abstain.

Q: I've heard that assisted reproductive techniques usually result in multiple births, such as twins, triplets or more. Is this true?

A: The great majority - about two thirds - of assisted reproductive births are single births. The rest are multiple births, with most being twins. Only six percent of these births are triplets or more.

Putting It All Together
Here is a summary of the important facts and information related to infertility.
· Infertility is a common condition that can be caused by illness, lifestyle habits or defects in the reproductive system.
· Many treatments can successfully resolve infertility, including medications, surgery and assisted reproduction.
· The emotions of infertility can seem overwhelming at times. Many support groups can give infertile couples advice and emotional support.

Herbal products works for male to increase fertility

Ashwagandha - the Indian ginseng

· Rejuvenates body and reproductive system
· Increases body energy levels
· Rectifies erectile dysfunction
· Increase libido
· Increase sperm count and motility
· Increases sexual energy
· Boosts body immunity

Eurycoma Longifolia Jack (Tongkat Ali)

Traditionally used for:
· Support general health and vitality
· Increase male sex drive
· Natural remedy for impotence
· Support healthy blood circulation

Herbal products works for female to increase fertility:

Agnus Castus (Vitex or Chaste tree berry)

This is the herb of choice for helping to restore hormone imbalance and increasing fertility. In one study 48 women diagnosed with infertility took agnus castus daily for three months, 7 of them became pregnant during that time and 25 of them regained normal progesterone levels.

Agnus castus is particularly helpful for those women who have a luteal phase defect (shortened second half to the cycle) or those with high prolactin levels, because it stimulates the proper functioning of the pituitary gland which controls the hormones.

Agnus castus works to restore hormonal balance and can be used where there are hormone deficits as well as excesses it:

· Regulates periods
· Restarts periods which have stopped
· Helps with heavy bleeding
· Increases the ratio of progesterone to oestrogen by balancing excess oestrogen