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The desire to have children and be parents is one
of the most fundamental aspects of being human.
The failure to achieve pregnancy even after one
year of unprotected coitus is generally termed as
infertility. This problem is recently gaining attention
by media mainly because of the following two reasons.
One is the nature of high expenses involved in the
treatment and second due to the alleged involvement
of unethical practices. The unethical issues came
into notice once after the introduction of assisted
reproductive techniques like In-Vitro Fertilization
treatments (Test tube baby treatment). |
What is Infertility? |
| Infertility
is a disease of the reproductive system that impairs
one of the body's most basic functions: the conception
of children. Conception is a complicated process
that depends upon many factors: on the production
of healthy sperm by the man and healthy eggs by
the woman; unblocked fallopian tubes that allow
the sperm to reach the egg; the sperm's ability
to fertilize the egg when they meet; the ability
of the fertilized egg (embryo) to become implanted
in the woman's uterus; and sufficient embryo quality.
Finally, for the pregnancy to continue to full term,
the embryo must be healthy and the woman's hormonal
environment adequate for its development. When just
one of these factors is impaired, infertility can
result. |
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| What Causes
Infertility? |
No one
can be blamed for infertility any more than anyone
is to blame for diabetes or leukemia. In rough terms,
about one-third of infertility cases can be attributed
to male factors, and about one-third to factors
that affect women. For the remaining one-third of
infertile couples, infertility is caused by a combination
of problems in both partners or, in about 20 percent
of cases, is unexplained.
The most common male infertility factors include
azoospermia (no sperm cells are produced) and oligospermia
(few sperm cells are produced). Sometimes, sperm
cells are malformed or they die before they can
reach the egg. In rare cases, infertility in men
is caused by a genetic disease such as cystic fibrosis
or a chromosomal abnormality. The problems of present
day life styles like smoking, use of tight undergarments,
the job atmospheres like high temperature etc.can
aggravate male infertility. Another cause for abnormal
semen parameters is varicose veins affecting the
testes.
The most common female infertility factor is an
ovulation disorder. Other causes of female infertility
include blocked fallopian tubes, which can occur
when a woman has had pelvic inflammatory disease
or endometriosis (a sometimes painful condition
causing adhesions and cysts). Endometriosis is very
common in Kerala.It may present as severe pain during
menstruation or ovarian cysts or may be an incidental
diagnosis in infertile woman. Congenital anomalies
(birth defects) involving the structure of the uterus
and uterine fibroids are associated with repeated
miscarriages.
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How is
Infertility Diagnosed?
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Couples
are generally advised to seek medical help if they
are unable to achieve pregnancy after a year of
unprotected intercourse. The doctor will conduct
a physical examination of both partners to determine
their general state of health and to evaluate physical
disorders that may be causing infertility. Usually
both partners are interviewed about their sexual
habits in order to determine whether intercourse
is taking place properly for conception.
If no cause can be determined at this point, more
specific tests may be recommended. For women, these
include an analysis of body temperature and ovulation,
x-ray of the fallopian tubes and uterus, and laparoscopy.
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With the
advent of Ultrasonography and colour Doppler the
female infertility evaluation is simplified and
less time consuming. It helps to evaluate the ovulatory
status as well as some space occupying masses in
Uterus or ovaries and a therapeutic strategy can
be planned accordingly. The X-ray of Fallopian tube
is known as hysterosalpingography. Other miscellaneous
tests like estimation of various hormones in blood
and significant presence of antisperm antibodies
can be helpful to arrive at a diagnosis.
For men, initial tests focus on semen analysis.
Semen analysis is the easiest test for male infertility.
According to WHO recommendations there should be
at least 20 millions of sperms per ML and of these
at least 50% of them should be motile.
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