Pregnancy is a wonderful gift. Almighty has bestowed many women with the miraculous power to give birth to a life. For couples, who are not blessed with their progeny, Infertility is no less than a curse.
For a woman to conceive – intercourse must take place around the time when an egg is released from her ovary. Husband’s and her reproductive system should be functional at optimum levels. She should have patent tubes to allow fertilization of eggs and a normal womb with balanced hormonal milieu to harbor the fetus for nine months.
According to the World health organization, “Infertility is defined as the failure to achieve a clinical pregnancy after 12 months or more of regular unprotected sexual intercourse in the absence of any other reason, such as breastfeeding or postpartum amenorrhoea.”
Worldwide around 7-10 percent of couple are affected by Infertility.
Primary infertility is labeled when the couple has never had a successful live birth inspite of in union for five years without any contraception. However, Secondary infertility is defined as the absence of a live birth for women who desire a child and have been in a union for at least five years since their last live birth, during which they did not use any contraceptives.
The obstetric history of still born and spontaneous miscarriages is not considered as pregnancy and such patients are also considered into primary infertility. Thus the distinguishing feature is whether or not the couple has ever had a pregnancy which led to a live birth.
What is responsible for Infertility?
What are the causes of Infertility in Males?
Male fertility peaks usually at age 25 and declines after age 40. The various causes of male infertility are categorized into –
Loss of libido.
Erectile dysfunction & Premature ejaculation.
Obstruction of genital tract that carry sperm form testis to penis leading to Aspermia.
Poor quantity or quality of sperms in semen due to testicular insufficiency.
(Sperms need lesser temperature for survival, and hence, the testes are placed outside the body safely in scrotal bag. High temperature exposure to testes like furnaces, extremely hot weather, tight clothing, infection/ inflammation or abnormal blood supply etc can adversely affect sperms resulting in male factor infertility.)
What is normal semen analysis report?
According to WHO criteria in 2010.
Treatment of Male Infertility
What are the causes of Female infertility?
Female fertility is high between 20-30 years of age, starts reducing after 30 and drastically falls after 35 with pregnancy occurring rarely after age 50.
The causes of female infertility are classified into –
1- Ovulatory causes of Infertility :
In normal menstruating females with 21 to 35 days cycle, the ovulation may occur anytime between 7th to 21st days respectively. The life of released egg is only 24 hours during which the female is most fertile.
The ovulation can be detected by
Potential causes of anovulation (absence of ovulation) include the following:
The tests that are recommended to access ovarian function:
No single test is a perfect predictor of fertility. However the commonly used tests are:
2- Fallopian Tubal causes of Infertility?
Blocked or unhealthy swollen fallopian tubes prevent fertilization of egg resulting in infertility. The tubes may be affected due to –
The patency of tubes may be evaluated by
It is an X-ray of the uterus and fallopian tubes. A radiologist injects dye into the uterus through the cervix and simultaneously takes X-ray pictures to see if the dye moves freely through fallopian tubes. This helps evaluate tubal caliber (diameter) and patency. The patient may experience pain, syncope, dye reactions etc.
The patency is checked by infusing normal saline and evaluating under ultrasonography. It is less painful and there is no risk of dye reactions.
It is a kind of surgery, where a special telescope called laparoscope, is inserted into the abdomen and the inside is visualized. It is often clubbed with diagnostic hysteroscopy (visualization of inner uterine cavity with the help of hysteroscope). The methylene-blue dye is injected into the uterus and tubal patency checked.
3– Uterine causes?
The uterus provides a home to the fetus. The following uterine pathologies may lead to infertility-
4- Miscellaneous causes?
5- Unexplained infertility
Up to 10-20% of infertile couples have unexplained infertility. In these cases abnormalities are likely to be present but not detected by current methods.
Effects of Infertility –
Emotional stress, family disharmony and marital difficulties are greater in couples where the infertility lies with the man.
Social impact –
Financial impact –
Physical health impact –
The management of infertility depends upon the age of the couple, duration of natural attempt, responsible causes and associated factors.
The treatment of infertility includes-
a- Intrauterine Insemination –
It is the deliberate introduction of male’s healthy sperms achieved by seminal wash into female’s uterus.
The ovulation induction drugs are prescribed to help 1 or 2 eggs grow. When the egg is 20-22 mm large and endometrial thickness is optimum 7 to 9 mm, the prepared sperms are injected into the uterine cavity with the help of special cannula so that the fertilization occurs inside the body.
b- Invitro fertilization –
The ovaries are stimulated to increase egg production. The maximum possible mature eggs are retrieved and fertilized by sperms outside the body producing embryos. One or more healthy embryos are transferred into the uterine cavity. With the method of ICSI, the DNA of sperm may directly be injected into the egg.
The success of Infertility treatment is assessed by the rate of live birth. It is only around 40-50 percent.
To understand this low rate of success, let us take an example. If we sow 100 good quality seeds, few would fail to germinate, some would be arrest at plant or bust stage and only around 40-50 percent would attain their potential to become tree. Like seeds, the live birth rate of embryo depends on many factors like, genetic potential of the embryo, its structural development, safe uterine and hormonal environment, optimum nourishment through the placenta etc.
Law is simple – “Survival of the Fittest“. The healthy embryo would find its place in this world by any means, & the progeny would continue
The information is shared to create awareness towards Pregnancy and Childcare to reduce maternal and child deaths. Atmost care has been taken by the author to include the verified information from authentic sources. However, kindly discuss the same with your health care provider before implementation.