Infertility is a global health issue affecting millions of people. Data suggest one in six people suffer from infertility worldwide and it is a leading cause of concern among eligible Indian couples. Dr GSS Mohapatra, endometriosis specialist and senior obstetrician-gynecologist, Apollo Hospitals, talks about the causes and cure of infertility in a conversation with Hemant Kumar Rout.
Q. Amidst declining total fertility rate, infertility is a cause of concern among couples. What’s the current trend in India?
According to a recent study, around 17.5% of the adult population experience infertility worldwide indicating the urgent need to increase access to affordable, high-quality fertility care for those in need. In India, 3.9% - 16.8% couples suffer from the condition, which is more in urban than rural areas. A double digit increase in rate of infertility has raised the alarm, both personally and socially. The estimated infertile population in India stands at around 30 million. The incidence is more in those who marry after 35 years.
Q. What are the common causes of infertility?
Infertility can happen because of health issues with the man or woman, or a mix of factors that prevent pregnancy. Genetic and environmental issues including infections or parasitic diseases, demanding lifestyle, stress, late marriages, obesity, postponing pregnancy, excessive consumption of fast food, alcohol, smoking and drug addiction are responsible for infertility. Common causes of infertility include quality of sperm, genetic defects, hormone issues, lack of regular ovulation, blocked or damaged fallopian tube, endometriosis, cervical mucus issues, polycystic ovary syndrome, uterine fibroids and poor nutrition. Lifestyle factors such as smoking, excessive alcohol intake, consumption of tobacco and obesity have been associated with higher chances of infertility in both women and men.
Q. Studies indicate infertility in men leads to difficulties in conceiving in at least 30% of cases.
Conditions affecting the formation and quality of sperm quality are the most important factor in men. Other medical conditions can include undescended testicles, genetic defects, hormone problems and health problems such as diabetes. Infections like chlamydia, gonorrhea, mumps, HIV and enlarged veins in the scrotum (varicocele) can affect the quality of sperm. Problems with sperm reaching the female reproductive tract due to sexual conditions such as premature ejaculation, genetic diseases such as cystic fibrosis, physical problems like blockage in the testicle or damage to the reproductive organs, cancer or treatment of cancer also lead to infertility. Certain factors in the environment like exposure to pesticides, other chemicals or radiation can affect fertility.
Q. What are the major factors behind the spike in infertility in women?
Women’s fertility slowly declines with age, especially in the 40s. Infertility in older women likely is due to the lower number and quality of eggs or health problems that affect fertility. Ovulation disorders, conditions of the uterus, damaged or blockage in fallopian tube, endometriosis, polycystic ovarian disease (PCOD), primary ovarian insufficiency, pelvic adhesions and certain cancers, especially ones that affect the reproductive organs, often reduce female fertility. Around 50% of women suffering from endometriosis are infertile and one in five women suffers from PCOD that leads to acne, scanty menses, delayed periods and no ovulation. Too much thyroid hormone or too little can affect the menstrual cycle or cause infertility. Some factors linked with primary ovarian insufficiency, genetic conditions such as turner syndrome and radiation or chemotherapy treatment also disrupt fertility.
Q. What are the treatment options available to treat infertility?
Although some types of infertility cannot be prevented, treatment depending on the causes can boost the chances of pregnancy. Treatment of hormonal issues by endocrinologists to bring down prolactin levels, removal of polyps by hysteroscopy and fibroids by hysteroscopy/laparoscopy, removal of blockage of fallopian tube by tubal cannulation, treatment of endometriosis and PCOD can help women regain fertility. In men, treatment of diseases, use of drugs to check premature ejaculation, quitting smoking and tobacco will help improve the condition. Couples can opt for intrauterine insemination, in-vitro fertilization (IVF), intracytoplasmic sperm injection (ICSI) and third-party assisted reproductive technologies (ART) if their conditions are untreatable. Early marriage, planning early pregnancy, moderate physical activities, consulting doctors at the right time, lifestyle modifications, nutritious diets, meditation and yoga can be helpful for couples.