Infertility - The Empty Womb

by Dr.Eva Bell
(Bangalore)

Infertility is the inability to conceive even after a year of cohabitation between husband and wife. About one in ten couples worldwide are unable to have children. In India, the estimate is 1.6 to 1.9 million couples. To some extent, changing life styles can be held responsible. As incomes and stature increase, sexuality has a tendency to dip. One Indian study showed that 74% of working couples have no time for sex. 50% have infertility because of infrequent sexual activity. Voluntary Childless Couples (VCC) are on the rise. DINS (Double Income No Sex) is by mutual consent. Others postpone child bearing until they have achieved their goals in life. Work stress too can alter a woman’s fertility.

Age: The most fertile period in a woman’s life is between 22-35 years. Fertility progressively decreases after the age of forty. Thirty seven is said to be the watershed year. As age increases, the chances of abortions or abnormal foetuses increase. Medical complications like pregnancy induced hypertension or diabetes are likely to occur.

Though males retain their fertility almost till the seventh decade, there is evidence that the sperm count may be low, the motility reduced, and more abnormalities detected. The older the age of the male, the more likely are genetic abnormalities such as Autism or Schizophrenia in the offspring

General Health: Anorexia in women brought on by excessive loss of weight through dieting, may lead to stoppage of periods or ovulation. Similarly, obese women menstruate or ovulate less frequently.

Fast foods, processed foods, lack of exercise make bodies resistant to Insulin. As a result, more Insulin is produced leading to fat deposition.

Female causes of Infertility:

1.Failure to ovulate.

• This may occur due to dysfunction of the endocrine glands like the hypothalamus, pituitary, thyroid or adrenals.

• Primary Ovarian failure is when the ovary fails to produce ova. Sometimes, after a few years of normal menstruation, periods may stop due to premature menopause. Polycystic Ovarian Syndrome has been diagnosed in 22-33% of infertile women. Here the ovaries are enlarged with multiple small ovarian cysts. A triad of symptoms – obesity, hirsutism and infertility, is usually associated with PCO. But many young women are neither hirsute nor obese, and are diagnosed only when they seek help for infertility.

2. Fallopian tubes may be blocked due to diseases like TB, Gonorrhea, Chlamydia, pelvic inflammation or Endometriosis. In Endometriosis, bits of endometrial tissue (lining of the uterine cavity) are found outside the uterus either in the ovaries, or tubes or on pelvic structures. During menses, these cells break down and bleed, causing a local inflammatory reaction, which is followed by fibrosis. If the ovaries are involved, large chocolate cysts may develop. Endometriosis is closely associated with women who postpone pregnancy to the fourth decade or in women of high social status and is referred to as ‘the scourge of the private patient.’ Also, the frequent use of laparoscopy for diagnostic purposes can lead to endometriosis. About 15% of infertile patients suffer from endometriosis.

Male Factors:

The normal sperm count is between 60 – 200 million/ml. When the sperm count is low or the motility is decreased or the number of abnormal sperms is large, infertility is most likely to occur. This may be a result of testicular inflammation or injury, or complications of surgery for undescended testes or varicocele.

According to research done a few years ago by the Mumbai Institute of Research for Reproduction, the quantity and quality of sperm has decreased over the last 30 years. Of the 1500 men tested between 1986 -95, they observed a 30% reduction in sperm count and 10% reduction in motility. There has also been an increase in testicular cancer. Pollution through pesticides with a high percentage of lead is cited as the cause.

Narcotics, tranquillizers, medicinal drugs used for prolonged periods can also reduce sperm count. Marijuana reduces testosterone by 41%.

TB, gonorrhea, and other sexually transmitted disease may also lead to infertility.

Tight jeans which are the rage with youngsters, increases the temperature in the scrotum by 3 degrees. Similarly laptops supported on the thighs for long periods increases scrotal temperature which affects sperm production.
Male menopause may also cause diminished libido.

Coital Factors:

• 3-4% of males have coital problems such as impotence, and females may complain of severe pain (dyspareunia) during intercourse.

• Cervical mucus is hostile towards male sperm. The mucus has ‘sperm immobilizing’ properties.

• According to evolutionary biologist Oren Hanan of Tel Aviv University, some men may produce “super sperm” which are too fast and too powerful for fertilizing the ovum.

• Intercourse may not coincide with ovulation.

Unexplained Infertility: In about 4-10% of couples, investigations show no abnormality in either the man or the woman. Many get pregnant after they adopt a child, or move to a new place or the husband changes his job.

Detailed investigations are available for both infertile males and females. Specific defects can be diagnosed and appropriately treated.

Artificial Insemination with husband’s sperm (AIH) or with donor sperms (AID) have been done over the years.

In vitro fertilization (IVF) and Embryo transfer is available to those with tubal damage, endometriosis not responding to treatment, cervical mucus hostility or even unexplained infertility. Though this is still expensive and there are failures, the procedure has brought joy to many childless couples. There are methods to select the best embryos and implant them in the uterus instead of the earlier methods of implanting multiple embryos.

Intracytoplasmic injection of a single healthy sperm into an egg has also met with success. However researchers warn that babies born through Assisted Reproductive techniques are 2-4 times more prone to abnormalities such as cleft lip or palate, and abnormalities of the gastrointestinal tract. Others say the risk is minimal.
Infertility today, is not as alarming as it used to be.

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