Infertility

Infertility is the inability of a couple to have a child. Medically speaking, it is the failure of a couple to get pregnant after 12 months of regular unprotected intercourse. In the majority of the population, pregnancy occurs after 6 months of regular unprotected sex, and about 90% will get pregnant after 1 year of unprotected sex. About 10% of the adult population age 15-44 suffers from infertility.

The process of fertilization is a complex wonder. For a successful conception of a child, the following steps must happen:

• A woman must release a healthy and viable egg from her ovary to her fallopian tube.
• A man must release healthy and viable sperms that must unite with the egg to form a zygote in the fallopian tube.
• The zygote must then travel through the fallopian to the uterus. It should implant there and start to grow.
• The woman’s uterus should be able to carry and sustain the growing fetus until it is ready for delivery.

Any abnormality in those steps can lead to infertility.

Causes

The causes of infertility can be due to male factors or female factors. Statistically, infertility is due to male factors in one-third of cases, to female factors in one-third of cases, and to a combination of male and female factors in the remaining one-third.

The male-related causes of infertility are due to:

• Problems in producing viable sperms - Some males are unable to produce viable sperms. In some cases, the sperms are lacking in number; in other cases, the sperms are not motile enough to swim towards the egg; and in others, the testicles are not able to produce any sperms at all.
• Problems in delivering the sperm - In some males, there is no problem with sperm production. The sperms are sufficient in quantity and are of good quality. However, the tubes where the sperms have to go through are defective. Because of this, the sperm cannot pass through or they get damage along the way.
• External factors that damage the reproductive tract - Some external factors can damage the male reproductive tract. For example, some toxins (like pesticides), infections (like mumps), and drugs (like chemotherapy) can damage the testicles and affect a male’s ability to produce sperms. Sometimes, surgery in the inguinal area, where the male reproductive tubes pass, can damage the tubes or cause a stricture that makes it difficult or impossible for the sperms to pass.

The female-related causes of infertility are:

• Problems in producing a viable egg - Some hormonal imbalance in women can make it difficult for them to produce eggs regularly. The lesser the chances of egg production, the lesser the chances of fertility. In others, the ovaries have deformities like cysts that result in the abnormal functioning of the ovaries.
• Problems in the anatomy of the reproductive tract - Some women are able to produce eggs, but those eggs somehow are unable to pass unremarkably through the female reproductive tract. In some cases, there are strictures or abnormalities in the fallopian tube that prevents the transfer of the fertilized egg to the uterus. In other cases, the fertilized egg is not able to implant to the uterus because the uterus have deformities or masses.
• External factors that damage the reproductive tract - Some external factors can damage the female reproductive tract. For example, some toxins (like pesticides), infections (like some STDs), and drugs (like chemotherapy) can damage the female reproductive tract. Sometimes, abdominal surgery can cause scarring in the abdomen that might impinge on the fallopian tubes and make it difficult or impossible for the egg to pass.

When to seek consult

In general, you should consult a fertility specialist if you have been unsuccessful in getting pregnant with your partner for 1year. However, in some cases, earlier consult is advised.

For women, consult should be done:

• If you are more than 35 years old and has been trying to get pregnant for at least 6 months
• If you are more than 40 years old
• If you have irregular menstruation
• If you have a history of cancer treatment or radiation
• If you have a known disease of the reproductive tract, particularly in the ovaries or the uterus
• If you have a history of two or more miscarriages in the past

For men, consult should be done:

• If you have a history of cancer treatment or radiation
• If you have a history of surgery in the groin
• If you have deformity in your reproductive organ like swelling or mass in the testicles, small testicles, or absent testicles.

Treatment

The treatment for infertility can be quite complex because of the many possible causes of the problem. In general, infertility is treated by addressing the underlying cause. For example, women with problems in ovulation are given ovulatory drugs to increase their chances of getting pregnant. Men should avoid tight fitting underwear and hot tubs as well as repetitive trauma such as horse-riding. However, sometimes the underlying cause of fertility has created a permanent change in the reproductive tract such that the natural way of fertilization is no longer possible. In these instances, the process of fertilization has to be scientifically assisted. This is where assisted reproductive technology (ART) comes into play.

ART consists of various techniques that artificially supplement the process of fertilization. A very popular example of this is in-vitro fertilization or IVF. In IVF, eggs are taken from a woman’s ovary and are fertilized with a man’s sperms in a tube inside a laboratory. The fertilized eggs are then implanted into the woman’s uterus three to five days later. This procedure bypasses the problems of ovulation in a woman, the problems in the passage of the sperm through the male’s tubules, the process of transfer of the fertilized egg to the uterus, and so much more. The ART is a progressively advancing technology that gives hope to many couples in the world.