Horizon Hospital - Thane

Infertility If Treated, Can End With A Smile

Infertility On The Rise, One in Six People Affected Globally

Becoming a mother has a very special place in a woman’s heart and for so many women is the fulfilment of a lifelong dream. While there can be curiosity about what it will like to be pregnant and to actually have a baby, pregnancy and childbirth are not usually lifelong dreams but are journeys they need to go on to achieve that lifelong dream of becoming a mother. A woman does not become pregnant to be pregnant. She becomes pregnant to have a baby, and pregnancy is the necessary journey she must go on to achieve that goal.

While pregnancy and childbirth are times associated with great happiness and excitement, they also times associated with fears and anxieties. There is  uncertainty about whether the journey will be successful. In this pregnancy journey, there are many couples who face hurdles. For many couples, the dream of starting a family can be a source of immense joy and fulfilment. However, when faced with the challenges of infertility, that dream can quickly turn into a journey of emotional turmoil, uncertainty, and frustration. In this article, we delve into the topic of infertility, aiming to shed light on its various aspects, including its emotional impact and available options for couples seeking to overcome this hurdle.

Infertility has become a common problem for people across the globe. India stands at a critical crossroads, facing an unprecedented infertility crisis that threatens not only millions of families but the country’s future demographic balance.

According to the World Health Organisation (WHO), 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.

There are several reasons causing infertility, which can be both male and female factors. Some causes are preventable. Possible causes of infertility in males include a low sperm count and taking certain medications. Possible causes of infertility in females include ovulation disorders and endometriosis.

Diet, environment, Pollution, Occupation, Hormonal issues,  increasing substance use, and changing lifestyle are also leading to an increase in infertility in India, which may irreversibly altar India’s population dynamics, potentially leading to an ageing crisis.

Dr Hrushikesh Vaidya, Medical Director and Chairman Horizon Group of Hospitals said “Infertility is on rise in India and current statistics have revealed that 27.5 million couples actively seeking children suffer from infertility. Affecting both men and women equally while at least 10-15 percent of married couples are experiencing fertility issues at some point. One in Two millennials are delaying having family and think they can conceive later but 54% of those delaying pregnancy face issues in conception in their 30’s”.

Dr Ria Vaidya, CEO, Horizon Group of Hospitals said “Infertility is not an end to parenthood, the treatment is a journey. Couples often experience a wide range of emotions, including grief, frustration, guilt, shame, and a sense of loss. Each unsuccessful attempt at conception can lead to feelings of inadequacy, self-doubt, and stress, straining the relationship between partners and affecting their overall well-being. It is crucial for couples to recognize and address these emotions, seeking support from loved ones or professional counsellors specializing in infertility”.

Infertility has significant negative social impacts on the lives of infertile couples and particularly women, who frequently experience violence, divorce, social stigma, emotional stress, depression, anxiety and low self-esteem. In some settings, fear of infertility can deter women and men from using contraception if they feel socially pressured to prove their fertility at an early age because of a high social value of childbearing.  In such situations, education and awareness-raising interventions to address understanding of the prevalence and determinants of fertility and infertility is essential.

Dr Ria Vaidya further said “Infertility is not a new issue in reproductive treatment. However, in recent years, the discussion on infertility has developed quite dynamically around the world. A WHO report estimates that 8 to 10 percent of couples globally deal with infertility cases, or about 50 to 80 million couples. Unfortunately, women are often the ones to blame when talking about infertility. Both parties (husband and wife) contribute to the success of having a child. About one-third of fertility issues are dominated by men, one-third by women and one-third are unknown causes. “

Dr Manali Shilotri, Leading Gynaecologist and Consultant Horizon Prime Hospital said “Infertility is high because the awareness has increased in the couple of decades. Earlier it was found that 30% of causes of infertility is because of the female reproductive system, 30% is male, and 30-40% is both. Now, the male infertility has crossed more than 50%”.

Dr Manali Shilotri further said “Increase in infertility is attributable to our inactive lifestyle, stress, pollution, unhealthy habits, delayed parenthood and much more. Growing health problems like endometriosis, PCOS (polycystic ovarian syndrome), male factors, and sexually transmitted diseases (STDs) have also become the reasons for infertility. With growing infertility issues among couples, in vitro fertilization (IVF) has become a prominent treatment option. However, since IVF is expensive, it is largely inaccessible to a majority of people in India”.

Dr Ria Vaidya stressed that IVF should come under insurance to become acceptable, accessible and affordable to couples going through infertility.

Dr Manali Shilotri further said “Infertility can cause significant distress, stigma, and financial hardship, affecting people’s mental and psychosocial well-being. Despite the magnitude of the issue, solutions for the prevention, diagnosis and treatment of infertility – including assisted reproductive technology such as in vitro fertilization (IVF) – remain underfunded and inaccessible to many due to high costs, social stigma and limited availability. High costs frequently prevent people from accessing infertility treatments or alternatively, can catapult them into poverty as a consequence of seeking care.”

Infertility can be primary or secondary. Primary infertility is when someone is not able to conceive at all. Secondary infertility is when someone has previously conceived but is no longer able to. If the female partner is over age 35, the couple may wish to see a doctor earlier, as fertility testing can take time, while a person over 40 years may want to see a doctor as soon as they realize they are not becoming pregnant. A doctor can give advice and carry out some preliminary assessments.

CAUSES

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 or complications of unsafe abortion, postpartum sepsis or abdominal/pelvic surgery;
• uterine disorders which could be inflammatory in nature (such as such 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.

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. 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.
• testicular failure to produce sperm
• abnormal sperm function and quality.

Lifestyle factors such as smoking, excessive alcohol intake and obesity can affect fertility. In addition, exposure to environmental pollutants and toxins can be directly toxic to eggs and sperm, resulting in their decreased numbers and poor quality.

TREATMENT

Treatment to help a person conceive naturally will depend on many factors, including the age of the person who wishes to conceive, how long infertility has lasted, personal preferences, and their general state of health.

Frequency of intercourse

The first strategy a couple trying to conceive may wish to try is having sexual intercourse more often around the time of ovulation. Typically the menstrual cycle lasts for about 28-32 days. Counting from the first day of the last period, a female will usually ovulate anywhere between day 11 and day 21. Any person whose cycle is shorter than 21 days or longer than 35 days should see their doctor for an evaluation.

Other treatments

However, timing intercourse may not be sufficient on its own to help a couple conceive. Treatments will depend on the underlying cause of infertility. In males, this can include medications for erectile dysfunction. In females, doctors can prescribe fertility drugs to regulate or induce ovulation. If the fallopian tubes are blocked or scarred, surgical repair may make it easier for eggs to pass through. A person may also be advised to undergo IVF. Sometimes doctors may also treat endometriosis with laparoscopic surgery.

Assisted conception

The following methods are currently available for assisted or artificial conception

• Intrauterine insemination (IUI)
• In vitro fertilization (IVF)
• Sperm or egg donation
• Surgical sperm aspiration

Conclusion

To effectively address infertility, health policies need to recognize that infertility is a disease that can often be prevented, thereby mitigating the need for costly and poorly accessible treatments. Incorporating fertility awareness in national comprehensive sexuality education programmes and promoting healthy lifestyles to reduce behavioural risks and addressing environmental toxins associated with infertility, are policy and programmatic interventions that all governments can implement.