Infertility is a reproductive health condition that affects both males and females. It is defined as an inability to conceive (become pregnant) after a year or more of unprotected intercourse. Infertility affects millions of people all around the world and can impact their families and communities. As women advance in age, their fertility is known to drop significantly. With the advancement of technology, several treatment options are available to treat infertility.

Causes of Infertility

Infertility may be caused due to various factors, both in males and females. For females to get pregnant, it requires proper functioning of the uterus, ovaries, and fallopian tubes.

In females, infertility may be caused by:

• Uterine disorders: These include septate uterus (congenital), endometriosis (inflammatory), and fibroids (benign tumour).

• Tubal disorders: These include blocked fallopian tubes (caused by untreated sexually transmitted infections), abdominal surgery, unsafe abortion, and postpartum sepsis.

• Ovarian disorders: These include polycystic ovarian syndrome (PCOS) and other disorders of the follicle.

• Endocrine disorders: These include disorders of the pituitary gland and hypothalamus, causing an imbalance of reproductive hormones.

In males, the main reasons for infertility are:

• Abnormal quality and sperm function: The quality and functioning of sperm can negatively affect fertility. The use of steroids can change sperm morphology (shape), motility (movement), and count (number).

• Reproductive tract obstruction: The blockage of reproductive tubes (seminal vesicles and ejaculatory ducts) that carry seminal fluid can lead to infertility.

• Hormonal disorders: These include disorders of the pituitary gland, testicles, and hypothalamus that cause hormonal imbalance.

• Testicular diseases: Conditions such as varicocele, haematocele, and various other testicular disorders can reduce sperm-producing cells, causing infertility. 

Types of infertility:

• Primary infertility: It is the inability to conceive after a year (or six months if you are 35 years or older) of regular, unprotected sexual activity and you have never become pregnant.

• Secondary infertility: After one successful pregnancy, you are unable to become pregnant again.

• Undiagnosed infertility: A person's or a couple's inability to become pregnant where the cause has not been diagnosed by fertility tests.

Infertility signs and symptoms

In women, signs and symptoms of infertility are related to changes in the menstrual cycle and ovulation. Common symptoms include:

• No periods or irregular periods: Periods stop suddenly, or the number of days between each menstrual cycle varies.

• Painful periods: Abnormal cramps, pelvic pain, and back pain may happen.

• Abnormal periods: Bleeding is lighter or heavier than usual.

• No ovulation or irregular ovulation: Ovaries do not release enough or no eggs during menstrual cycle.

In a few women, hormonal imbalance can cause infertility. Symptoms include:

• Weight gain

• Thinning or loss of hair

• Acne

• Changes in sexual drive 

• Dense hair growth on the chin, lips, and chest

Other symptoms of female infertility include:

• Pain during sex

• Abnormal milky discharge from nipples 

 In men, signs and symptoms of infertility can be vague. Common symptoms include:

• Changes in sexual drive

• Changes in pubic hair growth

• Small and firm testicles

• Pain, swelling, and lump in the testicles

• Difficulty with erections and ejaculation

Anti-Müllerian hormone (AMH) Gold Plus

AMH GOLD Plus measures the amount of anti-Mullerian hormone (AMH) in the blood. AMH is a hormone that is produced by the testicles in males and the ovaries in females. The role and amount of AMH present in the body differ depending on sex and age. AMH Gold Plus is commonly recommended for women to evaluate their reproductive health and predict their chances of conceiving.  

Role of AMH in developing reproductive organs

• In male babies, higher levels of AMH prevent them from developing female reproductive organs.

• In female babies, a small amount of AMH is required for their development.

• AMH regulates the follicle-stimulating hormone (FSH) and luteinizing hormone (LH) during the process of egg development and release (ovulation) in women.

How AMH Gold Plus testing is beneficial to an individual?

AMH Gold Plus in Women: An AMH test is ordered to estimate the remaining time left to conceive (ovarian reserve) while being evaluated for infertility in women of childbearing age. This test will provide information on the number of remaining eggs women have and determine whether the ovaries might be aging too quickly. An AMH test is also used to evaluate the response to injectable fertility drugs in preparation for in vitro fertilization (IVF).

AMH Gold Plus in Infants: An AMH test helps to determine the sex of an infant with external genitals that are difficult to identify as male or female. This test may also be used to determine whether testicles are functioning normally in baby boys by measuring the AMH level.

Interpretation of Results

The normal value ranges may vary slightly among laboratories, and some labs use different measurements.

In women:

In women, a decreased AMH level may indicate a low number and quality of eggs (low ovarian reserve) with diminishing fertility, resulting in less responsiveness to IVF treatment. It may also indicate that the ovaries are not functioning properly (premature ovarian failure).

In Infants:

In male infants, low levels of AMH may indicate defective testicles. Lack of male sex hormones may result in underdeveloped genitalia and abnormal internal reproductive structures. 

Advanced maternal age, smoking, consumption of alcohol, being over or underweight, a history of recurrent abortions, exposure to environmental toxic chemicals and pollutants, and a lack of physical activity may indicate a higher risk of having fertility issues. 

Although infertility may be increased in individuals with the above risk factors, it can be prevented to a certain extent by taking precautionary measures such as the AMH gold plus. Thus, it is advisable to undergo an AMH Gold Plus test that helps evaluate a woman’s current fertility status if you are experiencing any signs of infertility.