Getting Started

What is Infertility?

Infertility is “a disease of the reproductive system defined by the failure to achieve a clinical pregnancy after 12 months or more of regular unprotected sexual intercourse .

Most couples (approximately 85%) will achieve pregnancy within one year of trying, with the greatest likelihood of conception occurring during the earlier months. Only an additional 7% of couples will conceive in the second year.

Infertility may be caused by many factors including problems with egg or sperm production, genetic factors, age, or too much exposure to certain chemicals and toxins.

Causes of Infertility?

AMH

Anti-Mullerian Hormone (AMH) is a hormone secreted by cells in developing egg sacs (follicles). The level of AMH in a woman's blood is generally a good indicator of her ovarian reserve.

AMH is produced solely in the granulosae cells of pre antral and antral ovarian follicles. Measuring the AMH levels gives an indication of the size of the cohort.

The number of antral follicles (the cohort) size, correlates with fertility potential. Young women, who normally have better fertility, will normally have a larger number of antral follicles visible on ultrasound and higher AMH levels.

Low anti-Mullerian hormone and high follicle stimulating hormone levels are indicators of diminished ovarian reserve (DOR), a decline in the ovaries' ability to produce good-quality eggs. DOR is one of the major causes of infertility among women. In reverse,high AMHcan signal polycystic ovary syndrome (PCOS)

The level of AMH in the blood can help to estimate the number of follicles inside the ovaries, and therefore, the woman's egg count. A typical AMH level for a fertile woman is 1.0–4.0 ng/ml; under 1.0 ng/ml is considered low and indicative of a diminished ovarian reserve.

The study found women with high AMH levels were 2.5 times more likely to have a successful IVF cycle than women of a similar age with low levels of the hormone. ... "High levels of this hormone mean there is a greater chance they have plenty of healthy eggs remaining to support a pregnancy."

Women with PCOS have higher level of AMH, and therefore have high number of small (antral and preantral ) follicles and at risk of developing OHSS with hormonal stimulation.

ENDOMETRIOSIS

What is Endometriosis ? What are the types of endometriosis?
Endometriosis is a disorder in which tissue similar to the tissue that forms the lining of uterus grows outside of uterine cavity. The lining of uterus is called the endometrium. Endometriosis occurs when endometrial tissue grows on ovaries, bowel, and tissues lining pelvis.

Endometriosis is classified into one of four stages (I-minimal, II-mild, III- moderate, and IV-severe) based upon the exact location, extent, and depth of the endometriosis implants as well as the presence and severity of scar tissue and the presence and size of endometrial implants in the ovaries.

Endometriosis and Infertility
Endometriosis is a very common debilitating disease that occurs in 6 to 10% of the general female population; in women with pain, infertility, or both, the frequency is 35–50%. About 25 to 50% of infertile women have endometriosis, and 30 to 50% of women with endometriosis are infertile.

Should I get preganant with endometriosis?
Yes definitely. Grade 1 and 2 which may cause low ovarian reserve needs Ovulation Induction, 3-4 IUI can be done depending upon patient’s age. Grade 3 and 4 level needs surgical management with IVF to get pregnant.

POOR OVARIAN RESERVE

Ability of the ovaries to generate viable eggs from the earliest follicles in the ovaries is called ovarian reserve.

Poor ovarian reserve is a condition of low fertility characterized by 1): low numbers of remaining oocytes in the ovaries or 2) possibly impaired preantral oocyte development or recruitment.

Known causes of diminished ovarian reserve include smoking, endometriosis, previous ovarian surgery, exposure to toxic chemicals, chemotherapy or radiation. In many cases, the cause is unknown and most likely reflects a combination of environmental and genetic causes.

Tests to detect ovarian reserve
There are many tests but commonly used are tansvaginal sonaography done in early days of menustrual cycle day 2-5 to detect no. small follicles measuring 2-5 mm and serum level of AMH.

No treatment can stop the process of diminished ovarian reserve, but women who are infertile due to low egg count or quality can sometimes use IVF to achieve a pregnancy.