Defined as the inability of a couple to conceive after 1 year of unprotected intercourse, infertility affects 10-14% of the Indian population, which currently stands at 1.32billion. Clearly, the disease burden is huge. The contribution to this problem comes from the men in about 40% of the cases, women in about 40% and from both in about 10% of the cases. In the remaining 10%, no cause may be found, a situation known as unexplained infertility.
The causes in females essentially fall under 3 categories- difficulty with ovulation (egg production and release), damaged fallopian tubes or unsuitable conditions of the uterus (womb). An important fact to be understood is that every baby girl is born with a definite number of eggs. In every menstrual cycle, a few of these are lost till the time of menopause. Consequently, the later in life, a woman tries for pregnancy the lesser is her ovarian reserve. In some women, this decline of ovarian reserve happens much faster resulting in premature menopause. With more women delaying motherhood due to numerous reasons, age-related infertility is becoming a major concern in India and world over. Men too are affected by the age-related decline in fertility but to a lesser extent.
In men, in simple terms, infertility results either due to problems with semen production or its expulsion. Lifestyle issues such as obesity, smoking and excess use of plastics are contributing to the rising rates of infertility in both men and women.
So what can be done?
Early recourse to a fertility expert is an important first step for couples struggling to conceive. If the woman suffers from conditions such as PCOS (polycystic ovarian syndrome) or endometriosis amongst many others or men are known to have issues with ejaculation, for instance, this advice should be sought even earlier. The couple should attend the consultation together ideally so that appropriate investigations can be initiated for both without wasting time. A systematic evaluation by an expert can find a cause for infertility in the majority of cases which is then followed by a suitable treatment.
Does everyone end up requiring IVF?
Infertility treatment is certainly not synonymous with IVF (in-vitro fertilization or test-tube baby)!. In some cases, good psychosexual counselling for the couple is all it takes to solve the problem. Occasionally, there may be an endocrine problem such as underactive thyroid that will respond to simple medicines and set the problem right. Cutting down smoking, alcohol, caffeine is known to improve semen quality. Women with PCOS benefit from weight loss and respond better to ovulation induction (medicines are given to bring about egg production). Depositing a small amount of processed semen into the woman’s womb is known as intra-uterine insemination. This cost-effective and simple treatment may be all that is needed for many a couple.
IVF is a treatment reserved for the couples where simple options do not work or are unsuitable, such as both tubes blocked in the woman or very low sperm count in the man. It involves stimulating the ovaries with hormonal injections to cause multiple eggs to develop, rather than just the 1 or 2 that one sees in a natural cycle. These eggs are then extracted under ultrasound guidance from the ovaries and mixed with the sperms
in an embryology laboratory. The embryos that are formed are then transferred into the womb. Extra embryos are frozen for future use. Pregnancy test follows in a couple of weeks. Thus IVF is the highly skilled procedure. Though expensive, it has brought joy to many. Till date, more than 5 million babies have been born through IVF!
What are the new developments in this field?
Use of donated eggs (donor egg IVF) or another woman’s womb (surrogacy) came into existence sometime back. With improvements in freezing techniques, women now have the option of freezing their eggs or embryos for use at a later date. This is a boon, particularly in women about to undergo chemo or radiotherapy- which is likely to destroy their eggs prematurely. Semen freezing has been around for a while and is used, should the male partners be unavailable at a given time due to job constraints or in cancer settings.
Transplanting a womb from one woman into another is another exciting development for making the news. This complex procedure is suitable for a very select group of women only and hence not offered liberally.
Take home message
Infertility is a significant problem in India. It is important to remove the stigma attached to this condition in many parts of our country. Couples need to recognize and consult a fertility expert early so that a systematic evaluation and appropriate treatment can be offered in a timely manner.