Did you know that one in every five to six couples could have some fertility-related problem? In India, infertility affects 10—14% of the population, i.e., 22 to 33 million couples. The stress of being diagnosed and dealing with the issue can cause a sense of hopelessness, frustration, and unhappiness due to a feeling of inadequacy or unfulfillment. But it’s important to know that treatments are available in the form of medicine, surgery, and assisted reproductive technology such as artificial insemination.
What is infertility?
Infertility is characterised by the failure to establish a clinical pregnancy after 12 months of regular, unprotected sexual intercourse or due to an impairment of a person’s capacity to reproduce either as an individual or with his/her partner.
Capacity here is in the context of sexual maturity, which men and women attain at the age of 12 or 13 years. Women can have children until they are 48—50 years, after which menopause ends fertility. Men can father a child for many more years, but the chances of conception and having a healthy child reduce after the age of 40. Capacity also implies a full-term pregnancy which lasts between 39 weeks and a day short of 41 weeks.
Infertility can take different forms
Infertility can be primary or secondary.
In primary infertility, the woman is unable to become pregnant or carry pregnancy to a live birth. Thus, pregnancy that spontaneously miscarries, or results in a stillborn child, without ever having had a live birth would suggest primary infertility.
In secondary infertility, the woman is unable to become pregnant or carry a pregnancy to a live birth following a previous successful pregnancy. It also implies repeated spontaneous miscarriage or stillbirths.
Treatment of primary and secondary infertility
As secondary infertility is usually due to certain health or environmental changes, it can be treated directly with medication. In the case of primary infertility, however, there is always the likelihood of a comparatively serious abnormality of the reproductive system, or a long-term ongoing endocrinal issue. Knowing the nature of infertility (primary or secondary) can help in identifying possible causes.
Is it mostly in men or women?
The source of both kinds of infertility might be seen in either one of the partners or in both. In India, the female factor constitutes 40—50% of infertility, while male factor is rising to 30—40%.
Causes of infertility
In men, the causes of infertility could be:
- Abnormal sperm production or function due to undescended testicles, genetic defects, pre-existing health conditions – such as diabetes, mumps, or STI (chlamydia, gonorrhoea, HIV) – or varicocele
- Poor transmission of sperm due to sexual conditions (premature ejaculation), genetic ailments (cystic fibrosis), physiological problems (a blockage in the testicle), or a damaging injury to the reproductive organs
- Overexposure to pesticides and other chemicals, radiation, tobacco, alcohol, recreational drugs (marijuana), medication (select antibiotics, antihypertensives, anabolic steroids), or heat (saunas or hot tubs) can affect sperm production
- Cancer and its treatment
In women, the causes of infertility could be:
- Impaired ovulation due to excessive exercise, eating disorders, injury, tumours, or hormonal imbalance which affect the release of eggs from the ovaries. Hormonal disorders include polycystic ovary syndrome, hyperprolactinemia, hyperthyroidism or hypothyroidism
- Abnormality in uterus or cervix such as deformed cervical opening, uterine polyps or fibroids, or uterus shape
- Damage or blockage in the Fallopian tube due to an inflammation from a pelvic inflammatory disease by a STI, endometriosis or adhesions
- Endometriosis – growth of the endometrial tissue outside of the uterus
- Pelvic adhesions – bands of scar tissue that bind organs after pelvic infection, appendicitis, or abdominal or pelvic surgery
- Delayed puberty or the absence of menstruation (amenorrhea) or premature menopause due to immune system diseases, genetic conditions (Turner syndrome, Fragile X syndrome), radiation, chemotherapy, or smoking
- Cancer and its treatment
- Poor diabetes management
- Autoimmune diseases such as lupus and Celiac disease
If you’ve been struggling to get pregnant despite a year of concerted efforts, it may be time to visit a gynaecologist. Men can visit an andrologist or urologist to check for infertility. You will soon see that an effective step to tackling infertility is to open up to talk about it and seek medical counsel at the first sign of trouble.