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Patient Review Highlights
1. What is infertility?
Infertility is a term that is used to describe the inability of an individual to successfully contribute to the process of conception. In females, it refers to their lack of ability to conceive post having regular, unprotected intercourse. In some cases, it also refers to their inability to carry a pregnancy to its full term. A normal fertility helps conception in the first 12 months of trying for almost 86% of couples, with around 7-8% couples conceiving in their second year, depending on their age. Hence, many practitioners also treat an inability to conceive within the first 12 months as infertility.
2. Is infertility a global problem?
Sub-fertility as well as infertility are a global public health issue affecting approx. 8-12% couples, worldwide. It is prevalent in both males and females. While over 10% of women world-wide, who have been in stable relationships for over 5 years yet been unsuccessful in conceiving, have been estimated to be inflicted with this problem; the count is much smaller in the case of men, primarily because of non-acknowledgement, even though it contributes to almost 50% of reported cases.
3. Do infertility problems occur only among women?
No, infertility problems are as common in men as they are in women. Almost 50% of cases of infertility are attributable to male infertility related issues. However, due to the social structure prevalent, most of such male infertility related issues go unacknowledged.
4. What could be the probable symptoms that suggest a possibility of infertility related problems?
Though the process of conception and the possibility of infertility related problems could be time-driven factors, some symptoms could indicate a bent towards infertility and could be medically examined and addressed in time to curb the problem at the very onset. Some of these indications include:
Indications in Females:
Infertility symptoms in females can be related to either one of multiple of these problems:
• Changes in menstrual cycle: Irregular or infrequent periods mean that the number of days between two cycles varies each month. This is a common indication of infertility as it reflects that the ovulation cycle is not stable, i.e. the body is not producing ovules (egg) regularly or at times not at all.
• Abnormalities in periods: Sudden changes in the bleeding pattern – heavier periods, no period or cramping and pelvic pain associated with periods – could also be indicative of an underlying fertility related problem.
• Hormonal Disturbances: Sudden changes in skin like more than usual acne, changes in sexual drive, unexplained and sudden growth of facial hair, excessive weight gain/loss, etc.
• Other Symptoms: Other symptoms such as pain during sex, milky-white discharge from breast/nipples (unrelated to lactation) can also be indicative of infertility and one should seek medical advice at the earliest.
• Age-related: As one advances in age, the egg count decreases rapidly along with a related deterioration in the egg quality. Hence, if a woman is in her early 30s and is failing to conceive, it could be related to a fertility problem.
Indications in Males:
Infertility symptoms in men can be quite elusive as they are very closely related to the cause of infertility. These often go unnoticed until the point that the couple start trying for a baby. Some of these are:
• Sudden changes in sexual drive.
• Pain, inflammation or lump in the testicles or if the testicles are small and firm.
• Problems related to ejaculation and erection
• Sudden, unexplained changes in hair growth patterns.
• Known semen abnormalities
5. Who are at risk of infertility problems?
Age is one of the most crucial risk involved in fertility related matters. For couples who start trying for a baby later in age, the chances of infertility increases manifolds. Couples where either partner is in their mid-30s or into 40s are at higher risk of infertility problems. While a man’s overall lifestyle, health and other factors can affect his chances of contributing to a successful conception, in a woman age and chronic health conditions play a major role.
6. What increases infertility risk in men?
While health and lifestyle are the most important factors that contribute to their fertility levels, including their sperm quality and count, there are many other factors that affect fertility and push towards higher infertility risk among men. Some of these include:
• Alcohol and tobacco consumption
• Excessive physical exercise, especially excessive cycling
• Weight related issues
• Exposure to toxins at workplace or as part of a medical treatment like chemotherapy/radiation
• Surgical procedures like vasectomy or its reversal
• Family history of infertility or fertility related disorders or other genetic medical conditions like cystic fibrosis
• Medical history of sexually transmitted infections (STIs)
• Certain chronic problems like high blood pressure, diabetes, renal or hormonal problems
7. What can increase the risk of infertility among women?
Ovulation related issues contribute to over 25% of female infertility cases, with tubal blockage and uterine problems coming in as the other infertility causes in women. However, some other factors like the ones enlisted below also put females at risk of infertility:
• Advanced age
• Frequent or heavy alcohol or caffeine consumption
• Cigarette smoking
• Weight-related issues
• Eating disorders and lack of balanced healthy diet
• Intense and extended athletics or no exercise at all
• History of STIs, endometriosis, polycystic ovarian syndrome (PCOS) or fibroids
• Chronic health issues like high blood pressure or diabetes.
• Hormonal problems like thyroid etc.
• Mental stress and fatigue
8. How is age related to a woman’s ability to conceive or infertility aspects?
A woman’s fertility rate begins to recede with her age. As a woman nears her mid-30s, her natural fertility starts to fall and many experience difficulties in conception as well as multiple pregnancy failures. The reason for this is that the ovarian reserve in women is fixed since birth and as they age it starts to fall drastically as the follicles keep leaving the reserve in a continuous flow (menstrual cycle). This follicular depletion accelerated as she approaches 40s and decreases not just her egg count but its quality too, as she ages. For men, this progressive drop in fertility rate hits after the age of 40.
9. What are common causes of infertility in men?
One of the most common causes of infertility in men are semen disorders. The semen comprises a milky white fluid and sperms that are ejaculated during orgasm. Abnormal semen contributes to over 75% cases of male infertility. The common semen related disorders include:
i. No sperm presence in semen
ii. Low sperm mobility
iii. Abnormal sperm shape/size
iv. Low sperm concentration (under 10 million/milliliter) in the semen (Ideal: 20 million/milliliter of semen)
The major causes of these abnormalities and a consequent infertility in men are:
1. Ejaculation Disorders
2. Frequent use of saunas, hot baths etc. that lead to overheating of testicles.
3. Testicular infections
4. Testosterone deficiency
5. Deformed or undescended testicles that usually happens as a birth defect or abnormal fetal development.
6. Genetic disorders like Klinefelter's syndrome that lead to abnormally developed testicles.
7. Very frequent intake of medications like Sulfasalazine, Anabolic steroids (frequently taken by athletes), etc. or exposure to chemotherapy/radiation.
8. Conditions like hypospadias (a condition where the urethral opening is not at the tip of the penis but at its underside) or cystic fibrosis.
10. What are common causes infertility in women?
There are a number of conditions that lead to fertility among women, such as:
1. Ovarian Disorders: The most commonly reported reason for infertility among women is a disorder in the ovulation process.
Ovulation involves the production and release of egg. This cycle happens on a monthly basis. However, certain situations lead to a malfunctioned ovulation. These causes include:
i. Polycystic ovary syndrome (PCOS) which lead to mal function of ovaries
ii. Very high prolactin levels in non-lactating females
iii. Damaged or abnormal eggs – Poor egg quality is common in older women
iv. Thyroid disorders
v. Medical conditions like cancer, diabetes, AIDS, etc.
vi. Premature (before the age of 40) ovarian failure
2. Uterine Disorders: Once fertilized, the egg travels from the ovary to the uterus and it is important that the uterus be healthy to receive and nurture the fertilized egg. However, at times, disorders of the uterus lead to infertility problems in women. Uterine disorders can be attributed to one or more of these reasons:
i. Pelvic or cervical surgery that may cause scarring or damage of the uterus or fallopian tubes or at times shortening of the cervix which serves as the mouth of the uterus.
ii. Endometriosis – a condition where the cells that line the uterus start growing outside the uterus.
iii. Sterilization treatments like tying of tubes, etc.
iv. Uterine fibroids or endometrial polyps
3. Medications: Certain medications like those used in chemotherapy or certain NSAIDS like aspirin and ibuprofen lower fertility rates in females.