Treatment Options For Infertility In Both Genders

Infertility is defined by not being able to become pregnant after 12 months of having unprotected regular sexual intercourse without the use of birth control by reproductive endocrinologists in the United States. Using 22,682 interviews with men and women aged between 15-44, the average infertility rate in woman and men was 16% and 10.7% respectively. While there are many causes of infertility luckily there are many treatments for both genders as we indicate this report.

In men, generally the causes and likeliness for each infertility are endocrine and systemic disorders (2-5%), testicular defects (65-80%), sperm movement complications (5%) or it may be idiopathic causes (10-20%). This may all cause low volume in sperm, low concentration in sperm, abnormal morphology of sperm, or poor fertility of sperm. So we will an example for each condition and provide its respective treatment.

Endocrine and Systemic Disorders

Hypogonadism is condition is where there is a lower production of sperm which result in a low volume of semen and concentration of sperm that is may be caused by of an imbalance of Follicle Secreting Hormone (FSH), and Luteinizing Hormone (LH). The most appropriate treatment for this cause is gonadotropin replacement therapy in which the patient is simply injected regularly with Human chorionic gonadotropin (hCG). A study made in Japan has shown it to restore the hormonal imbalance back to normal within 2-12 months.

Testicular Defects

Testicular defects result in a deficiency in testosterone and can categorized into three different parts:

• Low serum testosterone and high serum FSH and LH concentrations
• Normal serum testosterone and isolated elevation of serum FSH concentration
• Normal serum testosterone and gonadotropins.

In the first category, the cause is usually a severely injured seminiferous tubules and unfortunately there is no effective treatment. Even assisted reproductive treatments (ARTS) such as in vitro fertilization and surrogacy has low chance of success.

The cause of the next category is caused by varying levels of dysspermatogenesis. These infertility can be circumvented with ARTs cause many of the cases sperm is present is the semen. Patients in the last category must be tested for any blockage in the ejaculatory duct or be put in the idiopathic causes category. If there is a blockage, it can be treated by joining the epididymal duct to epididymal duct or to the vas deferens by microsurgical end-to-end anastomosis.

Sperm Movement Complications

This occurs when the sperm has certain flaws with the tail of the sperm limiting with its motility or the sperm is no. When semen analysis shows a proportion of immotile sperms, the best treatment is intracytoplasmic sperm injection (ICSI) which basically directly injects the sperm into the egg and implant it to the uterus.

While the men factor is being evaluated in an infertile couple, the woman must also tested since the cause may be either one of them or both. Similarly in women, there are a few main causes for infertility such as ovulatory illnesses, problems with the uterine tube, Endometriosis, cervical and uterine factor, or unexplainable causes.

Ovulatory Illnesses

These are separated into three groups by the World Health Organization (WHO), but we will talk about the most common group that is WHO class 2 which involves a normal level of sex hormones and estrogen but is not capable of ovulating. One of multiple treatments available for it is using ovulation induction agents like Clomiphene and Aromatase inhibitors such as letrozole. Both of these drugs are effective for women who have an abnormally high males androgens level during ovulation (polycystic ovary syndrome (PCOS)). Clomiphene treats it by binding to the hypothalamus which results in stimulation of gonotrophic cells to produce more Follicle Secreting Hormone and Luteinizing Hormone. While it is effective, studies has shown Ietrozole may have a better response and negate the few side effects of Clomiphene such as gestation and estrogen antagonist to the vagina, cervix and endometrium. Unfortunately, the FDA has yet to approve this drug at this time.