W.H.O explains infertility as“a disease of the reproductive system defined by the failure to achieve a clinical pregnancy after 12 months or more of regular unprotected sexual intercourse.” This inability is attributed to an array of factors such as lifestyle indulgences, stress, hormonal imbalances and many more. Irrespective of the reason, the couple have to face tremendous social and psychological impacts especially in Indian society.
For couples eager to have children but dealing with fertility issues are like birds longing to fly but have their wings clipped. It is nothing less than a depressing and disheartening situation for them. It is typical of certain societies to blame women for not conceiving. But let’s not forget that men contribute equally towards childbirth and alarmingly infertility in men accounts to around 30-40% in couples who are unable to conceive.
Not everyone is fortunate enough to sail through the blissful experience called pregnancy. Approximately 15% of the couples in India have problems relating to infertility and conception. Nevertheless, technological advancement in science and medicine creates chances of hope for many aspiring couples. Advanced techniques and safe procedures can address fertility issues and can significantly transform hope into reality.
1.Overview of Infertility
Having children and continuity with family is immemorial and Infertility is a social stigma even today. When a couple is unable to have children through natural means despite trying for a year or more, they undergo a huge psychological and emotional stress.
The process of pregnancy can be penned down in stages as below.
- A woman’s body releases an egg from one of her ovaries. This process is called ovulation.
- The egg then goes through the fallopian tube and moves into the uterus or the womb.
- Here the man’s sperm fertilizes with the egg.
- The fertilized egg then attaches to the inner layer of the uterus called the endometrium.
Infertility can occur if there are problems in any of the above stages.
Are women or men more likely to be infertile?
Infertility is not merely a female’s problem. According to the Department of health and human services, about one third of fertility problems are due to men’s problems, another one third is due to female infertility and the rest one third is because of a combination of both men and women’s fertility issues or some other unknown cause. We can say that both men and women can have problems relating to fertility.
Proper diagnosis can be helpful to find the exact cause that paves ways for treatment options. Advanced treatment approaches to treat infertility in both male and female can definitely ameliorate the chances of conceiving for longing couples.
2. Types of Infertility
There are basically two types of infertility that depend on your status as a parent.
- Primary infertility which means that the couple coming for consultation has not conceived at all. conditioned that there is no use of contraceptives or protection.
- Secondary infertility is when the couple had conceived earlier but, unable to attain pregnancy now.Either they had carried the pregnancy to full term or they had a miscarriage
However, it is seen worldwide that couples seek treatment for primary infertility reasons more than that of secondary infertility. The time brackets of definitive infertility vary according to age of the women.
For women, who are of the age 35 and below, infertility refers to the inability to get pregnant for a year or more. But for women above 35 years, the time period is reduced to six months. As the age of the women increases, their ability to conceive decreases with fluctuations in hormones and early onset of menopause, decrease in ovarian reserve etc.
3. Main causes of infertility in men and women
A wide spectrum of infertility reasons in both men and women can be due to dietary, hormonal, age, obesity, medications or medical reasons. Not to forget the environmental, lifestyle and genetic factors that add up to the list. Psychological conditions like anxiety and depression too contribute to infertility.
Causes of Infertility in men – It is observed that 90% of the male infertility is due to low sperm count and poor sperm quality. Some of the causes of male infertility are:
- Oligospermia or low sperm count is one of the major reasons for infertility in men. Oligospermia is medically termed when the sperm count is less than 15 million /ml.
- Azoospermia refers to total lack of sperm production while ejaculation.
- Abnormal sperm morphology can affect the sperm’s ability to fuse with the ovum. At least 60% of the sperms should be in proper shape and dimension for fertilization to take place effectively.
- Ejaculation disorders and less motile sperms can also lead to infertility in men.
- Apart from the above conditions, genetic factors like klinefelter’s syndrome and certain environmental factors, etc contribute towards male infertility.
○ causes of Infertility in women
The causes of infertility in women are listed as follows :
- Problems relating to fallopian tubes or blocked tubes can cause hindrance to the movement of the egg. Inflammation and bacterial infection like tuberculosis in the pelvic region, endometriosis, etc can block the fallopian tubules.
- PCOS (polycystic ovarian syndrome) is one of the primary causes of infertility in women.Polycystic ovary syndrome is a disorder associate with an imbalance in female sex hormones. The imbalance can lead to a variety of symptoms and may affect a woman’s fertility.
- Premature ovarian failure where the ovaries stop producing eggs unusually early, before the age of 40. This is different from the menopause, which generally occurs around the age of 50.
- Hormonal imbalances cause anovulation where the ovaries fail to release an egg for a period of three or more months. Anovulation and irregular menstruation can lead to infertility in women.
- Endometriosis is a problem where the endometrium grows outside the uterine cavity. This ailment causes female infertility. These mechanisms for infertility in endometriosis include distorted pelvic anatomy, endocrine and ovulatory abnormalities.
- Based on common observations uterine problems like fibroids, polyps etc and cervical issues also can lead to infertility.
- Genetic factors too play an important role in infertility in women.Chromosome analysis of the parents’ blood identifies such an inherited genetic cause in such couples.
4. Are there any symptoms of Infertility?
The main symptom of infertility is not being able to conceive. Apart from this, how can a woman tell if she is infertile?
It’s necessary to understand that certain signs and indications are observed, they are :
- Irregular or absence of menstruation.
- Extended menstrual periods of 35 days and more or short termed menstrual periods of less than 20 days.
- Heavy periods with excessive muscle cramps
- Some even undergo pain during sexual intercorse.
- Hormonal fluctuations and reduced sex drive
Interestingly, even men having infertility do show some signs such as :
- Hormonal changes and changes in sex drive
- Problems relating to ejaculation
- Small and firm testicles
- Or sometimes swelling and pain in the testicular region can be observed.
The effects and aftermath of the coronavirus are known to almost everyone. We are much aware of the impact of SARSCov2 on the respiratory system. But, recent studies prove that this life-threatening virus can even cause fertility issues.
Actually, the virus releases the protein into the healthy cells of our body, and these healthy cells that COVID-19 targets are the ACE 2 receptors. These receptors are present everywhere in our body. Since the COVID-19 is a respiratory illness, the virus first enters the respiratory tract.
The virus and its multiple copies that it forms within the body later target the other cells with ACE2 receptors present in different organs like the kidney, liver, pancreas, blood vessels, eyes, and skin. They can attack the ACE2 receptor of cells present in the reproductive organs and thus lead to a reduction in sexual hormone production, hamper the proper functioning of reproductive organs and cause infertility.
In men, the ACE2 receptors present in testicles, prostate glands can get affected by the corona infection impacting the sperm numbers, morphology, and motility. In women, research findings have shown that reduced ovarian reserve, poor uterine receptivity as the covid 19 can attack the ACE2 receptors of the ovaries and uterus. The immune responses are also hampered and the hypothalamic-pituitary-gonadal axis is affected leading to hormonal variations causing an impact on fertility and pregnancy.
Studies also indicate that pregnant mothers with covid cannot transmit the corona infection to their child through the placenta, but severe covid infection can lead to preterm delivery affecting child development.
Since the studies are in their initial stages and need more statistical data, early diagnosis can help eradicate any negative impact on the reproductive system. Consulting an Infertility specialist to check with basic tests that can assess the fertility issues is advised for covid recovered patients and vaccinated couples with various telehealth options nowadays.
6. Test and Diagnosis
Diagnosis of infertility involves physical examination, a check over the sexual history and health records. The Infertility Doctor will also consider the couple’s age into account. After an in-depth medical assessment, the below mentioned tests can be considered for further evaluation.
○ Diagnostic tests for infertility in Men include
- Semen Analysis : The semen sample will be collected to check the sperm count, sperm motility, sperm morphology and sperm maturity. It also tests the volume and density of the ejaculate.
- Testicular biopsy : This test is performed to find the presence of obstructive azoospermia.
- Genetic tests : The sperm’s integrity is analyzed for any genetic or chromosomal mutation.
- Urine Analysis : It helps eliminate the presence of any infection in the urine sample
- Ultrasound : These imaging techniques can be used to view the presence of blockage in the reproductive ducts ,size of testis ,varicose etc
- Other tests : Other tests include blood analysis, post ejaculate urine analysis, etc that would help find out the exact cause of infertility in men.
○ Diagnostic tests for infertility in women include
- In women, the menstruation regularity, absence of menstruation and the menstrual cycle is monitored.
- Ultrasonography : This imaging technique is used to examine the integrity of the ovary and other reproductive organs of the female.
- Hysterosalpingogram : It is a radiological process where a fluorescent dye is injected into the uterus via the cervix, this shows images of the fallopian tubules, and can detect the blockage or any other abnormalities.
- Hysteroscopy : A small device with light and camera at the end is inserted into the cervix. This creates images of the uterus helping in diagnosis and treating polyps, fibroids if any.
- Laparoscopy : It is a surgical procedure for evaluating the structures of the reproductive system, including the ovaries, fallopian tubes, and uterus. This procedure is used in cases of endometriosis.Among the procedures that can help detect the cause of infertility, laparoscopy is less invasive.
- Complete hormonal assay : Hormonal imbalances need a check with a hormonal assay. They check the levels of hormones such as LH, FSH, AMH etc.
- Other tests : Tests like thyroid functionality test, testosterone and prolactin amounts are tested in case of PCOS, blood analysis, urinalysis, etc can be done.
7. Treatment options for Infertility in men and women
Can Infertility be cured? is a common question that comes to mind. A cure for infertility can be to undertake a treatment to conceive successfully. The treatment options available are :
- Initially, the treatment starts with medications, dietary changes, Lifestyle Modifications to Improve Fertility that are essential to create an environment for the reproductive organs to work efficiently. Sometimes these small changes can work.
- Hormonal therapy : Hormones stability, production and function is very crucial when it comes to the functioning of reproductive organs. Creating a hormonal balance of these hormones can help gain pregnancy for many.
- Surgery : In cases of treating blocked , inflamed ducts in the reproductive systems of both men and women, drilling of ovaries for PCOS surgery can be performed in selected cases.
- Artificial Insemination technique : Also known asIntrauterine insemination (IUI), is a procedure where the semen that is collected is inseminated into the vagina after washing while the woman is ovulating can help initiate pregnancy. It can be useful in patients who have healthy tubes .
- Assisted Reproductive Techniques : When the above treatment options are ruled out, ART techniques involve advanced procedures that can help improve the chances of conceiving. Different ART procedures used are :
- IN VITRO FERTILIZATION (IVF) : IVF procedure of ART requires the retrieval of the eggs and the sperms from the mother and father respectively, which are incubated together in a laboratory to form embryos. The embryo is allowed to develop further for 3-5 days until it is implanted in the uterus .
- INTRACYTOPLASMIC SPERM INJECTION (ICSI) : To address the problems related to sperm quality and morphology, the selected sperm is directly injected into the egg to cause effective fertilization also in cases where sperm are retrieved from the testicles or epididymis .
- Third party-assisted ART. This is when another person helps a couple get pregnant. They can help by donating sperm, donating eggs, or donating embryos. They may also serve as a surrogate or gestational carrier
- EMBRYO ADOPTION : Sometimes, when complications relating to infertility cannot be solved,multiple attempts at IVF treatment have failed or one or both parents has a genetic disorder, which they could pass onto their offspring use of donor sperms and eggs can help them conceive
- GESTATIONAL CARRIERS : When a woman is unable to carry her pregnancy because of being born without a functional uterus ,Significant uterine abnormalities, including uterine scarring (Asherman’s Syndrome) etc surrogacy can be considered.
Treatments for male infertility include: Surgery. For example, a varicocele can often be surgically corrected or an obstructed vas deferens repaired, treating infection, hormone treatments and medications- hormone in cases where infertility is caused by high or low levels of certain hormones,treatment for ejaculation disorders, Assisted reproductive technology (ART) which involve obtaining sperm through normal ejaculation or surgical extraction (TESA/PESA).
To know which Infertility treatment is the best in 2021 and most suited for your concern. Consult the best specialists at Omya for the right guidance and treatment.
Infertility is not any disease, it’s the inability of the reproductive organs or the organs of your spouse to indulge in an active pregnancy. For questions like, Is infertility permanent? It’s important to note that fertility issues can be there for a limited period of time for many if diagnosed and treated promptly. Analysing the exact reason for delayed pregnancy with diagnostic tests and a thorough examination process is the right approach. Comprehensive understanding of the causes of fertility issues can open a wide range of treatment options to deal with infertility. Omya, provides you the right advice, helps you evaluate the etiology and endures a proper treatment plan to overcome fertility issues and embrace parenthood.