INFERTILITY is defined as the failure to conceive after one year of regular intercourse without contraception, or the inability of a woman to carry a pregnancy to a live birth. Statistics show that infertility is estimated to affect 20 per cent of couples of reproductive age.

Dr Kamali Carroll, lab director at the Hugh Wynter Fertility Management Unit, lecturer and embryologist, recently broke down the topic at the Medical Disposables Continuing Education Seminar ‘MPowered’, at which she addressed the causes of infertility. She also explored solutions and shares how new medicine and technology can help.

Causes

Statistics show that 33 per cent of cases are female factor infertility, 20 per cent are male factor infertility, 39 per cent are a combination of male and female factor infertility, and eight per cent are unexplained infertility factors.

Female infertility is caused by a number of factors ranging from ovulation disorder cases, ageing, having diminished ovarian reserve, premature ovarian failure, and disorders like polycystic ovary syndrome (PCOS). There are also tubal causes and causes such as fibroids and endometriosis.

Male factor infertility is caused by several conditions. These include local, systemic or lifestyle conditions. Local conditions include varicocele (swollen vessels in the testicles), genitourinary infection, epididymo-orchitis (swelling of the testicle), or testicular trauma (injury to testicle). Systemic conditions include diabetes, cancer, and medications, while lifestyle factors include excessive smoking, exposure to pesticides, radiation, and excessive use of mobile devices close to the testicles (using a laptop on your lap for long periods, for example).

Treating infertility

Assisted conception is one of the main ways to treat infertility. This is when a patient uses medical intervention to become pregnant. There are two main types of assisted conception: artificial insemination and assisted reproductive technology (ART).

The most common type of artificial insemination is intrauterine insemination (IUI). With this technique sperm cells are inserted directly into the womb at the time of ovulation. An IUI is ideal for men with borderline sperm parameters, women with hostile cervical conditions, women with at least one patent (open) tube, men with ejaculatory dysfunctions, or for couples with unexplained infertility reasons.

Unlike IUI, ART involves treating infertility with both the eggs and sperm being outside of the body. The most common type of ART is in vitro fertilisation (IVF). In this process the woman is given drugs to stimulate the ovaries to produce multiple eggs. The eggs are then removed from the ovaries and inseminated in the lab, where they are grown and observed, after which the best quality embryos are taken and transferred to the uterus. IVF is suitable for individuals with previous failed IUIs, poor sperm count, blocked tubes, diminished ovarian reserve, recurrent miscarriages, endometriosis, and PCOS.

Innovations to treat infertility

Over the past decade, drugs, technology, and new research have become available to treat infertility and assist with conception.

Laboratory techniques include preimplantation genetic testing, which is a technique used to identify genetic abnormalities in embryos with IVF before putting the embryo back into the uterus.

Assisted hatching is when a laser is used to create a hole in the zona pellucida (layer of the egg), which forces the embryo to hatch and leads to higher pregnancy rates.

Vitrification is a complete dehydration process to freeze eggs that can be stored for later use.

Embryoscope is when eggs are grown in a womb-like incubator in the lab.

Third party reproduction options include donor eggs that have been preserved at an egg bank, which usually comes from a younger female donor. Additionally, there is gestational surrogacy; this is a process in which the child will have no genetic link to the surrogate.

Dr Carroll explained that, contrary to popular belief, many assisted conception services are available right here in Jamaica for couples experiencing infertility.