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INFERTILITY
An article of Indian Journal of Medical Research mentioned …
The World Health Organization (WHO) estimates that 60 to 80 million couples worldwide currently suffer from infertility. Infertility varies across regions of the world and is estimated to affect 8 - 12 % of couples worldwide. Underlying these numbers exists a core group of couples, estimated to be 3 - 5 %, who are infertile due to unknown or unpreventable conditions. A prevalence of infertility above this level suggests preventable or treatable causes.
Total infertility is divided into primary and secondary infertility. Definitions of primary infertility vary between studies, but the operational definition, put forth by the WHO, defines primary infertility as the “Inability to conceive within two years of exposure to pregnancy (i.e.- sexually active, non-contracepting, and non-lactating) among women 15 to 49 yr. old”. Secondary infertility refers to the inability to conceive following a previous pregnancy. Globally, most infertile couples suffer from primary infertility.
Among Indian women reporting primary infertility and PID (pelvic inflammatory disease), STI (Sexually transmitted infections) prevalence was high. The WHO estimates the overall prevalence of primary infertility in India to be between 3.9 -16.8 %. Estimates of infertility vary widely among Indian states from 3.7% in Uttar Pradesh, Himachal Pradesh, and Maharashtra, to 5 % in Andhra Pradesh, and 15 % in Kashmir. Moreover, the prevalence of primary infertility has also been shown to vary across tribes and castes within the same region in India.¹
Urban incidences of infertility are on the rise. In fact, every year, the number of infertile couples is increasing. This is primarily due to – stress, lack of sleep, bad diet, alcoholism, smoking, use of recreational drugs, late marriages, deferment of childbearing due to career aspirations or even expectation of financial stability ‘a few years later’ (easing of EMI burden) and cases of medical challenges (PCOS etc.) to conceive etc.
Due to social stigma, infertility ‘blame’ is more often thrusted on women; however, medical science deals with male infertility in as high as 40% cases. Similar to women, stress – lifestyle and environmental factors impact male fertility adversely. For example, lack of sleep, bad diet, alcoholism, smoking, use of recreational drugs, body building supplements; are known to reduce the sperm count / defect, chemical pollution distorting the hormonal system and creating reproductive birth-defects in male child (hypospadias) etc.²
Finally, diseases like obesity, diabetes, high blood pressure etc impacts fertility of both men and women.
Male Infertility
The principle causes of male infertility are: Pituitary Gland disorders, Hypogonadism (low function of testes), Oligospermia (Low sperm count), Poor quality of sperm
Some conditions that turn to infertility in men are :
Oligospermia
The sperm count in a single ejaculate of a man should be 15 million sperm per millilitre for normal conception. The condition in which the sperm count is less than that is called Oligospermia.,
- Mild oligospermia is when the count is 10 to 15 million sperm/ml.
- Moderate oligospermia is when the count is 5 to 10 million sperm/ml.
- Severe oligospermia is when the sperm count falls between 0 to 5 million sperm/ml.
Poor Sperm Motility
For successful fertilization of ovum, adequate sperm motility is critical. Healthy sperm shows a forward progression of 25 micrometres per second. Depending on the mobility, sperm motility issues are classified as:
- Slow or sluggish sperm motility.
- Non-progressive motility when the motility is less than 5 micrometers per second.
- No mobility. The causes for low sperm motility can be heavy smoking, alcoholism, stress, and repeated trauma to the pelvic area. The condition can be treated by avoiding smoking and alcohol, exercise, healthy diet and medication if required.
Abnormal sperm morphology
One of the key parameters of male fertility is heathy sperm morphology, e.g., the size and shape of sperm. Normal sperm has an oval head and a long tail. Abnormal sperm may have large head and crooked or double tail. These defects might affect the sperm’s ability to reach and penetrate the egg. Only 4% to 10% of sperm in any sample appear normal. Experts are of the opinion that sperm morphology is a poor predictor of infertility unless 100% of the sperm are abnormal.
Erectile dysfunction
One emerging issue encountered very often is inability to get and maintain an erection and produce an ejaculation during orgasm. Once again, heavy smoking, alcoholism, stress, trauma apart from various psychological issues are the primary cause of ED.
Female Infertility
The common causes of infertility in women are:
- Ovulation disorders caused due to hormonal imbalances or Polycystic ovary syndrome (PCOS)
- Pelvic inflammatory diseases caused due to STD (Sexually transmitted diseases)
- Endometriosis
- Uterine fibroids
- Premature ovarian failure
- Scarring from previous surgery
Blighted Ovum
After being fertilized ovum implants itself in the uterus and starts the process of development (called embryo). In case of blighted ovum, no embryo is formed (known as anembryonic). The pregnancy ends with the symptoms of miscarriage like spot bleeding, cramps, and breast soreness etc. This is the major reason of miscarriage. The exact cause is not known however, it may be attributed to chromosomal abnormalities. In many instances, this happens at an early stage and is never realised by the women.
Ovulatory dysfunction (Anovulation or Irregular Ovulation)
Absence of or lack of ovulation is called Anovulation. It happens when the ovaries do not produce any egg causing infertility. Irregular ovulation is a condition in which cycles of menstruation are shorter than 21 days or longer than 36 days. Some of the causes for ovulatory dysfunction could be hormonal imbalances, obesity, low body weight, stress, thyroid dysfunction etc.
Tubal Block
During ovulation, the egg travels from the ovaries to the uterus via the fallopian tubes. The sperm must travel from cervix into the uterus to the fallopian tubes to meet the egg for fertilization to happen. If the fallopian tubes are blocked, both the sperm and egg are unable to travel leading to infertility. The symptom of blocked tubes is infertility itself. In severe cases there may be foul smelling vaginal discharge and, lower pelvic and abdominal pain. The causes could be history of STD (sexually transmitted diseases), uterine infection, history of abdominal or other surgeries, endometriosis etc.
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