Pregnancy happens after the ability of the man to produce healthy sperms and the woman healthy eggs. Then the Release of the egg from the ovary to be picked by the tubes, the Ability of the sperms to move from the vagina through the secretions of the cervix and continues its way through the uterus to the tubes till it meets the egg and fertilizes it.  

What are the Causes of delay?

Male reasons

Testicular varicocele, Problems in the spermatic cord, Erection problems, Problems in the testicular tissue not being able to produce sperms at all, Disturbance in the hormones concerned with making of sperms, Sexually transmitted diseases, Bad habits like nervousness and smoking.

Female reasons

• Ovary problems like Poly cystic ovarian syndrome, ovarian cysts, Low ovarian eggs reserve, tumors in the ovary or Genetic disturbance.
• Fallopian Tubes kinking or occlusion
• presence of endometrial tissue outside the uterus –endometriosis,
• Disturbance of the hormones that control endometrial growth and egg growth
• Uterus problems like congenital abnormalities or Presence of fibroids or polyps obstructing the cavity of the uterus or Weakness in the endometrial cavity that hosts the fertilized ovum.

Others

 e.g. sperm antibodies, unorganized sex, Psychological disturbance and stress, obesity, old age, unexplained infertility.  

How is a diagnosis reached?

When the couple agrees on starting their quest to know their problem they visit the reproduction specialist. The specialist takes a good history of the case then performs specialized tests.

Male diagnosis

• Semen analysis: A normal man ejaculates about 1-3 ml of semen, each ml contains more than 20 million sperm , more than 50 % of it moves normally and the abnormal forms does not go more than 20%.The test is performed after 3 days of abistence.
• Ultrasound and Doppler study, Analysis of the hormones and a Testicular biopsy.

Female diagnosis

• Hormonal analysis on special days for Pituitary hormones, Progesterone, Prolactin, Testosterone and thyroid hormones level.
• Ovulation detection by ultrasound or Progesterone levels or Temperature rise on ovulation day or Examination of the cervical discharge.
• Hysterosalpingiography: The doctor injects a solution through the cervix which is reflected by X-Ray to check patency of the tubes and abnormalities in the shape of the uterus.    
• Ultrasonography examination: It is a machine that uses ultrasound waves to draw the internal organs of the female on a display screen.
• Endometrial biopsy: It reflects the influence of hormones on the endometrial lining of the uterus.
• Laparoscopy: The doctor inserts a scope through a small incision in the abdomen which is connected to a monitor allowing the surgeon to see what is inside.
• Hysteroscopy exam: It is a scope that allows the doctor to look into the uterus directly by inserting it into the uterus after inflating it with certain fluid or gas. It is attached to a TV system...
• Post coital test: The couple has intercourse on ovulation day then the wife comes to the doctor without vaginal washing to take a sample from the fluids inside it which is then tested for presences of sperm problems or cervical problems.

What is the treatment?

The doctor directs treatment according to the results of the testing performed and they can be summarized into: Treating the general condition like diabetes mellitus or anemia, Stopping bad habits, Weight control programs and exercises. Male factor treatment is done by surgical treatment of varicocele or hormonal induction and tonics or by Extraction of the sperms from the testes. Treating of hormonal disturbance and Ovulation induction and monitoring. Treating tubal occlusion, uterine fibroids, and endometriosis by surgery or endoscopy. Performing Laparoscopic ovarian drilling or cyst removal for managing ovarian problems.  

Assisted reproductive techniques

Assisted reproductive techniques involve the laboratory preparation of sperms, ovum or both and artificially bringing them together to raise the fertility rates.

• Artificial insemination: Intra uterine injection of sperms after preparing them with special material that increases their motility. They are injected by a special catheter at ovulation time in the uterus.
• Intracytoplasmic Sperm Injection ICSI: Ovulation induction followed by egg collection through the vagina with the aid of vaginal ultrasound with a special aspiration needle attached. Eggs are fertilized by the embryologist by injecting a sperm into the egg under microscopy. Then they are put into an incubator for cell division. After 2-5 days embryos are transferred into the endometrial cavity using a special embryo transfer catheter. Then the woman is given hormonal support drugs that help the embryos to implant inside the endometirum. After 14 days the woman is tested for pregnancy