WHAT IS INFERTILITY?
Infertility is a disease of the male or female reproductive system defined by the failure to achieve a pregnancy after 12 months or more of regular unprotected sexual intercourse.
Infertility can be primary or secondary. Primary infertility is when a pregnancy has never been achieved by a person, and secondary infertility is when a woman can’t get pregnant again after having at least one successful pregnancy.
WHAT CAUSES INFERTILITY?
Infertility may be caused by a number of different factors, in either the male or female reproductive systems. However, it is sometimes not possible to explain the causes of infertility.
In the female reproductive system, infertility may be caused by:
• Tubal disorders such as blocked fallopian tubes, which are in turn caused by untreated sexually transmitted infections (STIs) or complications of unsafe abortion, postpartum sepsis or abdominal/pelvic surgery.
•Uterine disorders could be inflammatory in nature (such as endometriosis), congenital in nature (such as septate uterus), or benign in nature (such as fibroids).
•Disorders of the ovaries such as polycystic ovarian syndrome and other follicular disorders.
•Disorders of the endocrine system causing imbalances of reproductive hormones. The endocrine system includes hypothalamus and the pituitary glands. Examples of common disorders affecting this system include pituitary cancers and hypopituitarism.
In the male reproductive system, infertility may be caused by:
•Obstruction of the reproductive tract causing dysfunctionalities in the ejection of semen. This blockage can occur in the tubes that carry semen (such as ejaculatory ducts and seminal vesicles). Blockages are commonly due to injuries or infections of the genital tract.
•Hormonal disorders leading to abnormalities in hormones produced by the pituitary gland, hypothalamus and testicles. Hormones such as testosterone regulate sperm production. Example of disorders that result in hormonal imbalance includes pituitary or testicular cancers.
•Testicular failure to produce sperm, for example, Overheated testicles. Causes include an undescended testicle, a varicocele or varicose vein in the scrotum, the use of hot tubs, wearing tight clothes, and working in hot environments or medical treatments that impair sperm-producing cells (such as chemotherapy). Mumps If occurs after puberty, inflammation of the testicles may affect sperm production.
•Abnormal sperm function and quality, there are conditions or situations that cause abnormal shape (morphology) and movement (motility) of the sperm negatively affect fertility. For example, the use of anabolic steroids.
•Anti-sperm antibodies
Environmental and lifestyle factors can affect both male and female fertility such as smoking, excessive alcohol intake and obesity. In addition, exposure to environmental pollutants and toxins can be directly toxic to gametes (eggs and sperm), resulting in their decreased numbers and poor quality, leading to infertility.
DIAGNOSTIC TOOLS USED FOR FEMALE INFERTILITY ARE
•Pelvic examination including PAP smear
•Blood tests like, hormone levels – Thyroid, AMH, FSH and LH
•Transvaginal USG
•Hysteroscopy
•Saline sonohysterogram
•Hysterosalpingography (HSG)
•Laparoscopy
DIAGNOSTIC TOOLS USED FOR MALE INFERTILITY ARE
•Semen analysis
•Blood test–Testosterone, Thyroid, Genetic blood test for chromosomal abnormality
•Scrotal USG
RISK FACTORS
•Age above 40 years (male) and above 32 years (female)
•Smoking and alcohol
•Being overweight/obesity
•Not enough exercise
•Hormone Imbalance
•History of Sexually transmitted Infections (STIs)
•Irregular periods
•Mental stress
•Exposure to some chemicals: pesticides, herbicides, metals, such as lead, and solvents.
•Chemo or Radiotherapy
•Drug addiction
TREATMENT
Treatment will depend on the underlying cause of infertility, in form of
•Medication
•Surgery: blockage in tube that store and carry sperm (male) or blockage in fallopian tube/fibroid/polyp/endometriosis (female).
•Assisted conception
a. IUI (Intrauterine insemination): Used long thin tube to place sperm directly into the uterus.
b. IVF (In vitro fertilisation): Harvesting egg at the end of stimulation and placing sperm and egg together in a lab dish. The sperm fertilises the egg. Fertilised egg is transferred into the uterus.
c. ICSI (Intra-cytoplasmic sperm injection): tiny needle, called a micropipette, is used to inject a single sperm into the centre of the egg.
d. Sperm or egg donation
e. Assisted hatching
f. Electric or vibratory stimulation to achieve ejaculation
g. Surgical sperm aspiration
HOW TO PREVENT INFERTILITY
•Eat a well-balanced diet and maintain a healthy weight.
•Don’t smoke, misuse drugs or drink excessively.
•Get treated for STIs.
•Limit exposure to toxins.
•Stay physically active, but don’t overexercise.
The writer is Chief of Laboratory Services (Rajkot, Gujarat), Metropolis Healthcare Limited.