The right ways to overcome Infertility

The joy of being able to create your own kind remains unmatched. Unable to start the much-awaited journey of parenthood? It can be ensured that what you are about to read can help you with the smooth sailing of trying to combat infertility.

Before we start, there is the good news and a bad one. The bad news is that one in six couples are affected by infertility in urban India and the good news is that many couples who are treated for infertility get to experience blissful parenthood.

A journey becomes smoother and destination more delightful if you have planned your itinerary well, so here’s an attempt to make your journey to parenthood well-informed, well-planned and fruitful.

WHAT IS INFERTILITY?

Infertility is diagnosed:

• if the couple is unable to conceive after 1 year of trying (unprotected sex)
• if the woman is over 35 years of age and has not been able to conceive after 6 months of trying
• if the woman is able to get pregnant but not carry it to the full term (9 months)

It is important to remember that about one-third of infertility causes are attributed to women, another one-third to men and rest of the times it can either be attributed to both or the cause remains unknown. Infertility is not to be associated with just women, infertility in men can also lead to the inability of being able to conceive for the couple.

About one-third of infertility cases can be attributed to women, another one-third to men and rest of the times it can either be attributed to both or the cause remains unknown.

Infertility can be:

Primary infertility– Associated with women who have never been able to conceive.

Secondary infertility– Associated with women who have had at least one successful pregnancy in the past.

CAUSES OF INFERTILITY

INFERTILITY IN WOMEN:

• Anovulation (inability to ovulate/release an egg)
• blockage, cancerous or non-cancerous growth in the reproductive system
• abnormal opening or constricted cervix
• Endometriosis (abnormal growth of uterine tissue outside the uterus)
• PCOS (Polycystic Ovarian Disorder)- enlarged ovaries with cysts
• cancer treatment (radiation and chemotherapy)
• older women (fertility in women declines naturally with age)
• smoking
• heavy alcohol consumption
• being overweight or underweight
• uncontrolled diabetes
• Any surgery involving ovaries or reproductive system
• autoimmune disorder (body produces antibodies against its cells)
• Pelvic inflammatory disease (PID)

INFERTILITY IN MEN:

• unhealthy or poorly functional sperm
• bacterial infection or sexually transmitted infection (STI)
• varicocele- enlarged veins inside the loose skin around the testis
• retrograde ejaculation- the semen goes into the bladder rather than outside the penis
• auto-immune disorders (with antibodies against sperms)
• undescended testicles
• hormonal imbalance
• medicines treating cancer and infections
• blockage in the reproductive system
• smoking can affect sperm quality and number
• heavy alcohol consumption
• exposure to radiation and heavy metals
• being overweight

Apart from these, sexual dysfunction- inability to have an erection for sex or inability to ejaculate into the vagina could also contribute to male infertility.

ASSOCIATED SYMPTOMS OF INFERTILITY:

The main symptom of infertility in both men and women is the same, the inability to conceive. While there are no other evident symptoms, a few might point in the direction of infertility like unusual menstrual discharge or pain, irregular menstrual periods, soreness or discomfort in the vagina/penis during sex. Other symptoms:

FEMALES:

-menstrual cycle which is too long, too short, irregular or absent

MALES:

• problem in sexual function (ejaculation)
• pain, swelling or lump in the testicular area
• abnormal breast growth (gynaecomastia)

DIAGNOSIS OF INFERTILITY:

FEMALES:

• History and Physical Examination: The doctor starts by taking a medical history, sexual history and menstrual history. Following which they perform a physical examination of the pelvic area to check for any structural abnormalities including height, weight and BMI
• Ovulation test: This is the simplest test to check ovulation or to check if the egg is releasing from the ovary. Elevated progesterone causes the temperature of the body to rise 0.5-1.0 °F. A chart to be maintained to check the temperature rise and ovulation usually occurs around midway between the period (on 14th day of the cycle for a woman with 28 days cycle period).
• Hormonal tests: Hormones like FSH (follicular stimulating hormone), AMH (Anti-Mullerian Hormone), estrogen and prolactin may also be checked to find out the underlying cause of infertility.
• Imaging scans: Ultrasound may be done to examine the uterus and ovaries while X-Ray hysterosalpingogram may be done to examine the fallopian tubes. CT scans or MRIs are also used to diagnose complex abnormalities related to uterus or pelvis.
• Laparoscopy: This is an invasive or a surgical procedure which may be performed to identify any reproductive system related irregularities like any tumor, cyst or growth etc. The presence of multiple small follicles in the ovary confirms the presence of PCO.
• Genetic testing: This is done sometimes to rule out genetic defect causing female infertility.

MALES:

• History and Physical Examination: The doctor takes a medical history, sexual history and asks about the factors that could affect your fertility. The doctor then performs physical examination of the genitals to check for any structural abnormalities.
• Semen analysis: The doctor asks for the semen sample to check for the quality, quantity and motility of sperms:
• Hormonal tests: To check for hormonal imbalance.
• Routine blood test:
• Genital ultrasound: To check for any abnormalities like enlargements or blockages in and around the testicles.
• Genetic testing: This is done sometimes to rule out genetic defect causing male infertility.
• 7. Urine analyses: this is done to check the urinary tract infections and sexually transmitted diseases which can also cause infertility. It is important to evaluate such infections. These infections can also cause partial or complete obstruction of the male reproductive system.

TREATMENT OF INFERTILITY:

The treatment of infertility depends upon the cause of infertility. The treatment for both males and females broadly comprises of medications, surgery and ART (Assisted Reproductive Technology).

TREATMENT IN FEMALES:

• Medications: These are prescribed for either hormone replacement or improving the quality and quantity of the eggs. Doctor’s consultation is essential for medication for infertility.
• Surgery: Surgeries are required in case of any abnormal growths or tumours. Surgery for treating infertility in women includes laparoscopic surgery as well.
• Artificial insemination or intrauterine insemination: Millions of sperm are placed close to the uterus around the time of ovulation artificially.
• ART (Assisted Reproductive Technology) or IVF(in-vitro fertilisation): In this women are given various injections for further maturation and development of eggs. Multiple eggs are retrieved from the woman and these eggs are fertilised with sperm obtained from the man externally in the laboratory. After fertilization, the embryos are obtained and they are then returned to the women’s uterus. This is in-vitro fertilisation (IVF) which is a laborious process but has proven to be quite successful and the baby born through IVF is called test-tube baby.

TREATMENT IN MALES:

Treatment for abnormal sperms: Depending on the sperm count or abnormality of sperms treatment provided.
Surgery:Surgery may be done for the removal of varicocele or to rectify any structural abnormalities. In some cases, surgery may be required for sperm retrieval.

ART (Assisted Reproductive Technology): Sperm through normal ejaculation, sperm retrieval technique or the sample obtained from a sperm donor are artificially placed in the female genital tract or taken for in-vitro fertilisation (IVF).

Treatment of infections and sexual problems: Medications may be prescribed for the same. In case of sexual problems sometimes counselling may also be required.
 
AUXILIARY INFERTILITY TREATMENT:

These are associated with improving the fertility rates while undergoing the treatment of infertility.

YOGA AND EXERCISE: The breathing techniques and exercises help reduce the stress levels associated with Infertility and its treatment. They also help in reducing the body weight as well as help tackle diabetes and maintaining normal levels of blood sugar if diagnosed.

VITAMINS AND MINERALS: The vitamins promoting fertility like zinc, folate, iron, Vitamin A and C can help you increase the success of infertility treatment.

TEA AND ESSENTIAL OILS: Both tea and essential oils (used in aromatherapy) are known to reduce stress levels and overall benefit.
 

TACKLING INFERTILITY:

The taboos and myths about infertility can cause a lot of additional emotional turmoil and also lead to unavoidable stress further hampering the possibility of conceiving. Both the partners need to work as a team, consult their doctor, look out for the treatment options and choose wisely based on the circumstances. Psychological counselling is very crucial and can help you cope with the issues related to infertility in a better manner. It can be a tough road but the key is to keep trying and not lose hope. Lastly it is essential to keep in mind, if things still don’t work out then adoption and surrogacy are potential alternatives one can turn to.