Infertility is defined as not being able to get pregnant
after one year of unprotected sex.
According to statistics, 57% of women get pregnant within 3 months without a special contraception and 72% of women get
pregnant within 6 months. Chances for pregnancy per each ovulation cycle are only about 25%.
If women experience artificial abortion surgery or it is difficult to predict the ovulation cycle due to very irregular ovulation cycle,
women may need to get the test even within one year.
It is largely divided into primary infertility(a woman has not been pregnant at all) and secondary infertility(a woman has been
pregnant before, but she is not pregnant after that).
Cause & Diagnosis
Causes in men and women account for 40% for each. Both sides and unknown causes account for 10% for each.
It has been known that men eject 100 million . 200 million
sperms during one ejaculation. When compared with the past,
the count of sperm is reduced by almost 50% and the
frequency to cause the infertility is naturally increased.
Since test for male infertility is simple and it can be determined
within a short period of time, it is the principle to take the
- Medical history : Undescended testis or testicular torsion, hernia surgery, diabetes and hypertension
- Environment : Smoking, drinking, high temperature exposure of the scrotum, radiation, pesticides, agricultural chemicals
- Sexual disorders
- Disorder of sperm production
- Disorder of sperm passage
- Disorder of sperm in semen
- When vas deferens are blocked : case of innate closure of vas deferens, case of closure of vas deferens after suffering from
severe illness such as tuberculosis and case in which vas deferens are not restored even if it is tried to be restored after
- Case of disorder in spermatogenesis in testis.
Male infertility tests
- Semen test : For men, reproductive ability is primarily evaluated only through semen test. For accurate semen test, abstinence
is required for 2~3 days. If it is found that count or motility is abnormal according to semen test, re-test is performed after
a week to obtain accurate results. As a result, if specific abnormality is found, urology examination or treatment or assisted
reproductive technology such as artificial insemination or in vitro maturation can be given.
- Anti-sperm antibody test : It is tested whether there is antibody against sperm by using sperm of men and serum of women.
(It is always possible. It is tested whether antibody against sperm is present and normal insemination can be made).
For female infertility, causes are various and treatments are
complex compared with men. The role of men is to produce
sperm and ejaculate in the vagina. Women have more factors
related to pregnancy to accept sperm and fertilize it with egg.
Thus, the related role is big.
- Sexual disorder : Colpostenosis, neurological convulsion of the vulva, imperforate hymen, vaginal atresia, vaginal defects and
- Ovulation disorders : When 2 or more anovulatory menstrual cycles are present in three consecutive menstrual cycles, causes
could be central nervous system disorders, ovarian functional disorder or metabolic processes disorder.
- Oviduct obstruction : Oviduct plays roles to move egg to accept it in lumen of oviduct, provide the fertilization place for egg
and sperm and move the fertilized egg to uterus. If one of them has a problem, it will become infertile.
- Body of uterus disorder : Since uterus accepts the sperm and implants the fertilized egg to grow, it is an important place.
If there is a problem, it will become infertile.
- Cervical cannai disorder : cervical cannai have a lot of mucous glands and secrete a lot of cervical cannai mucus.
If cervical cannai mucus is transformed into inflammation, it could be a cause of infertility.
Female infertility tests
- Basic tests : Urine test, general blood test, blood type test, serum test, presence of chronic and infectious diseases
- Basic body temperature table : Basic body temperature of women is increased by 0.5°C immediately after ovulation compared
with 36.6°C at the time of ovulation. If you can create a table for basic body temperature, you can easily see if ovulation occurs.
However, since the change of basic body temperature is very sensitive, you have to exactly follow the instructions of
.(Everyday, you have to write it down, check whether ovulation is made or it is increased by
0.5 °C shortly after ovulation).
- Instruction of creation of basic body temperature table : Since change of body temperature cannot be accurately measured
if you smoke or drink water or eat any foods before measuring it, you have to measure it immediately after you wake up.
While you are not moving, you can put a thermometer under your tongue for 3~5 minutes and then read and record the
temperature. In order to do so, you have to place the thermometer in the place where you can reach it before you go to bed.
- Hormone tests : It is the blood test to check thyroid-stimulating hormone, lactation hormone, gonadotropin and follicle-
stimulating hormone in three days after menstruation. It tests the hormone level which affects growth of follicle and ovulation
function(2~3 days after menstruation, check ovarian function and ovulation function).
- HSG(Hystero Salpingography) : It is a test using x-ray and contrast media to check the inside of uterus and status of oviduct.
It is performed after menstruation.(Closure and adhesion of fallopian tube can be determined).
- Cervical mucus test and postcoital test : It is performed during ovulation and it tests the effect of mucous at the entrance of
the uterus on motility of sperm. To perform the test, you visit the hospital after having sexual intercourse at dawn of the same
day or the night before and you have not washed your vagina yet.(during ovulation period and mucous state, evaluation of
status of sperms that remain in the mucous).
- Biopsy of endometrium : Some endometrial tissue is collected to test whether endometrium responds appropriately to
ovulation and hormones. It is performed a couple of days ahead of expected menstruation.(2~3 days ahead of expected
menstruation, check the ovulation and evaluation of status of development of endometrium).
- Laparoscopy : After above tests are completed, it can be performed if necessary. It is the test to directly see endometriosis or
adhesion in abdominal cavity and status of openness of oviduct. (It diagnoses the particular disease such as adhesion or
endometriosis after menstruation).
It is performed when the couple does not succeed to have pregnancy through marital relationship during ovulation period,
or when the state of sperm is not severely bad, or the amount or quality of cervical mucus is not enough to maintain the
survival of sperm.
Artificial insemination is the method to add the husband’s sperm into the uterus of wife in time of ovulation without sexual
contact to induce the pregnancy. After the husband’s sperms are collected and most active sperms are selected in the ovulation
period, they are inserted into uterine cavity using a thin implantation tube.
When artificial insemination is performed, the timing is important. Thus, it is the key for increase in pregnancy rate to predict the
ovulation period accurately. However, pregnancy rate per cycle is 10~17%, which is relatively low compared to normal pregnancy.
It is a relatively simple procedure without anesthesia and it is less expensive.
The method for artificial insemination includes the artificial insemination after using natural cycle, or clomiphene or ovaluation
inducer. It is classified into intrauterine insemination(IUI), intracervical insemination(ICI), intravaginal insemination(IVI) depending
on the insertion part of semen.
Currently, intrauterine insemination(IUI) is the most widely used. The reason is that injection of sperm into uterus has higher
pregnancy rate than injection into cervix.
Artificial insemination has the side effect in which multifetal pregnancy can be made due to ovulation induction.
It has been known that combination of ovulation induction and artificial insemination has higher pregnancy rate in patients with
unexplained infertility than combination of ovulation inducer and artificial insemination.
Upon artificial insemination, only normal sperms with motility are inserted into uterus and the place in which egg meets sperms
in a normal woman is the oviduct. Therefore, oviduct must be normal.
In addition, if you have other infertility factors, you are less likely to get pregnant by artificial insemination.
For women at age 40 and above, or those who had a medical history of pelvic inflammatory disease, or suspicion of oviduct
adhesion or had other reasons for infertility and had tried artificial insemination three or four times but had failed pregnancy,
the probability to get pregnant through artificial insemination becomes lower.
In vitro fertilization(IVF)
It is called external fertilization. If the fertilization is made after sperm meets egg in the tube, the fertilized egg is implanted into
the uterus which is the embryo transfer process.
It can be applied to oviduct infertility(oviduct occlusion, pelvic adhesions, failure of oviduct plastic surgery and tubectomy),
men infertility(endometriosis), unexplained infertility, several failures of artificial insemination and immunological infertility.
IVF goes through four stages such as ovulation stimulation, egg recovery, embryo transfer and confirmation of pregnancy.
If follicle does not grow well due to poor response to ovulation inducer or egg cannot be collected due to early ovulation,
re-attempt can be made after 2~3 months.
Even if egg is collected, embryo transfer may not be able to be made due to no fertilization, which is rare.