Today’s video is related to reproduction, especially infertility. 

Who doesn’t love kids? Their presence in a place with their innocent acts brings us, adults, pleasure and happiness. 

Of course, having a child is a big responsibility but it also brings a big deal of joy and satisfaction. 

Unfortunately, some people might be struggling to have a baby. If you and your partner are having this struggle, you are not alone. Globally, 8 to 12% of couples experience fertility problems. 

Many people struggle with infertility. 

Infertility, in general, according to the CDC, is defined as not being able to conceive, get pregnant, after one year or longer of regular unprotected sex. And because in women fertility declines steadily with age, some doctors evaluate and treat women aged 35 years or older after 6 months of unprotected sex. 

It might be the result of issues with you, your partner, or a combination of both. Luckily, there are many ways to treat infertility and significantly improve your chances. 

As we mentioned, infertility can be because of the male, the female, or both of them at the same time. However, the main symptom regardless of the origin of the cause is not getting pregnant. No other obvious symptoms can be felt or recognized; you can’t tell that you aren’t able to have a child unless you try to have one. However, in some cases, a woman with infertility might experience disturbances in her menstrual cycle, either irregular or absent cycles. Sometimes males have some signs too that might be an indication for fertility problems including changes in sexual functions or hair growth pattern.

The causes of infertility are many. But before we explain causes for you, you need to understand how pregnancy happens. Well, pregnancy is the result of a process that consists of some steps. 

To get pregnant:

• The female body must release an egg from one of her ovaries; a process known as ovulation. 
• The male’s sperm must join the egg; a process known as fertilization.
• The fertilized egg travels through the fallopian tube to the uterus. 
• The fertilized egg implants itself into the inside of the wall of the uterus; a process known as implantation. 

All of these steps must occur correctly to achieve pregnancy. 

Infertility may occur due to a problem in one or more of these steps. These problems might be present since birth or might develop later in life. Although infertility is always thought of as a female problem, it could be due to male or female. According to the Center for Disease Control and Prevention (CDC)

• In about 35% of cases, a male factor is identified along with a female factor. 
• In about 8% of couples with infertility, a male factor is the only identifiable cause. 

So, now, let’s have a look at the causes of infertility. 

Let us start with causes due to man’s factors.

These include: 

• Abnormal sperm production or function. This problem the male wouldn’t be aware of unless he does a sperm analysis. It might be due to many reasons such as undescended testis, infections such as sexually transmitted disease including chlamydia, gonorrhea, and HIV. health problems such as diabetes and enlarged veins of the testicles known as varicoceles. Those problems can affect the quality of the sperm. 
• Damage related to cancer or cancer treatment. Chemo or radiotherapy can severely impair sperm production. 
• Problems in delivering the sperm. It can be due to sexual problems such as premature ejaculation, genetic factors such as a disease known as cystic fibrosis, and structural problems if any blockage happened in the testicles. 
• Certain environmental factors. Some chemicals or certain substances can affect the sperm formation processes such as pesticides, radiations and other chemicals. Smoking, alcohol, marijuana, anabolic steroids and other drugs can cause infertility. High blood pressure and depression can also affect fertility. 

When doctors are searching for the cause of infertility in a couple, they usually start with the male infertility factor and they ask the male to do a semen analysis so they can decide whether he needs treatment or not. 

As for female causes of infertility, they are:

• Ovulation disorders. Several disorders may cause infertility in females. They affect the release of the egg from the ovary. They are usually hormonal disorders such as polycystic ovarian syndrome, hyperprolactinemia- a condition where there is too much prolactin, the milk-producing hormone. Which subsequently interferes with ovulation. Too much thyroid hormone (hyperthyroidism) or too little thyroid hormone (Hypothyroidism) can affect the menstrual cycle and, hence, cause infertility. There are other causes related to eating disorders, doing aggressive exercises, and stress. 
• Fallopian tube damage or blockage. You might ask why would fallopian tubes be damaged? Well, this would be due to inflammation of the tube that results in adhesions and blockage. Inflammation of the fallopian tube is known as salpingitis and it might occur due to ascending infection, causing pelvic inflammatory disease or sexually transmitted disease. 
• Uterine abnormalities. Anatomical abnormalities in the uterus, polyps, tumors, or fibroids can possibly cause infertility because they prevent the fertilized egg from implantation. 
• Cervical abnormalities. Abnormalities with the cervix, polyps, or cancer can be the cause of infertility. 
• Endometriosis. It is a disease that occurs when the lining of the uterus starts growing outside the uterus, so it affects the function of the tubes, ovaries and uterus. 
• Pelvic adhesions. They usually result from the inflammation following a surgical procedure such as removing the appendix, infections, appendicitis, or endometriosis. 
• Early menopause. Some women may have their menstrual cycles stopped although they are still too young and below 40. This is a condition known as premature ovarian insufficiency where the ovaries stop working. It is so bizarre that the cause is unknown. However, certain genetic disorders are related to early menopause such as immunological disorders and Turner syndrome. 
• Cancer and its treatment. Especially if it is a reproductive system cancer treatment. 

So, according to the steps of pregnancy we mentioned earlier, any disorder in any part of the female reproductive system might affect fertility. 

However, to say a couple is infertile and they need to see a doctor, experts suggest it should be after a year of frequent unprotected sex. But some signs or symptoms might give the couple a hint that there is a problem, it is going to affect fertility, and they should not delay seeing their doctor. Here are some of the common symptoms:

• Irregular periods of absence of periods.
• Painful periods.
• Endometriosis.
• Pelvic inflammatory disease.
• More than one miscarriage. 

 It is always preferred to talk to your doctor whenever you are planning to have a baby to help you prepare your body for the baby and know the best times for intercourses. 

Now, the question is, can we prevent infertility? 

The ugly truth is that some types are not preventable, however, there are some risk factors you might avoid and several strategies you might follow to increase your chances. 

Some of the risk factors can’t be stopped or reversed such as age, you can’t do anything about it. If you are a woman, your fertility decreases rapidly with ageing, especially in your mid-thirties. 

But you can always improve your chances by reversing and stopping the preventable risk factors such as smoking, alcohol, overweight, underweight, or lack of exercise. 

You can also further improve your chances by having regular intercourses especially around the time of ovulation when you have the highest pregnancy rate. 

Diagnosis usually requires some physical examinations and investigations. For men, they would be asked to do semen analysis, hormone testing, genetic testing, testicular biopsy, or imaging. 

For women, doctors usually test every part of the reproductive system if her partner was free. They start with an ovulation test to measure hormone levels to determine if there is ovulation or not. They also perform hysterosalpingography, where an X-ray contrast material is injected, and an x-ray is taken. It determines if there is any abnormality or blockage in the uterine cavity or the fallopian tubes. 

Other hormonal tests might be needed to make sure that there is no other endocrine abnormality causing infertility. 

Sometimes doctors need to have a look by themselves at the part they are suspecting in the female reproductive system. It is not done routinely though but it depends on the symptoms and the case. 

For example, your doctor might perform a hysteroscopy where a thin lighted device is inserted into the cervix to view any abnormality in the uterine cavity.

We must emphasize that not everybody needs all the tests or even many, it all depends on the case. 

And now, what about treatment? 

Treatment of infertility depends on many factors such as, how long you have been infertile, the cause of infertility, the couple age, and their preferences. 

Our role today is to answer most of your questions regarding periodontics. Today we have Dr. Kang, who is a leading doctor at Miraeyeon Fertility Clinic in Seoul. She is going to discuss with us about infertility from an experienced medical point of view.

Interview

We are here in Miraeyeon Clinic, and it is known for infertility, obstetrics and gynaecology treatments. Can you please explain more about it?

Our clinic is an infertility hospital, and we are also able to perform in-vitro fertilization procedures.

We have 4 female doctors gathered here together. It is a hospital started by doctors with long enough clinical trials at Gangnam Cha Hospital, which has a history of infertility. We also have an infertility laboratory, so we are proud to have a world-class level of equipment, machinery, and technology in our laboratory that can be put out anywhere in the world.

In addition, it is a hospital that provides full treatment for women as there are doctors with many experiences in both gynaecology and obstetrics as well as infertility.

How is infertility defined in general?

Usually, a couple is diagnosed with infertility if they haven’t been able to get pregnant without contraception for more than a year. Nowadays, as women have more social lives and social advances, the marriage age is pushed back and delayed a lot. This is also the case in Korea.

So women are ageing, and the age of women is important in the fertile zone of pregnancy. So, in the case of women over the age of 35, if they do not get pregnant even though they have not used contraception for more than 6 months, they should consider it as infertility, conduct tests and start considering treatment.

What are the tests that are done to diagnose infertility?

In the case of women, the fertility test starts according to the menstrual cycle. If you come during menstruation, you can start with a hormonal test, check if the fallopian tube is fine, and see if you are ovulating well with an ovulation ultrasound.

As men should be tested together, we have tests available for men also. For men, a semen test is the most common, and a fungal test can be performed to see if there are any infection problems within the couple.

Dr. Kang, what are some of the things that can cause infertility?

There can be several causes. You will find the cause through examination. In 30-40% of cases, there are Unknown Causes where no specific cause can be found, and in many cases, the male factor and the female factor should also be considered. In the case of male factors, there are many cases that are found by sperm tests.

In the case of female causes, there may be anatomical problems, such as endometriosis or adenomyosis, there may be an anatomical problem with the ovaries or problems with ovulation.

In addition, there may be functional problems such as the fallopian tubes, and immune systems for example autoimmune diseases, chromosomal abnormalities, and various other problems.

For infertility, in some cases, does it have bad consequences?

The procedure itself is not very dangerous or invasive, so in many cases it won’t be too difficult. But in the case of hypertrophic syndrome, electrolyte imbalances also come, and some women have difficulties as their ascites are filled up.

The procedure itself can also cause blood-abdominal cavity, and there are cases where there is a slight abdominal pain or passing after the oocyte collection, but usually it’s not problematic.

Dr. Kang, what are some of assistive reproductive technologies to help in getting pregnant?

Assisted reproductive surgery is approached differently depending on the cause, but when there is no specific cause at first, the first thing you can try is ovulation induction.

You can ovulate at the right time with medicine, and then induce ovulation first so that you can try to conceive. The next step is a procedure called artificial insemination. It is a procedure that can be done first without being very invasive. The sperm is first treated according to the ovulation period and then the sperm is injected into the uterine tube.

This is an assisted reproductive technique that can be tried first because it is done in 2-3 minutes and the pain is not severe. The most involved and the highest success rate is the in-vitro fertilization procedure. In this case, first, by inducing super ovulation, stimulate the egg as much as possible and grow the follicle as much as possible. After collecting an egg through an egg harvesting procedure, it is fertilized in a test tube, aided in fertilization, and then the fertilized eggs (embryos) are cultured.

It is a procedure in which embryos selected as the healthiest in culture are transplanted into the uterine tube, and it takes about two weeks.

What is some advice you can give to any woman who is preparing for a pregnancy?

In general, when preparing for pregnancy, you can first check whether there are any particular problems with maternal health by taking a gynaecological checkup as well as general health checkups.

In gynecology, ultrasound can be used to see if there are any anatomical problems, as well as various bacterial tests for infection, cervical cancer tests, and so on. You can also test for antibodies to women who are preparing to become pregnant.

Through antibody testing before pregnancy, if you do not have antibodies, you can be vaccinated in advance and tested for viruses and bacteria to make it safer when trying to conceive.

What is the gynaecological examination that should be done, and how often should it be done?

Normally, you can think of checkups as every 1-2 years, and in the case of something else, such as a bacterial test or a virus test, you can add it at the time of an event. As mentioned earlier, basic ultrasound or cervical cancer screening, usually a once a year checkup, is recommended.

Conclusion

Usually, a couple is diagnosed with infertility if they haven’t been able to get pregnant without contraception for more than a year. Nowadays, as women have more social lives and social advances, the marriage age is pushed back and delayed a lot. This is also the case in Korea. So, women are ageing, and the age of women is important in the fertile zone of pregnancy. So, in the case of women over the age of 35, if they do not get pregnant even though they have not used contraception for more than 6 months, they should consider it as infertility, conduct tests and start considering treatment.

In the case of women, the fertility test starts according to the menstrual cycle. If you come during menstruation, you can start with a hormonal test, check if the fallopian tube is fine, and see if you are ovulating well with an ovulation ultrasound. For men, a semen test is the most common, and a fungal test can be performed to see if there are any infection problems within the couple. There can be several causes. You will find the cause through examination. 

In 30-40% of cases, there are unknown causes where no specific cause can be found, and in many cases, the male factor and the female factor should also be considered. In the case of male factors, there are many cases that are found by sperm tests. In the case of female causes, there may be anatomical problems, such as endometriosis or adenomyosis, there may be an anatomical problem with the ovaries or problems with ovulation. In addition, there may be functional problems such as the fallopian tubes, and immune systems for example autoimmune diseases, chromosomal abnormalities, and various other problems.