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Infertility

If your partner and you are not able to get pregnant and are thus, struggling to conceive, you need to know that you are not alone. In fact, this problem is faced by 12 to 16 % of the Indian population. In urban areas, one out of every six couples has to put a lot of struggles to conceive. This condition is called infertility which is found in 27 million people of the Indian population. Infertility Definition/ What is Infertility? Infertility refers to the condition in which a person is not able to get pregnant after regularly trying for one year to conceive. A couple is considered by the healthcare providers if they are not able to get pregnant even after regular unprotected sexual intercourse for a year. This time for trying decreases if the woman is older as it becomes 6 months if the woman is older than 35 years and if the woman is over 40 then an urgent and immediate evaluation is necessary. There are many reasons for one being infertile like for men, the sperm count can be low, or the testosterone can be low. In the case of women, there is a greater number of factors that can cause infertility like if the woman is older as the chances decrease with increasing age after adulthood, or if she has any condition/ conditions like endometriosis, uterine fibroids, etc. Infertility can be because of either one or both of the sexual partners trying to conceive. Infertility should not be considered as a woman’s problem like it is generally considered in our society because men can also be infertile. Although, the reasons given for male infertility seem to be less than the ones for female infertility. You would be shocked to know that men and women have the same likelihood of being infertile i.e., one-third. The remaining one-third can be caused either due to the combination of both male and female infertility or any other unknown reasons.

 

Types of Infertility:

Infertility can be a primary or a secondary one.

Primary Infertility: A woman who has never been able to conceive a child will be diagnosed with primary infertility.

Secondary Infertility: A woman would be diagnosed with secondary infertility if she has conceived in the past but is not able to conceive now.

 

Causes of Infertility:

There are many causes of infertility. These causes can be varying depending on the sex of the concerned partner.  For a successful pregnancy, all of the steps/ checkpoints need to take place in the correct order. At times, infertility can be caused due to issues present in the couples since birth, and, other times, these issues can develop in later life. These infertility causes can be affecting one or both of the partners. Let’s talk about the causes concerned with male infertility first.

 

Infertility Causes in Males:

The milky fluid that is released from a man’s penis during orgasm refers to semen which consists of fluid and sperm. This fluid is derived from the prostate gland, seminal vesicle, and other sex glands and helps in transporting the sperm as it makes it to the egg and hence, makes fertilization possible. On the other hand, testicles are responsible for producing sperm. For fertilization, everything must happen within a certain time frame i.e., at the exact time. Hence, for successful fertilization, the sperm should have the normal shape, travel fast, and with accuracy towards the female gamete i.e., egg. There can be, hence, various problems that are possible:

  1. Low Sperm Count: This refers to the condition in which the man ejaculates sperm which is low in number. Normal sperm count is million so anything less than that is considered as low sperm count. This condition can be found in one-third of the couples having difficulties in conceiving.

  2. Low Sperm Mobility: The sperms can also be unable to move normally when they are on their way to the egg for fertilization.

  3. Abnormal shape: Sperm can also have an unusual shape which can make it difficult to move for the sperm and hence, no fertilization takes place.

These above problems can be caused due to:

  • Any medical condition: If there are any medical conditions like cancer, any infection like testicular infection, or any surgery being done on the male.

  • Ejaculation Disorders: There can also be a possibility that the ejaculatory ducts can be blocked. In such cases, the semen can be then ejaculated into the urinary bladder.

  • Problematic Testicles: If the testicles have been overheated due to the use of hot tubs, saunas, or working in hot environments. There can be other things that can cause problems to the testicles like an undescended testicle, varicose vein, or wearing tight clothes.

  • Hormonal imbalance: Hormonal imbalances can also cause infertility issues. For example, testosterone deficiency can be caused due to hypogonadism.

 

Infertility Causes in Females:

Infertility in women can be caused due to a lot of reasons. These are:

  1. Ovulation Disorders: Ovulation disorders are the most commonly found causes of female infertility. Ovulation refers to the monthly release of a mature egg from the ovary. There are chances that these eggs may not get released or may get released in some cycles.

Ovulation disorders can be due to the following reasons:

  • Premature Ovarian Failure: As the name suggests, this refers to the condition in which the ovaries, which usually stop working after the age of 40 years i.e., menopause, do so before the age of 40.

  • Poor Egg Quality: The eggs can be unable to sustain a pregnancy when they are damaged or if they have developed any genetic abnormalities. The risk for these increases with increasing age.

  • Polycystic Ovary Syndrome: This is a hormonal disorder that causes enlargement of ovaries and hence, the ovaries become unable to function properly leading to missed or irregular periods.

  •  Thyroid Problems: These problems can also be caused due to hormonal imbalances caused by either hypoactivity or hyperactivity of the thyroid gland.

  • Chronic Conditions: Infertility can also be caused if there are any chronic conditions that one is suffering from, like AIDs, cancer, etc. 

  1. Problems related to the Uterus or Fallopian Tubes: If there are any problems related to the uterus or fallopian tubes then also, the egg can be prevented/ blocked from reaching the uterus or womb.

These can be caused due to:

  • Endometriosis: This is a condition in which uterus-like cells grow outside the uterine cavity i.e., elsewhere.

  • Fibroids: Fibroids are common to be found in the woman. These fibroids can be benign or cancerous. Such fibroids can act like blockages in the fallopian tubes and hence, can block the sperm from meeting with the egg.

  • Surgery: There can be scarring or damage caused in the fallopian tubes as a result of pelvic surgery.

  1. Pelvic Adhesions: These are the bands of scar tissue that can be formed after pelvic infections, appendicitis, endometriosis and can bind the organs together.

 

Risk factors for Infertility:

There are a lot of factors that can make you prone to infertility issues. Most of these factors are common in both males and females. Since we have already discussed the specific risk factors in males and females above, let’s discuss the risk factors which are common to both genders. These include:

  1. Smoking: Smoking can cause various problems other than fertility problems. The risk for infertility problems increases with the increased intensity of smoking a person is used to doing. The greater the number of cigarettes, the greater is the risk.

  2. Age: Fertility also decreases with advancing age after adulthood. The ability to conceive starts declining after the age of 32 years.

  3. Alcohol: Alcohol has also been found to cause a serious effect on a person’s ability to conceive.

  4. Obesity: Being obese i.e., having a BMI over 30, also causes serious infertility issues and can hence, make a person unable to conceive.

  5. Diet: If one is lacking a balanced diet, which most people are, then also infertility issues can be faced. One should, therefore, have a diet rich in folic acid, iron, zinc, and Vitamin B12.

  6. Mental stress: Mental stress has been found to cause a serious effect on fertility as it can cause serious effects on both, ovulation in females and sperm production in males.

  7. Exposure to chemicals: Exposure to certain chemicals like pesticides or herbicides, metals like lead, and some solvents can cause serious effects on one’s fertility.

Diagnosis:

The diagnosis is different for both sexes. Let us discuss the diagnosis for both genders one by one.

Diagnosis for Women:

Your healthcare provider would ask you for recording the signs of ovulation like the basal body temperature, mucus in the cervical, etc. She/ He can then go for the following tests in order to carry out an accurate diagnosis.

  1. Pelvic Exam: In this test, your doctor or healthcare provider will do a pelvic exam in which a Pap Smear Test in order to check for any structural problems.

  2. Blood Test: A blood test is performed to check the levels of the hormones including the thyroid hormone.

  3. Ultrasound: In this test, an ultrasound wand is inserted into the vaginal cavity by the doctor in order to look for any problems related to the reproductive system.

  4. Hysteroscopy: This test is used by the doctor to look inside the uterus for any problems related to the reproductive system of the woman being diagnosed.

  5. Hysterosalpingogram: In this test, a dye is injected into the system of the woman and then X-ray imaging is used to capture its flow as it passes through the fallopian tubes. This test is used to look for any blockages.

  6. Laparoscopy: In this test, a thin and long tube that has a camera fitted on it, known as a laparoscope, is inserted through the abdomen through a small incision so as to check the pelvic organs and the internals of a woman. It is used to identify problems like scarred tissue, endometriosis, or uterine fibroids.

Diagnosis for Men:

The following tests are done by the doctor to diagnose male fertility issues:

  1. Semen Analysis: In this test, problems related to the sperm like low count and poor mobility are diagnosed. This is the only test needed to look for infertility problems for most males.

  2. Blood Test: This test is used to check for the levels of hormones like thyroid, testosterone, etc. Genetic blood tests are done to look for any kind of abnormality related to the chromosomes.

  3. Scrotal Ultrasound: In this test, ultrasound is used to check for varicoceles or any other problems related to the testicles.

 

Treatment:

The treatment will be depending on many factors like age, how long has the person been facing infertility and their state of health.

First of all, the doctor would advise you to have regular sexual intercourse around the phase of ovulation. Sperm is able to survive inside the female for as long as 5 days while the egg needs to be fertilized within 24 hours after the ovulation has taken place as after this time, the egg is no longer viable. So, the fertilization can take place any day within these 6 days that take place during and before ovulation. Surveys have, however, suggested that the 2 days before ovulation and one day after it are the days when there is the highest chance of fertilization to take place.

Fertility Treatments for Males:

  1. Erectile Dysfunction/ Premature Ejaculation: There are various medications, behavioral therapies that can be used to help the person suffering from erectile dysfunction.

  2. Varicocele: Varicose vein can be removed from the scrotum with the help of surgical intervention.

  3. Ejaculatory Duct Blockage: In such a case, the sperm can be directly extracted from the testicles and can then be injected into an egg under laboratory simulations.

  4. Retrograde Ejaculation: Retrograde ejaculation refers to the condition in which the semen gets released in the bladder instead of being ejaculated by the male genitalia i.e., penis. In this case, sperm can directly be taken from the bladder and then injected into the egg under laboratory simulations.

  5. Surgery for Epididymal Blockage: Epididymis refers to the structure in testicles that is responsible for storing and transporting the sperm. If a man is having a blockage in the epididymis, the sperm will not be able to pass only. Hence, surgery is done to repair this blocked epididymis. So that the sperm can then pass and can hence, be ejaculated properly.

Fertility Treatments for Females:

  1. Stimulating Ovulation using Fertility drugs: Your doctor can prescribe some fertility drugs with an aim to regulate or even, induce ovulation. Such drugs are:

  • Clomifene (Clomid + Serophene): This drug is used to encourage ovulation in women who have either irregular or no ovulation at all caused due to any disorder like PCOS. This drug makes the Pituitary gland release more FSH (Follicle Stimulating Hormone) and LH (Luteinizing hormone) both of which induce ovulation.

  • Metformin (Glucophage): If Clomifene is not that effective and hence, this drug is used for women who have severe PCOS.

  • Human Menopausal Gonadotropin (HMG- Repronex): This drug consists of both, FSH and LH. This is given in the form of an injection to individuals who are unable to ovulate due to a faulty pituitary gland.

  • Follicle Stimulating Hormone (Bravelle): This consists of the FSH which is a hormone normally produced by the pituitary gland responsible for regulating and controlling the estrogen production by the ovaries.

  •   Gonadotropin-Releasing Hormone (GnRH): These drugs are usually given to women who ovulate too early i.e. before their lead follicle gets mature-during HMG treatment. It constantly supplies GnRH to the pituitary, altering the hormone production and thus, allowing follicle growth with FSH.

  • Bromocriptine: This drug is used to inhibit the production of the Prolactin hormone. Prolactin is responsible for stimulating milk production during the time when the woman is breastfeeding. Women who have high levels of Prolactin have to face irregular ovulation cycles and hence, fertility problems as well.

  1. Intrauterine Insemination (IUI): IUI is a procedure in which healthy sperm is directly inserted into the uterus around the time of ovulation. IUI can be given as per the normal cycle of a person or with a combination of fertility medications.

  2. Fertility Restoration Surgery: If a woman is having any problems in her uterus (like endometriosis, fibroids, adhesions, etc.) which is causing infertility then surgical intervention can be used to restore the fertility of the concerned individual.

Assisted Reproductive Technology (ART):

Assisted Reproductive Technology refers to the miraculous infertility treatment consisting of a complex set of procedures that are used to treat infertility or to prevent any genetic problem from being inherited to the child. It consists of fertility treatments that can handle both, the woman’s eggs and the man’s sperm.  

In Vitro Fertilization (IVF): It is the most effective treatment used for infertility. It consists of various procedures and is usually done in 3 weeks. Although, at times, it can take longer if the steps are split and done.

In this process, the following procedures are followed in order:

  • Ovulation: This refers to the process where ovulation is induced so as to release eggs from the ovaries for fertilization.

  • Egg Retrieval: This refers to the procedure of extracting matured eggs from the ovaries. It is followed by sperm retrieval in which the sperm is collected either from the partner or a healthy donor.

  • Fertilization: After both the egg and the sperm are collected, they are then made to fertilize under laboratory conditions. This process can take place by two methods: the conventional method or by ICSI. In the conventional method, healthy sperms and eggs are mixed and kept incubated overnight. In ICSI, a single healthy sperm is collected and then directly injected into mature eggs. The embryo is then cultured.

  • Embryo Transfer: After the fertilization has been done, the doctors and the couple then both determine the exact time for the embryo transfer. It can be done between 1-6 days but it is usually done 3-5 days after the egg retrieval procedure has been carried out. After the genetic results have been checked, the embryo is then transferred/ placed in the uterus.

Conclusion:

Infertility is not an uncommon condition as 12 to 16 % of the Indian population is suffering from it. There is a need for awareness about it in our society. Most of our population do not even know that they can get rid of their infertility problems due to the lack of awareness and stigmatization faced by infertility in our society. You just need a little patience, knowledge, and competent medical help by your side. You just need a little trust to have the blessings you have always been wanting to be bestowed upon you.  

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