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EDUCATION CORNER
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    Infertility

    Every couple dream of having a child at one point or another during their lifetime. According to WHO, globally 10% of women are inflicted- women who have tried for conceiving and remain unsuccessful even been in a stable relationship for five years or more. 

    Therefore, infertility is termed when the couple undergoes unprotected sexual intercourse and unable to conceive, at least one year of period or more.

    Infertility is not the plight of a woman but can occur in males as well. Hence, it is recommended that both the partners are thoroughly checked with equal importance to find out the cause of infertility. 

    Infertility is categorized into two types:- 

    1.Primary infertility

    Primary infertility is when the couple is having sex for about a year without using birth control and still are not able to conceive. 

    2.Secondary infertility - Secondary infertility is when the couple has conceived once but are not able to conceive anymore. 

    There are numerous reasons for infertility, and most can be diagnosed and treated.

    • Infertility in females
    • Infertility in males

    1.Risk factors of infertility


    Risk Factors for women

    Factors which affect the ability of the women to ovulate, conceive or to carry a full term baby are:-

    • Age: Fertility is an age-related factor. It decreases with age. Women are highly fertile in their early 20s and becomes less fertile in their late 35s. See your specialist if you are over 35 and you are trying to get pregnant from the past 6 months or more.
    • Sexually transmitted diseases: These are the most common cause of PID (pelvic inflammatory disease) which decreases the chances of fertility.
    • Endometriosis: Endometriosis is a disease in which uterine tissue is found outside of the uterus. 
    • Hormonal imbalance: Hormonal imbalance can cause irregular periods, heavy bleeding, hirsutism (facial hair) and acne.
    • Multiple miscarriages: More than two miscarriages can cause infertility. Consult your doctor to know the problem.
    • Ovulation disorders: The eggs may never be released, or they may only be released in some cycles. They are like Premature ovarian failure, Polycystic ovary syndrome (PCOS), Hyperprolactinemia, Poor egg quality. Regularly monitor your ovulation days through ovulation calculator to get aware of any upcoming risks and concerns.
    • Problems associated with the uterus or fallopian tubes: It can prevent the egg from reaching the uterus or womb from the ovary. So if the ovum will not reach the right place then it is hard to conceive. 


    Risk factors for men:

    • Problems in sperm: Sometimes the sperm cannot travel effectively to meet the ovum.it is because of low sperm count, low sperm motility or abnormal sperm.
    • Problems in semen: if the semen is abnormal it may not carry sperm effectively. Cause of abnormal semen is an infection of testis, cancer, if the testis not descended, wearing tight clothes, and working in a hot climate.
    • Ejaculation disorders: when the ducts of ejaculation are the semen reach into the bladder and therefore not able to reach the ovum, which leads to infertility. 
    • Hormonal imbalance: For example, decreased the level of testosterone which occurs due to the hypogonadism.
    • Genetic factors: If the person is having Klinefelter’s syndrome that is instead of having one X and Y chromosome man have 2 X and one Y chromosomes. This can lead to defective growth of gonads which results in low sperm count or no sperm. 
    • Mumps: If this happens after adolescence, inflammation of the testicles may affect sperm generation.
    • Radiation treatment: It decreases the semen production therefore low sperm count. The seriousness depends upon the site of exposure. 
    • Some diseases: Certain diseases like Anemia, Cushing's syndrome, diabetes mellitus, and thyroid dysfunction decreases fertility in males.
    • Age: In male too fertility is an age related factor it declines after 40 years of age.


    Common Risk factors for men & women both:

    • Emotional factors: Depression and pressure may directly affect the hormones that control reproduction and affect sperm production or ovulation.
    • Occupational and environmental risks: Prolonged introducing to high temperatures, high mental pressure, radiation, chemical, or overwhelming electromagnetic or microwave emissions may become reason of infertility in men & ladies.
    • Unprotected sex: Multiple sex partners and not using condoms predisposes you to the risk of sexually transmitted diseases (STDs) which is a leading cause of infertility in men & women.
    • Smoking: Smoking also results in Infertility in women and low sperm count in males. 
    • Alcohol consumption: Even moderate alcohol consumption – as few as five drinks a week – can impair conception.
    • Being overweight or underweight: Body fat levels 10 percent to 15 percent below or above normal have a greater risk of infertility. It’s important to consult dietician and yoga & exercise expert for proper weight management.  


    Causes of infertility in females are:



    • Autoimmune diseases like ant-phospholipid syndrome (APS)
    • Reproductive tract birth defects
    • Cancer or fibroids
    • Clotting disorders
    • Diabetes mellitus
    • Alcohol consumption over limit
    • Too much of exercise
    • Nutritional deficiency
    • Abnormal growth in the uterus and cervix (polyps or fibroids)
    • Side effects of drugs
    • Hormonal imbalance
    • Obesity
    • Old age
    • polycystic ovary syndrome(PCOS)
    • Pelvic inflammatory disease
    • Smoking
    • Surgical procedures 
    • Thyroid abnormalities


    Specially with Men: Issues with semen and the sperm

    During ejaculation male release the semen which consists of Sperm (release from testes) and fluids (release from various glands) which help in travelling the sperm towards the egg after the sexual intercourse. The issues which lead to infertility are

    • Low sperm count
    • Issue with sperm motility
    • Abnormal shape of sperm
    • Abnormal semen
    • Hormonal issues (testosterone deficiency)


    Causes of infertility in males are:

    • Birth defects
    • Medication like chemotherapy for cancer
    • Extreme heat exposure for a long period of time 
    • Alcohol and drug abusers
    • Hormonal imbalance
    • Impotence
    • Infection
    • Obesity
    • Old age
    • Reverse ejaculation
    • Smoking
    • Environmental toxins
    • Vasectomy 


    2.Treatment:

    • Treatment for infertility depends upon its cause. Your doctor is the best person to evaluate your reasons and advice appropriate treatment for it. Some treatment options include: 
    • Education and counselling of the couple about the right time for sexual intercourse and healthy living. 
    • Medication: consult with a gynecologist. 
    • When there is any tubal or pelvic abnormality it can be surgically corrected with laparoscopy, consult your gynecologist for better understanding.
    • Hysteroscopy is done to remove any fibroids or tumors present in the uterus


    In case all these treatments fail to result in pregnancy, the following novel techniques can be adopted for pregnancy: 

    Assisted Reproductive Technology (ART): This is a procedure where the woman's egg is taken out and fertilised with a sperm. The embryo formed is put back into the womb of the woman. (IVF)  

    Artificial insemination: In this, egg donation is done when the ovary is not functioning properly. So the egg is taken from a reproductively healthy donor and fertilization is induced in a laboratory. After fertilization, the embryo is transferred into the recipient's uterus. (Intrauterine insemination, also known as IUI).


    Women are highly fertile in their early 20s. After the age of 35, the chances of conceiving highly decrease and especially after age 40.


    The problem of Infertility and rate of miscarriages increases greatly after 35 years of age. 


    There are several strategies which can increase the chances of conception.

    Having intercourse regularly many times especially around ovulation increases the chances of getting pregnant. Start having intercourse 5 days before till 1 day after ovulation increases the chances of conception.


    References:

    https://www.who.int/reproductivehealth/topics/infertility/perspective/en/

    https://www.cdc.gov/reproductivehealth/infertility/index.htm

    https://www.acog.org/Patients/FAQs/Having-a-Baby-After-Age-35-How-Aging-Affects-Fertility-and-Pregnancy?IsMobileSet=false#how ---- (Pregnancy in age 35-45 years)

    https://www.who.int/news-room/fact-sheets/detail/adolescent-pregnancy --- (Pregnancy < 18 years)

    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3017326/ --- (Advantages of pregnancy between 18-35 years)

    Frequently Asked Questions

    Timing: Most of the females make wrong assumptions about their ovulation day. Though it is stated that ovulation occurs on day 14 in a normal 28 days cycle, but this 28-day cycle is not common for everyone. So, in order to figure out the ovulation day, you need to count back 14 days from the day of your period through ovulation calculator. This is back counting for the period that has already passed. But if your cycle is fairly regular, you can assume the ovulation day in the next cycle. You can also take the help of fertility calendar. 

    Waiting too long to take specialist’s advice: You may feel absolutely normal but if pregnancy is not happening even after 6 months of unprotected sex, it is time to consult a specialist and take advice for conception. 


    • Laboratory testing
    • Transvaginal ultrasound 
    • An endometrial biopsy 
    • Hysterosalpingogram (HSG)
    • Laparoscopy 
    • Semen analysis (male fertility test)


    In females, infertility can be due to: 

    • Damage to the fallopian tubes
    • Pelvic inflammatory diseases  
    • Hormonal imbalance 
    • No or improper ovulation 
    • Uterine abnormalities like fibroids, polyps
    • Cervical problems 
    • Advancing maternal age
    • Endometrial polyps
    • Endometriosis


    In males, infertility can be due to: 

    • Unusual function or production of sperm 
    • Undescended testicles
    • Genetic Issues
    • Health issues like diabetes or infections 

    Cure for infertility depends upon its cause. There are many infertility treatment options that can help a couple conceive but even if they fail, Assisted Reproductive Technology (ART) and Artificial insemination can be your ray of hope in the darkness.