It is the inability of a couple to get pregnant in spite of regular unprotected sex for a period of one year or more.

As natural fertility in women decreases after 25 years, they are investigated / treated if they do not conceive within 6 months of regular unprotected sex.

Fertility affects 10-14% of Indian population.

Infertility

Understanding fertility/reproduction in humans:

  • The day a woman menstruates ( 1st day of cycle ) a hormonal cycle sets off.
  • Over the period of next 14-16 days in a regular 28-30 days cycle, an egg ( dominant follicle ) grows gradually, ripens and ruptures / comes out of the ovary.
  • It gets sucked in the tube and stays there for approximately 24 hours.
  • When the partners have sex, sperms are deposited high up in vagina and have to travel upto the distal part of tube to meet the egg. During this travel they undergo series of changes termed Capacitation.
  • A single capacitated sperms comes in contact with the egg and fertilization occurs.
  • The fertilized egg now travels back towards the uterine cavity and gets buried in the Endometrium.
  • Periods are missed and pregnancy / life happens.

Causes / Risk factors associated with Infertility:

  • Age:

       Women more than 35 years and men more than 40 years of age are more likely to require help to get pregnant.

  • Tobacco:

        Tobacco uses in both partners directly affects the quality of sperms / eggs formed and thus decreases chances of getting pregnant. It is advisable to stop tobacco use when trying to achieve pregnancy and also when you are pregnant as it may adversely affect your baby.

  • Alcohol:

        Alcohol use directly affects pregnancy in both partners, more in women than men and hence it is advisable to avoid alcohol when trying to conceive, specially the first three months of pregnancy.

  • Drugs:

        Certain medicines may affect the sperm quality / motility or may interfere with ovulation hence it is important to discuss with your prescribing doctor about your plans for trying to conceive so that they may give medicines accordingly.

  • Recreational drugs:

        Recreational drug use should be entirely stopped before trying to get pregnant and throughout period of pregnancy and lactation.

  • Weight Issue:

        Both extremes of weight ( i.e underweight and overweight ) directly affects fertility and may cause difficulty in conception.

  • Exercise:

        Moderate regular exercise in recommended for fertility. Extremes of workout regimen and sedentary lifestyle both affect fertility outcomes adversely.

  • Vitamin D deficiency:

       Vitamin D / Sunlight is directly related to gonadal health and hence fertility. Regular early morning sun exposure will help the synthesis of adequate amount of vitamin D by the body and positively impact outcome.

Understanding causes:

Female

  • Ovulation disorder:

        Where the egg is not formed / released on time.

  • Cervical abnormalities which affects the process of penetration of sperms.
  • Uterine:

       Affecting Implantation of fertilized egg in the Endometrium and/ or its growth.

  • Fallopian tube:

       May be blocked / damaged due to which the sperm cannot travel to the egg to achieve fertilization.

  • Others:

        Endometriosis / fibroid uterus / primary ovarian failures / uterine adhesion to name a few.

Male

  • Production of sperms:

        Decreased or absent sperm production secondary to infection in childhood or congenital abnormalities.

  • Delivery of sperms:

       Premature ejaculation / problems with penetration.

  • Motility disorder:

       Due to which sperm cannot travel upto  the egg.

  • Environmental factors:

       Over exposure to heat / chemicals/ environmental pollutants which may affect fertility.

Treatment Modalities:

Infertility treatment is a complex combination of counseling, medical and surgical management.

First 2-3 cycles are required in understanding the exact cause and its severity following which a step wise treatment plan is chalked out and followed.

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