Infertility is defined as the inability of a couple (male or female) to achieve conception or to bring out pregnancy even after a year or more of regular, unprotected intercourse.
Is infertility only a female problem?
No. There are almost identical cases of infertility in men and women. About 10-15 % problems are diagnosed as common to both partners of infertile couples. In minority of infertile couples (5-10%), the causes of the fertility problem remain unexplained even after thorough medical investigations, this is known as unexplained infertility.
Common reason of female infertility
Ovulatory and anatomical abnormalities are the most common causes of female infertility. While less frequent causes are hyperprolactinemia, endometriosis, thyroid gland related problems etc. Also various infections of the womb such as gonorrhoea, chlamydia and tuberculosis significantly contribute to female infertility in developing countries like India.
Cervical Causes- Infections, Hostile mucus, Hypoplastic cervix and Cervical anomalies
Ovarian Causes :Luteal phase defects, Annovulation and Polycystic ovarian syndrome
Uterus Causes : Development – e.g. hypoplastic uterus,bicornuate uterus
Endocrine Causes : Hypothalamic dysfunction, Pituitary failure, Thyroid disturbance, Adernal hyperplasia, and Androgen excess
Infections : Tuberculosis endometritis, gonococcal endometritis , infections after abortions
Tubal Factors : Acute PID, Chronic PID, and T.B.
General : Stress, Anorexia, Obesity , Anxiety, fear, Unexplained Infertility.
It can be divided into three main categories such as; Sperm production disorders, Anatomical obstructions and other factors like immunological disorders.
In almost half of the infertile male patients, no cause may be found for low semen report.
A number of factors which could be responsible for male infertility are;
It affects 20 % of all infertile men and may happen due to tumor or cysts, destruction of pituitary tissue, thyroid deficiency, congenital adrenal hyperplasia, and hyperprolactinemia. There may be Genetic causes also such as; True hermaphroditism, gonadal dysgenesis , klinefelter syndrome.
Varicocele:Infective Pathology such as Viral orchitis , gonococcal & tuberculous infection, prostatitis, seminal vesiculitis.
Block: Any obstruction in the passage of sperms.
Testicular Causes: Sertoli cells syndrome.
Immunological Causes: Physical & Chemical agents including some anti-depressant, anti-malarial, and anti- hypertensive medications; Chemotherapy may affect Spermatogenisis.
Non Endocrine causes:
Nutrition: Vitamin E, B Complex deficiency, and Protein.
Smoking: An abnormal and significant decreased sperm motility and counts have been found compare to non smokers.
Alcohol Abuse: Chronic alcoholism may cause decreased sperm production.
Heat: Excessive heat can adversely affect spermatogenesis especially in men whose occupation involves long hours of sitting e.g. Taxi or truck driver, travelling salesmen or business executives may develop excessive scrotal heat and suffered with impaired spermatogenesis.
Age Factor (Above 40 years): Recent research has revealed that fertility is decreased with the age because of the declining quality of the woman’s eggs. A woman in her early forties has only 5% chance of a naturally occurring pregnancy as compared to women of age between twenties and thirties (20-25%).
- In this condition the inner lining of the uterine wall is found outside of uterine wall identical to endometrium. Although, it is confined to the pelvic and lower abdominal cavity, but sometimes it may also reported to occur in other areas as well.
- It is usually diagnosed at the time of Laparoscopy.
- Advanced Laparoscpic surgery is performed using Lasers, electric current and scissors.
- Various drugs like Danazol, GnRh analogues or progesterones are useful in controlling Endometriosis.
Polycystic ovary syndrome (PCOS)
It is an ovulation disorder which affects 4-6% of all women. Several factors contribute to the disease. Some researchers confirmed it as genetic disease.
The major features of PCOS are
- Large polycystic ovaries can be seen using ultrasound.
- Irregular or no menstruation, hirsutism and acne due to increase in male hormones.
- Causes obesity in 40-50% women.
- High insulin levels with risk for developing diabetes.
- Treatment options are usually focused on regulation of the menstrual cycle.
- Several drugs are helpful like Clomiphene Citrate, Bromocriptine, and Gonadotrophins etc.
- Weight loss management is strongly advised.
- Newer oral anti-diabetic ‘Metformin’ is frequently used for a good outcome.
- In women with high levels of Luteinizing hormone (LH), a laparoscope is used to electrocoagulate the ovarian surface.
- If these women fail to become pregnant, then they may be subjected to Gonadotropin injections combined with an Intrauterine insemination procedure (IUI).
- Resistant cases of PCOS may be treated by performing ART procedures such as IVF or ICSI.
Damaged fallopian tubes
- Patients with Damaged fallopian tubes are affected with fertility problems and at a risk for having a pregnancy located in the tubes (ectopic or tubal pregnancy).
- In older years, IVF was specially developed for women facing infertility due to damaged fallopian tubes.
- Today tubal damage still accounts for a large number of all IVF treatments due to various abdominal infections.
- In India, Genital Tuberculosis and sexually transmitted diseases are the biggest culprits of a womb infection.
- Complicated appendicitis or Pelvic Inflammatory Disease (PID) can also cause damaged tubes.
- Other causes are abdominal operations such as gynecological operations, cesarean section, sterilization, or other procedures and internal diseases like Crohn’s disease.