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INFERTILITY

CAUSES OF IVF FALIURE:
Polycystic Ovarian Syndrome (PCO, PCOS, PCOD)
Polycystic ovarian syndrome (also called Stein-Leventhal Syndrome) is a hormonal disorder that affects approximately six to ten percent women in the child age group and is the major cause of infertility. Polycystic Ovarian Syndrome is the result of the overproduction of hormones in a woman's body. During ovulation, the ovaries receive hormones from the pituitary gland. These hormones, follicle-stimulating hormone (FSH) and luteinizing hormone (LH), help the egg reach maturity in preparation to be fertilized.In women with PCOS, there is an abnormal leve of LH being secreted. The overproduction of LH causes the ovaries to overproduce androgens. Increased androgen production produces high LH levels and low FSH levels, so the follicles are prevented from producing a mature egg. Thus the ovulatory process is not allowed to complete itself.

The partially-developed egg (inside its follicle shell) dies. Without egg production, the follicles swell with fluid and form into cysts, and it is these cysts that create polycystic ovaries. Every time an egg is trapped within the follicle, another cyst forms, so the ovary swells, sometimes reaching the size of a grapefruit. Without ovulation, progesterone is no longer produced, whereas estrogen levels remain normal. Although Polycystic Ovarian Syndrome presents itself during adolescence or the early adult years, women often do not know they have the disorder until after they attempt to conceive. No two women affected by PCOS have the same symptoms. Common characteristics associated with PCOS are:

· Insulin Resistance
· Hyperandrogenison (Increased male hormones)
· Polycystic ovaries
· Irregular menstrual cycles (oligomenorrhea) or no menstrual cycles (amenorrhea)
· Excessive facial and body hair growth (hirsutism)
· Male pattern hair loss (androgenic alopecia)
· Acne
· Obesity/weight gain
· Infertility
PCOS is of two types -Obese PCOS and Lean PCOS.
In Obese PCOS one uasually encounters hyperinsulineia and these patients benefit from weight loss , life style changes and use of Insulin sensitising drugs . In the PCOS Patients, the condition is due to a genetic disorder where in there is increased production of LH which in turn produces hyperanddrogenism.

Endometriosis
Endometriosis, is believed to be quite common. It is estimated that between 25% and 50% of women with Infertility have endometriosis. This disorder develops when fragments of the endometrial lining are implanted in other areas of the pelvis. These endometrial, or misplaced tissue implants will still respond to a woman's monthly hormonal cycle, causing pain and discomfort, slowly increasing in number and size with each menstrual cycle and eventually causing scarring and inflammation. Endometrial implants in the ovaries or fallopian tubes are particularly likely to cause infertility, even if the endometriosis is mild.

Endometriosis-can causes of conception difficulty due to organ damage, low levels of a molecule specific to enhancing implantation, increased presence of peritoneal white blood cells, and dysfunctional immune system. Unfortunately, there exists no simple blood or urine test to detect this common affliction of the reproductive organs; the only true diagnosis is via Laparoscopy, a fortunately simple, yet still surgical, procedure.

Pelvic Inflammatory Disease and Sexually Transmitted Diseases
Pelvic Inflammatory Disease (PID) is the major cause of infertility worldwide. PID includes a variety of infections caused by different bacteria that can affect the uterus, fallopian tubes, ovaries, appendix, parts of the intestine that lie in the pelvic area, or, in the worst case, the entire pelvic area (peritonitis). The sites of infection most often implicated in Infertility are in the fallopian tubes, a condition known as Salpingitis. Although PID can be a result of nonsterile abortions, use of an IUD, or a ruptured appendix, most infections are caused by sexually transmitted diseases. Chlamydia Trachomatis is an infectious organism that causes 75% of Salpingitis cases. A small US study suggests that Chlamydial infection of the upper genital tract, even without severe inflammation, may cause a higher proportion of fallopian ectopic pregnancies than previously thought. Gonorrhea is responsible for most of the remaining cases. Severe or frequent attacks of PID can eventually cause scarring, abscess formation, and tubal damage that result in Infertility. The severity of the infection, not the number of the infections, appears to pose the greater risk for Infertility. About 20% of women who develop symptomatic PID become infertile. PID also significantly increases the risk of ectopic pregnancy.

Ovulation and Hormonal Disorders : Given the intricate interaction of the hormones necessary for ovulation, it is not surprising that about 33% of Infertility cases can be traced back to ovulation and hormonal problems. They may result in the failure of the ovarian follicle to rupture, an empty follicle, or entrapment of the egg so that it isn't released. Various medical conditions, as well as lifestyle factors such as excessive exercise, eating disorders, smoking, or stress can change normal hormonal rhythm. Even slight irregularities in the hormonal system can result in ovulation disorder.
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Fibroid Tumors
Benign fibroid tumors in the uterus are extremely common in women over 30. In rare cases, they can cause Infertility by interfering with the uterine cavity, blocking the fallopian tubes, or altering the position of the cervix and preventing sperm from reaching the uterus. High levels of estrogen seem to stimulate the growth of fibroid tumors; heredity may also play a role in their development. Only those fibroids interfering with fertility require removal before ART procedures.

Premature Ovarian Failure (POF)
Sometimes referred to as "premature menopause", is a loss of ovarian function in women under 40 years of age. Periods stop, estrogen is low, and the follicle-stimulating hormone (FSH) level is elevated. Some women may experience premature ovarian failure because of adrenal, pituitary, or thyroid deficiencies. Radiation therapy and anti-cancer agents may achieve a cancer cure at the cost of Fertility by causing premature ovarian failure. Women with Turner's Syndrome, a rare genetic disorder, do not develop functional ovaries at all.

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