INFERTILITY

  • Infertility refers to an inability to conceive after having regular unprotected sex for one year.
  • Primary infertility is when the women has never ever conceived in her life , irrespective of the outcome of the conception.
  • Secondary infertility is when the women has conceived once but is having problem in conceiving next time.
  • Almost 20 percent of couples suffer from sub fertility or infertility and the incidence is rising.
  • Difficulty in getting pregnant could be due to both male and female factor. Infact the male factor is solely responsible for around 15-20% of reason for infertility. Another 30% could be due to issues in both the partners.

Risk factors of Infertility

  • Age – As age increases (30 years and above) the chances of spontaneous conception decreases in a women. Women are born with a fixed number of eggs and due to the process of aging the number as well as the quality of egg goes on reducing. The best age for conception for women is between 23- 28 years. Getting pregnant after 35 years may be difficult for many women. Also the risk of genetic abnormalities in the baby increases due to abnormal changes in the egg of the women.
  • Smoking – Tobacco consumption in any form – smoking, pan, mishri, chewing tobacco, gutkha, hooka etc significantly increases the risk of infertility in both men and women. Smoking may also undermine the effects of fertility treatment. Smoking also increases the risk of miscarriage/ abortion in pregnant women.
  • Alcohol consumption – A woman’s pregnancy can be seriously affected by any amount of alcohol consumption. Alcohol abuse may lower male fertility. Moderate alcohol consumption has not been shown to lower fertility in most men, but is thought to lower fertility in men who already have a low sperm count.
  • Being obese or overweight – In industrialized countries overweight/obesity and a sedentary lifestyle are often found to be the principal causes of female infertility. An overweight man has a higher risk of having abnormal sperm.
  • Over-exercising – Woman who exercises for more than seven hours each week may have ovulation problems.
  • Not exercising – Leading a sedentary lifestyle is sometimes linked to lower fertility in both men and women.
  • Sexually transmitted infections (STIs) – Chlamydia can damage the fallopian tubes, as well as making the man’s scrotum become inflamed. Some other STIs may also cause infertility.
  • Exposure to some chemicals – Certain pesticides, herbicides, metals (lead) and solvents have been linked to fertility problems in both men and women.

Causes of Infertility in Women

Ovulation disorders – Problem with ovulation (release of the egg from the ovaries) is the most common cause of infertility in women. Ovulation is the monthly release of a mature egg from the ovary. In some cases the woman never releases eggs, while in others the woman does not release eggs during some cycles. Ovulation disorders can be due to:

  • Premature ovarian failure – The woman’s ovaries stop working (producing eggs) before she is 40.
  • PCOS (polycystic ovary syndrome) – The woman’s ovaries function abnormally. She also has abnormally high levels of androgen (male hormone). About 10% of women of reproductive age are affected to some degree. They may be affected by weight gain and abnormal facial hair growth as well irregular menstruation and cycles without egg production.
  • Hyperprolactinemia – If serum prolactin levels are high and the woman is not pregnant or breastfeeding, it may affect ovulation and fertility.
  • Poor egg quality – Eggs that are damaged or develop genetic abnormalities cannot sustain a pregnancy. The older a woman is, the higher the risk. Patients with reduced egg reserve and low AMH levels also might have poor egg quality.
  • Overactive thyroid gland – hyperthyroidism.
  • Underactive thyroid gland – hypothyrodism.
  • Other conditions like endometriosis may also sometimes affect egg quality and ovulation.

Tubal factors

Blocked fallopian tubes can cause difficulty in getting pregnant. If fallopian tubes are blocked the sperm from husband cannot reach the eggs and hence cannot fertilise it to form an embryo (baby).

How to check for Tubal patency ? What is HSG ?

Uterine factor

Some women have congenital absence of uterus and hence never get their periods (menses) and also can never carry a baby.

Other uterine causes of infertility could be due to abnormal shape of uterus or lining of the uterus. Thin endometrial lining or poor blood supply to the endometrial linning can cause infertility or recurrent abortions.This could be due to past pelvic infections, tuberculosis, repeated D & C etc.

Causes of Infertility in Men

Men may have a low sperm count or motility leading to infertility. Sometimes there may be problem with ejaculation or erection and hence the sperms are not getting deposited in the vagina.

They could have suffered from some infections like mumps or previous surgery on the testis or scrotum like hydrocoele which could have lowered their sperm count.

Normal sperm parameters as per World Health Organisation (WHO) guidelines 2010

PARAMETERS

LOWER REFERENCE LIMIT

Sperm volume (ml)

1.5

Sperm concentration (106/ml)

15

Total sperm number (106/ ejaculate)

39

Progressive motility (PR %)

32

Total motility (PR + NP, %)

50

Vitality (live sperm, % )

58

Sperm morphology (NF, %)

4

Ph

Ø  OR  = 7.2

Leucocyte (106/ml)

< 50

With the advancement in science it is now possible to treat most of these conditions and a couple can achieve pregnancy.

Causes of Infertility

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