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What is Infertility in Male and Female? Infertility: Know About it Scientifically

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What is Infertility in Male and Female? Infertility: Know About it Scientifically

Infertility is one of the most common health problems in today's life. There are millions of people of reproductive age who are infertile worldwide.

According to WHO(World Health of Organization) around 48.5 million couples and 186 million individuals are infertile globally.

 

What is meant by infertility?

 

When a person cannot conceive after having regular unprotected sex with no contraceptive at least for a year (12 months) is defined as infertility.

If the woman got pregnant but keeps having miscarriages or stillbirths that is also infertility.

 

Is infertility only caused by women?

 

Many people have this misconception that a woman is the only one to blame for not being able to get pregnant but it's wrong. A man also can be as infertile as a woman.  

According to the Office on Women's Health, one-third are because of female infertility, another third for males and the remaining third because of the combination of two or for unknown causes. Around 9 percent of men experienced fertility issues.

 

Types of infertility:

 

Types of Infertility
 

There are two main types of infertility:

 

  • Primary infertility: After having regular unprotected sex for 1 year, when a couple unable to get pregnant it's called primary infertility. 

  • Secondary infertility: In this case, a couple who got pregnant before at least for 1 time but is now unable.

 

What are the most common symptoms of infertility?

 

What are the most common symptoms of infertility (1)
 

The key sign of infertility is not getting pregnant after having unprotected sex for long time. There are also some underlying symptoms.

 

In men these symptoms can be seen:

 

  • Reduced sexual desires

  • Pain in testis

  • Swelling in testis 

  • Problems in maintaining the erection

  • Problems in ejaculation

  • Small genitals

  • Decreased hair amount in body

  • Gynecomastia or growth in breast area abnormally

 

In women these symptoms can be seen:

 

  • Irregular menstrual cycle

  • Pain during menstruation

  • Pain during intercourse or dyspareunia

  • Reduction in sexual desires

  • Abnormal facial hair growth

  • Thinning hair abnormally

  • Chronic pelvic pain and back pain

  • Dark or pale menstrual blood colour

  • Bowel problems 

  • Discharge release from nipples

 

Cause of infertility

 

There are several causes of infertility in both men and women. Many diseases, genetic disorders or many more that make people unable to conceive. There are some risk factors which affect both men and women.

 

  • Age: In men, after 40 years the fertility starts to decline and with women after 32 years the ability to conceive starts to decrease. According to the National Institutes of Health a woman in her 30s is half as fertile as a woman in her early 20s.

  • Excessive smoking: Excessive smoking can cause infertility in both men and women. Using tobacco directly harms the sex organs and makes people infertile.

  • Alcohol consumption: Consumption of too much alcohol can affect both men and women badly. It can also cause infertility in people.

  • Illegal drug Consumption: Drugs like marijuana and cocaine affect sexual health.

  • Chemical exposure: There are many chemicals like pesticides, herbicides, solvents and metals that can affect the sperm count of men and also affect the women.

  • Radiation: Radiation like chemotherapy, which is used to cure cancer harms sexual health.

  • Sexually transmitted diseases: Some sexually transmitted diseases like chlamydia can affect the women's fallopian tube and also affect the man's scrotum, causing inflammation. 

  • Exercise: Excessive exercise or too little exercise both cause infertility.

  • Stress: Mental stress can generate problems in the ovulation process in women and also affect the sperm production rate in men.

 

Causes of infertility in men

 

To describe the cause of infertility in men you firstly must know about how men are contributing to the fertilization process.

 

What is semen?

 

The semen is a type of liquid which ejaculates during sexual intercourse. This liquid is a mixture of sperm and body fluid. Male partner ejaculates semen into the female's vagina.

 

What is sperm?

 

The sperm is the reproductive unit of males. Through this, all the genetic materials transfer into the female's body. The sperm then travels into the female's body to reach the ovary and fertilize the ovum or egg.

 

Here are some cause of infertility in men:

 

  • Low sperm count in semen: The sperms or mature spermatozoa produced in prostate glands, comes through the seminal vesicles. Most times the sperm production rates are very low. For this reason, after ejaculation, the amount of sperm in the semen is very low, under 15 million per ejaculation. 

  • Sperm cannot reach the penis: Most times, even if sperm production is normal, it cannot pass through the seminal vesicles and reach the penis.

  • Mobility of sperm: The sperm has a tail in its side. Which helps it to swim and reaches the ovary. If the sperm mobility is low, the sperm cannot move towards the egg and that's why the fertilization process fails.

  • Abnormal shape of sperm: The sperm has a cap-like structure in his head and a tail as well. If the sperm has an abnormal shape, it's very difficult to move and complete the fertilization. According to the National Institute of Health up to 2% of men are infertile for this.

 

There are also many reasons like:
  • Ejaculation disorder: In this case ejaculatory ducts are blocked, so the semen cannot be ejaculated properly.

  • Varicose veins: varicose veins in the scrotum caused infertility in men. This is caused by excessive use of saunas or hot tubs, working in hot weather.

  • Hypogonadism: It is a type of hormonal disbalance. Hypogonadism leads the testosterone deficiency, which is the most important sex hormone in males.

  • Abnormal urethral opening: when the urethral opening is abnormal, it stays inside the penis, instead of its tips. This is known as hypospadias. A study says about 1 in every 500 newborn baby boys are affected by this.

  • Mumps: This is effective on testicles and lowers the sperm production rate.

  • Cystic fibrosis: Cystic fibrosis is a type of chronic disease which creates sticky mucus. In male it affects vas deferens which carries the sperm into it.

  • Klinefelter's syndrome: Every male genetically carries one X chromosome and one Y chromosome. Klinefelter's syndrome is a genetic disorder in which the person carries two X chromosomes and one Y chromosome. Here the genital organs grow abnormally and the sperm production is very low or unable to produce the sperm. 

  • Anabolic steroids consumption: Many people intake anabolic steroids for bodybuilding or many more but it can affect sperm count.

  • Also the radiation therapy, high diabetics, thyroid problems, Anemia can cause infertility in men.

 

There are some medications,that also affect the fertility

 

  • Sulfasalazine: It is used for rheumatoid arthritis or ulcerative colitis.

  • Calcium channel blockers: It is used for high blood pressure control.

  • Tricyclic antidepressant

  • Chemotherapy: It is used to cure cancer.

 

Causes of infertility in women:

 

To know the cause of infertility in a woman's body, we have to know about the processes through which she got pregnant.

 

  • Ovulation: It is a process of egg release in a woman's body. At day 14 of the menstrual cycle the egg is released from the ovary and waits for fertilization.

  • Fertilization: after ovulation, the egg released from the ovary waits for the sperm. When the sperm meets the ovum and fuses, that is called fertilization. It occurs in the fallopian tube.

  • Implantation: It is the process in which the fertilized egg is attached to the endometrial lining of the uterus.

 

Some medical conditions like ovulation disorders can affect the fertility of women:

 

  • PCOS or Polycystic ovary syndrome: In this disease multiple cyst formation in the ovary disturbs the function of the ovary and ovulation does not occur properly.

  • Pelvic inflammatory disease: In this disease, several types of bacteria infect the pelvic area including uterus, fallopian tubes and ovaries.

  • Premature ovarian failure: when premature menopause starts very early before the age of 40, it is called premature ovarian failure. Here the ovaries stop working very early. The National Institute of Health suggests that about 1% of women suffer from this.

  • Endometriosis: Endometriosis is a disease in which abnormal growth of endometrial cells occurs in various places of the pelvic region. This disturbs the implantation process after fertilization.

  • Hypoprolactinemia: When the level of prolactin hormone which helps in breast milk production increases in women's body abnormally, this can affect the ovulation process.

  • Uterine fibroids: In this disease cells grow abnormally, create tumors in the pelvic region and affect the reproductive system badly. It blocks the fallopian tubes and prevents fertilization, implantation processes.

  • Egg quality: The quality of eggs is very important. If the eggs are damaged or abnormal, it cannot carry the pregnancy.

  • Thyroid disease: Thyroid diseases can cause hormonal disbalance in women's body and cause ovulation problems.

  • Chronicle issues: Chronicle issues like cancer, AIDS cause infertility.

  • Sterilization treatment: Sometimes women choose sterilization and block the fallopian tubes but after that the chance of fertility later decreases.

  • Surgery: Surgery in the pelvic region can affect fertility. It causes scarring and damage in the fallopian tubes and cervix area.

  • Shape of uterus: The shape of the uterus is very important to hold the pregnancy. If the shape or size of the uterus is abnormal, it causes infertility. After fertilization, the fertilized egg is attached to the uterus wall, if the uterus has an abnormal shape, it causes difficulties to hold the pregnancy.

  • Obesity and cholesterol: Pregnancy is a very complex process in women's bodies. The fertility rate also depends on their health and fitness. Health problems like obesity, cholesterol, malnutrition can decrease the fertility rate.

  • Continuous use of nonsteroidal anti inflammatory drugs: Sometimes the use of non-steroidal drugs like aspirin (Bayer), ibuprofen (Advil, Motrin) may affect the fertility rate.

  • Chemotherapy: Chemotherapy, which used to cure cancer, can cause ovarian failure.

  • Long-term use of antipsychotic medications may affect the fertility rate.

 

When to consult with the doctor?

 

If a couple sees any of the following and fails to conceive after 12 months of trying they should consult a doctor.

 

In case of man

 

  • Ejaculation problems like retrograde ejaculation or delayed ejaculation

  • Having lower sperm count

  • Pain or swelling in reproductive organs

  • Reduce sex drive

  • Erectile dysfunction

  • Having a surgery in genital areas previously

  • If anyone in your family has any infertility problems in them

 

In case of woman

 

  • Are age 35 and above, have been trying to get pregnant for 6 months

  • Irregular and painful menstrual cycle

  • Diagnosed with disease like pelvic inflammatory disease, endometriosis, etc.

  • Undergone cancer

  • Having multiple miscarriages

  • Having surgery previously in reproductive organs

  • Pain in pelvic region

 

Diagnosis:

 

When you go to your doctor, first they will ask some questions about your health, medical history, sexual history that could affect your sexual health. They will also examine your genital areas.

 

Test for men: As we have said before, the sperms are the unit cells that produce in prostrad glands, come through the ducts and ejaculate into the women's vagina. After that, the sperm travels towards the ovary to fertilize the egg. Your doctor will look through various tests to see where this process is being hampered.

 

  • Physical examination: First your doctor will examine your genital areas to check any physical abnormalities.

  • Analysis of semen: Your doctor will ask for semen analysis test. Give a sample of your semen to them in the provided container. This test is very important to analyse the sperm count, quality of sperm, and quality of fluid in that sample.

  • Hormone testing: Through blood testing, your doctor will determine the sex hormone levels in your body like testosterone and many more.

  • Genetic test :  The genetic test is important to determine if the cause of infertility is related to any genetic defects like klinefelter's syndrome.

  • Biopsy: In some cases doctors recommend testicular biopsy to identify the problem.

  • Chlamydia test: Chlamydia test is required for infertility treatment because Chlamydia can cause sexually transmitted disease in men.

  • In some rare cases scrotal ultrasound, vasography, DNA analysis also performed.

 

Tests for women: Your doctor will ask you for the following tests, through which they can identify your problem.

  • Physical examination: Your doctor will examine your pelvic areas to check any type of abnormalities, fibroids or anything.

  • Ovulation test: ovulation test determines your ovulating status. It's a simple blood test through which they measure the hormone levels in your body.

  • Ovarian reserve test: Through this test the quantity and quality of eggs in your body determines.

  • Hysterosalpingography: Hysterosalpingography is a test, in which an X-ray contrast is injected into a woman's uterus and an X-ray is taken. It provides information on the condition of uterus and fallopian tubes. 

  • Hormone test: To determine the cause of infertility hormone testing is important. Through blood test they measure the levels of ovulatory hormones like estrogen, progesterone and some pituitary hormones like Follicle stimulating hormone (FSH) and LH in the body.

  • Ultrasound and sonohysterogram test: ultrasound and sonohysterogram or saline infusion sonogram evaluates the condition of the uterus area.

  • Hysteroscopy: In some cases doctors can suggest that you take a hysteroscopy test. They will insert a thin device into the uterus through the cervix to check any abnormal condition in that area.

  • Laparoscopy: It's a kind of surgical procedure in which doctors will enter a viewing device in your body to examine the uterus, fallopian tubes and ovaries. Through this process blockages in fallopian tubes, endometriosis, scarring or any type of problems or abnormalities in those parts are identified.

 

Treatment:

 

Treatment
 

The treatment depends on many factors like:

 

  • Cause of the infertility

  • Age of both partners

  • How long you have been trying to conceive a baby

  • Health of both partners

  • Personal preferences

 

In case of men:

  • Surgery: In some cases, the problem of infertility can be solved through surgery. Varicocele can be solved by surgically removing a varicose vein in the scrotum. Epididymal blockage can also be surgically repaired.

  • Medications: Some medications can improve the sperm count and quality of sperm in semen. Erectile dysfunction can be treated through medications.

  • Sperm retrieval: In this process when sperm is not ejeculate properly, the sperm is obtained from cells for later use. In retrograde ejaculation sperms got from the bladder and injected into the eggs. In case of ejaculatory duct blockage, the sperms are extracted from testicles and injected into the eggs.

  • Changes in lifestyle: There are some changes like reducing harmful substances consumption, stop taking some selected medications, regular exercise, frequency and timing of sex and many other factors may affect the fertility rate positively.

 

In case of women:

 

  • Medications or fertility drugs: The main treatment of women's infertility that is caused by irregular ovulation is taking medications. Through this they ovulation can be regulated properly.

  • Surgery: Through hysteroscopic surgery minor fibroids, endometrial polyps, uterine septum and other uterine problems can be treated. In case of larger fibroids, endometriosis laparoscopic surgery is required.

  • Assisted reproductive technology or ART: Assisted reproductive technology is a type of infertility treatment in which many technical methods are used to handle the sperm and eggs. There are several techniques used in ART such as

  • In-vitro fertilization (IVF): In-vitro fertilization is the most common technique of ART. In this process multiple mature eggs are retrieved, then fertilized to a healthy sperm in a petri dish in the laboratory. After fertilization, the embryo is placed in the uterus for implantation. In 1978 the first baby was born through IVF. By 2016 about 6.5 million babies had been born using IVF.

  • Intrauterine insemination (IUI): In this process a fine catheter is inserted into the uterus through the cervix. Healthy sperm specimens are injected directly. At that time the woman has to take some type of ovulation stimulating medication or due the normal ovulation cycle, fertilization occurs. When the male partner has some type of problem related to ejaculation like erectile dysfunction, low sperm count in semen, sperm motility related issues, this technique is used to solve that.

  • Intracytoplasmic sperm injection (ICSI): In this process a single sperm is injected into the mature egg directly. Through this process, achieving fertilization is easier, if the fertilization attempt in the IVF cycle fails, this technique can be useful. When the male has low sperm count in semen this technique is used.

  • Assisted hatching: This technique assists the implantation process of the embryo. The embryo is implemented at the lining of the uterus. The embryologists open a small hole in the outer membrane of the embryo and that hole helps the embryo to implant. This process is used when the IVF process has failed due to implantation problems or when the embryo growth rate is very low or when the mother is so older that the members become harder and make difficulties in implantation.

  • Sperm or egg donation: Usually in the ART process the couple's eggs and sperm are used for fertilization but if there is any type of severe problem with either the sperm or the eggs, they may choose sperm, egg or embryo from a donor. Fertility treatment using the donor eggs or sperm or embryo is usually done through IVF technique.

  • Gestational carrier or surrogate: Gestational carrier is a woman who carries a fertilized egg from another couple and implanted that in her womb. A gestational carrier carries the baby for another couple. If the carrier woman shares some kind of genetic link to the fetus she is called a surrogate. In some cases where the female partner cannot hold the pregnancy or the pregnancy can cause some serious health risk ,they can choose a gestational carrier. The couple's embryo can be placed in the uterus of Carrier's uterus through IVF technique for Pregnancy.

  • Electric or vibratory ejaculation stimulator: Through this process a man who has ejaculation related problems or can not ejaculate normally can be treated. In some cases where patients have spinal cord injury and can not ejeculate normally ,this process is used.

  • Surgical sperm aspiration: In this process a needle is inserted in the testicles or vas deferens to retrieve the sperm from the body for later use in IVF cycle.

 

Complications of infertility treatment:

 

There are many types of complications that can arise after the treatments.

 

  • Ovarian hyperstimulation syndrome: Ovarian hyperstimulation syndrome usually results from taking fertility medications like clomiphene and gonadotropins or it also develops after IVF treatment. In this case, the ovaries become swollen, producing small follicles and fluid sacks. The symptoms of OHSS are bloating, constipation, dark urine, diarrhea, nausea, abdominal pain, vomiting, rapid weight gain that lasts about a week or longer.

  • Multiple Pregnancy: Multiple pregnancy is one of the most common complications in infertility treatment. Twins, triplets or more, the greater number of fetuses, the higher the risk of premature delivery. 

  • Ectopic pregnancy: If the embryo implants outside of the uterus, usually in the fallopian tubes it's called ectopic pregnancy. Ultrasound scan is used to detect that. If the fetus stays there, the pregnancy has no chance to complete because the growing fetus can rupture the tube. Immediate surgery is required. 

  • Bleeding and infection: In some cases infertility treatment can cause continuous bleeding and infection also.

 

Natural treatment of infertility:

 

One 2018 review said that 29% of couples try traditional natural treatments of infertility and get results. Methods like acupuncture, yoga can help people to treat infertility naturally.

 

  • Acupuncture: Acupuncture is a type of alternative treatment, which is practiced worldwide. The National Institutes of Health found some evidence that it can improve menstruation and ovulation in women with polycystic Ovarian syndrome and also improves hormone levels.

  • Yoga: Yoga decreases mental stress and relaxes people. Recent studies said that yoga can improve fertility rate by relieving stress and many more.

  • By consuming multivitamins, antioxidants, and essential oils you can improve fertility naturally.

 

Conclusion:

 

At present, 1 out of every 6 people in India suffers from infertility. Certain medical conditions, genetic factors and also daily habits can affect the fertility rate. After 1 year of trying, if you cannot conceive you should consult a doctor. 

We hope that this article will be informative for you and will be able to raise awareness among you. Thank you.


Piyali Das

Piyali Das