What is infertility and why is it a
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.
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