Life is very short. The main purpose of all living things on earth is to reproduce. Likewise, we human beings are bound by our duty to reproduce. Reproduction is the art of producing new organisms that is the process whereby life is continued from one generation to other. Parenting a child is one of the best feelings in the world. But unfortunately, some of the couples are deprived of this opportunity because of infertility problems.
WHAT IS INFERTILITY ?
Infertility is the inability to conceive and become pregnant after 12 months of regular, unprotected sex. If a couple does not conceive after a year of effort, it is likely that the man, the woman, or both partners are infertile. Infertility affects men and women equally. Infertility affects 10-15% of all married couples. 80% of couples conceive within a year. Another 5-10% conceive in the subsequent years (within 2-3 years) and the rest remain infertile.
Conception and pregnancy are complicated processes involving many biologic factors. A man should produce healthy sperm and a woman healthy egg; the cervical mucus should be healthy and abundant so that the sperm travels through the cervical canal to the uterus and fallopian tubes; the fallopian tubes opens so that the sperm can reach the egg; the sperm fertilizes with the egg and the fertilized egg (the embryo) implants in the woman’s womb and the outcome is a beautiful baby. While this may seem simple, but if any one of the biologic factors is impaired or damaged in any way, infertility can result.
TYPES OF INFERTILITY
Infertility is classified into two types:
- Primary infertility – When no pregnancy has ever occurred. Approximately 70% of infertile couples have primary infertility.
- Secondary infertility – When there has been a previous pregnancy regardless of the outcome. Approximately 30% of couples have secondary infertility.
WHO IS RESPONSIBLE FOR INFERTILITY ?
In approximately 42% of infertile couples, the cause is identified in the male and in 38% the cause is identified in female and in 10% of couples, causes can be detected in both partners. In about 10% of cases, the cause is not yet found by the current diagnostic methods. It is known as unexplained infertility.
WHO IS RESPONSIBLE FOR INFERTILITY ?
In approximately 42% of infertile couples, the cause is identified in the male and in 38% the cause is identified in female and in 10% of couples, causes can be detected in both partners. In about 10% of cases, the cause is not yet found by the current diagnostic methods. It is known as unexplained infertility.
CAUSES IN WOMEN
1. Ovulation problems
This is the common cause of female infertility. The woman usually experience infrequent or scanty periods, irregular periods or absent periods altogether (amenorrhoea). Incidence of infertility due to ovulation problems is approximately 20-25%.
Ovulation disorders can be classified into:
• Annovulation i.e. lack of ovulation
• Oligoovulation i.e. infrequent ovulation
• Luteal phase defects
2. Tubal problems
Tubal damage is also a common cause of infertility. Damage to the fimbriae reduce or stop their ability to pick up the egg and direct it into the Fallopian tube. A woman with tubal problem will usually have severe period pains, irregular or heavy periods, chronic or recurrent pelvic pain and tenderness. Incidence of infertility due to tubal problems is approximately 15-25%.
3. Infection in reproductive organs
Pelvic inflammatory disease (PID) is a very serious abdominal inflammation that results from untreated vaginal or cervical infections and is one of the causes of infertility. PID does serious damage to a woman’s reproductive tract like scarring and blocking the fallopian tube. Scarring prevents fertilization from ever occurring.
4. Endometriosis Endometriosis is a condition in which cells that line the inside of the womb are established outside the womb like on the ligament supporting the uterus, in the ovaries, tubes, pelvis, bowels, bladder, etc. Endometriosis occur in women who are in their 30s and early 40s. It adversely affect the egg development, sperm binding to the egg, fertilization, tubal function and embryo implantation and thus cause infertility.
5. Cervical mucus hostility The cervical mucus is a jelly-like substance produced by minute glands in the cervical canal. It changes in consistency and composition with the menstrual cycle. Once the sperms are in the mucus, they can stay there for few days. Thus the mucus acts as a sperm reservoir. Cervical mucus hostility is the inability of sperm to penetrate the cervical mucus. Incidence of infertility due to cervical mucus hostility is 1-2%.
CAUSES IN MEN
There are four main causes for infertility in men. They are as follows :
1. Azoospermia (No sperm): Which accounts for about 3-4% of male infertility.
2. Abnormal semen: Oligospermia (Poor sperm quantity or quality): for e.g. Asthenozoospermia (low sperm motility) Teratozoospermia(high percentage of abnormal sperm) Antisperm antibodies, etc. This accounts for about 90% of male infertility.
3. Sperm dysfunction: Here the sperm have a defective fertilizing capacity, resulting in complete failure of fertilization or poor fertilization of the eggs. This accounts for about 3-6% of male infertility.
4. Ejaculatory failure: Inability to ejaculate into the vagina. This accounts for about 4-6% of male infertility.
GENERAL CAUSES
1. AGE : Age is one of the common causes of infertility. As one gets older the chances of infertility increases. But this is more commonly seen in women. Fertility will drop around the age of 35 and as many as 25-30% of women older than 35 are infertile. The ability to conceive naturally decreases over time as part of normal ageing process.
2. LIFESTYLE: In addition to sexual behavior, other behaviors have been shown to be associated with an increased likelihood of infertility, like
• SMOKING : Significant increase in infertility is seen among people who smoke at least one pack of cigarette daily.
• ALCOHOL : One of the study shows infertility is significantly greater among women who will have 5 or more drinks a week.
• OBESITY : Obese women are more likely to be annovulatory and consequently infertile, than women who are within their normal body weight range.
3. ABNORMAL HORMONE LEVELS: Diseases that affect hypothalamus, pituitary gland, adrenal gland, thyroid gland, pancreas, ovaries and testes where the hormones are produced can lead to infertility, because the activities of all these hormones are interconnected. An excess or deficiency of any hormone can lead to annovulation and cause infertility. This can happen in both partners.
4. IMMUNOLOGICAL INFERTILITY: Sometimes for unknown reasons the body develops antibodies against sperm. The sperm will then be sensed as “foreign” and are attacked by the body in a similar way like the body attacks infecting organisms. Antisperm antibodies can be present in one or both partners. It can be present either in the blood or in the genital tract secretions such as cervical mucus or ejaculate. Antisperm antibodies will make the sperm ineffective by making them stick together and preventing them from being released. In the female, antisperm antibodies will interfere with the process of sperm transport and fertilization.
5. COITAL FAILURE: Some infertile couples experience difficulty in having a baby because of coital failure or inappropriate timing of sexual intercourse. Infrequent intercourse or avoiding intercourse in the fertile period (middle of menstrual cycle) decreases the chances of pregnancy.
CONCLUSION
The causes of infertility are many. The cause may be physical or psychological. Many men and women suffer for years without seeking medical advice or help. This is often because they are unaware that in most cases, treatment will help. Some do not know whom to turn to for advice and others are too embarrassed to seek help. Infertility by itself may not threaten physical health, but it does have a serious impact on the mental and social well being of affected couples. Every problem has a solution. Ones intelligence lies in finding solution to that problem.