What is Infertility?

Infertility is defined as the inability to conceive within 12 months. In women who are older than 35 years of age, this time drops to 6 months and women above 40 should consult with their doctor immediately. As shown in the graph, the fertility rate in India has declined over the years from 1880 to 2020. A medical study estimated that the total fertility rate (TFR) in India will decline to 1.29 births/woman (vs 2.14 births/woman in 2017) by the year 2100.

Infertility can be caused due to problems in either or both the male and female reproductive system. Globally, 1 in 3 men and 1 in 3 women have problems with their reproductive system. In women, fertility could either be primary (a woman was unable to conceive at all after 2 year of trying) or secondary (a woman was unable to conceive again after having 1 successful pregnancy)

Causes of Male Infertility

Male infertility can be due to low number of sperms, defects in the quality of the sperm, or a blockage that prevents the sperm to be released. Some of the causes are listed below:

• Enlarged veins (varicocele) in the scrotum
• Older age
• Hormonal imbalance
• Obesity
• High heat exposure due to tight clothing, hot tubs, or sauna,
• Injury to the reproductive organs
• Genetic disorders such as cystic fibrosis
• Heavy use of alcohol, smoking, or drugs
• Cancer treatments including radiation and chemotherapy

Causes of Female Infertility

• Advanced age
• Blockage of the fallopian Tubes
• Ovulation disorders
• Uterine problems such as uterine fibroids, endometrial polyps, endometriosis
• Polycystic ovary syndrome (PCOS), ovarian cysts
• Past ectopic pregnancy
• Thyroid diseases
• Cancer treatments including radiation and chemotherapy
• Asherman syndrome (scarring of the uterine cavity)
• Unexplained infertility

Consult your Doctor Immediately

Do not wait for 1 year if you are aware of certain medical conditions such as infrequent menstrual periods, history of pelvic infections or sexually transmitted disease, uterine fibroids or polyps, or known male semen abnormalities

Tests for diagnosis of Infertility

Your doctor will ask you questions about your menstrual cycle, intercourse, prior pregnancies, family history of infertility or any birth-related issues, any other medical conditions, prior surgeries, etc.

Your doctor may also perform a pelvic exam or pap smear (cells from the cervix or vagina are taken and examined for cervical cancer)

The doctor inserts an ultrasound wand inside the vagina and examines the structure of the uterus, fallopian tubes, and ovaries.

Blood tests are used to measure the hormone levels of estradiol and FSH (related to ovarian function and overall egg numbers); TSH (for thyroid function); and prolactin, (increased levels can affect menstrual function)

This test detects the blockage in the fallopian tubes or fibroids or polyps in the uterus. A dye is injected into the reproductive system and its path is captured through x-ray. A lot of structural abnormalities can be corrected by surgery.

• Semen volume
• Sperm concentration
• Sperm motility or movement
• Shape of the sperm

Assisted reproductive technology (ART)

The choice of treatment depends on the reason for and duration of infertility, age, and personal preferences. Assisted reproductive technology (ART) is defined as any infertility treatment in which the either the eggs or embryos are handled. They do NOT include treatments in which only sperm are handled or when a woman takes medicine only to stimulate egg production without removing the eggs. ART procedures include:

• In vitro fertilization (IVF)
• Intrauterine insemination (IUI)
• Third party-assisted ART including egg, sperm, and embryo donation and surrogacy