Subfertility and infertility are often used interchangeably by both doctors and couples, but it is imperative to realise that both terms are not synonymous. The term ‘subfertility’ though not commonly used in medical literature but widely accepted one, possibly because of the negativity associated with the term infertility. As per Dr. Santosh Kumar Jena, Fertility Consultant, Nova IVF Fertility Kolkata, subfertility is defined as INABILITY to conceive or FAILURE to achieve pregnancy after 12 months of regular unprotected intercourse. To know how subfertility is caused, diagnosed and treated, read the complete article.
Subfertility vs Infertility
Infertility is a broader terminology which covers a spectrum of disorder ranging from sterility (absent uterus) to nearly normal fertility and sometimes its uniform application is misleading. In contrast to subfertility, a couple has reduced fertility or may experience a delay in achieving pregnancy, but the possibility of conceiving naturally still exists though it may take longer than the accepted time period. The duration of trying is the most important factor influencing the individual's spontaneous pregnancy prospects.
What Causes Subfertility?
Subfertility can be caused by a variety of factors either in females or males and sometimes in both partners. In female, the causes can be disorders of ovary ( polycystic ovarian syndrome (PCOS) or failing ovaries consequent to delayed childbearing age), tubal disease(blocked fallopian tubes), uterine defects(congenital uterine septum or benign uterine tumour like fibroid uterus or a thin endometrial lining) and other endocrinological factors. In men, the causes can be due to absent or low sperm count, abnormal shape(morphology) and movement (motility) of sperm. Many a times cause of subfertility can be due to failure to have successful intercourse due to erectile dysfunction in male or painful intercourse(vaginismus) in females or other psychological factors like stress. However, if these factors are mild and a couple only requires more time and minimal assistance like lifestyle modification and good sexual practice for a successful pregnancy to happen, then it is categorized as subfertility.
Hormonal Assay (early follicular FSH and LH levels, as well as mid-luteal progesterone levels) and transvaginal ultrasonography are used to detect disorders of ovulation in females as well as any defects in the uterus and adnexa (adjoining anatomical parts of the uterus). Tubal patency is assessed by using a radiological technique known as Hysterosalpingography (HSG). The dye is injected into the uterus through the cervix, and X-Ray images are taken at the same time to track the dye's passage through the fallopian tubes. The presence of dye in the abdominal cavity indicates that the tubes are open. Laparoscopy is a surgical technique that allows you to see through the abdomen and pelvis (uterus, fallopian tubes and ovaries). For possible genetic abnormalities, chromosomal analysis is used. Proper reproductive history and a simple semen analysis test can yield maximum information in suspected male factor subfertility.
Treatment is provided accordingly to the cause, diagnosed during the investigation of both male and female partners. Except in cases of ovarian failure, virtually all women with ovulatory dysfunction can have successful ovulation with proper and timely use of lifestyle changes and available medicines. Some patients with tubal injury, adhesions, endometriosis, and uterine anomalies may benefit from surgery. Male partners with abnormal semen parameters are advised lifestyle changes and medication, though in most instances the treatment is an empirical one.
When conventional treatments fail, a couple can choose assisted reproductive technology.
ART (assisted reproductive technologies): Intrauterine insemination (IUI) is a procedure in which a man's sperm is injected into a woman's uterus through a long, narrow tube. The following situations can necessitate the use of IUI.
- Cervical deformities
- Sperm counts are low or nil sperm
- Sperm with a slow movement rate
- Male partner's erection issues
There are two forms of IUI:
Artificial insemination (AI) can be done with the husband’s semen (AIH) or with donor semen (AID) obtained from semen banks with the consent of the couple.
In vitro fertilisation (IVF) is a procedure in which a couple's eggs and sperm are taken and incubated together in a laboratory dish to produce an embryo. The embryo is transferred through a thin tube into the woman's uterus, where it may implant and grow further.
Intracytoplasmic sperm injection (ICSI) is a process that involves injecting a single sperm into a mature egg. It is used to treat infertility caused by sperm problems.
Couples with advanced female age and failing ovaries can go for egg/ oocyte donation IVF (OD-IVF) procedure.
Surrogacy: If a woman is unable to bring a pregnancy to term, a surrogate or gestational carrier can be chosen by the couple. In the surrogacy process, couple’s embryo (formed after fertilization of male partners sperm with female partners oocyte) can be transferred into the uterus of a surrogate mother. Hence the child born through the process of surrogacy genetically resembles the couple.
Many couples assume that they are having infertility issues and this is why they are unable to conceive whereas, in reality, they are going through subfertility problems. They have chances for natural conception but how long it may take, depends. It is better to speak to an experienced doctor for the same.
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