All about infertility

Becoming a parent is a dream of every couple. It gives extension to ones personality and also makes the bond between a couple stronger. It is often taken for granted as something attainable by all who want to have children. But the fact is not so. Failure to conceive or infertility can become a chronic condition, wherein people experience major disruptions in their lives and their relationships. Failure of a couple to conceive after trying to do so for at least one full year is called infertility. When the couple is not able to conceive even for the first time, it is called primary infertility. In secondary infertility, one or both members of the couple have previously conceived, but are unable to conceive again after a full year of trying. Pregnancy is the result of a complex chain of events. In order to get pregnant:

• A woman must release an egg from one of her ovaries (ovulation).
  
• The egg must go through a fallopian tube toward the uterus (womb).
  
• A man's sperm must join with (fertilize) the egg along the way.
  
• The fertilized egg must attach to the inside of the uterus (implantation).

Infertility can result from problems that interfere with any of the above steps. There are many couples that establish their central identity as 'infertile' and they begin to define themselves by their infertility. They see themselves as failures because of their inability to conceive. This sense of themselves as failures takes on overwhelming proportions in their lives. They are unable to separate treatment failure from personal failure. They push themselves to the periphery. Infertility often leads to isolation because individuals find it difficult to socialize in the "fertile world." In the first part of the 20th century, scientists believed infertility was often psychogenic i.e. resulting from psychological stress. Later in the century, more attention was focused on infertility as a stressor in people's lives. Today, we recognize that stress can affect fertility, and we also recognize infertility is a major stressor for people.

Causes of infertility

If a couple is unable to conceive, the first thing they need to know is that they are not alone. According to the World Health Organization (WHO), about 15% of couples of childbearing age seek medical help for infertility, usually after about two years of failing to conceive. The problem can stem from both female and male issues. Generally speaking, the source of infertility is:

• Exclusively with the female in about 30 - 40% of cases.
  
• Exclusively with the male in about 10 - 30% of cases.
  
• A combination of both partners having detectable abnormalities in 15 - 30% of cases.

Causes of infertility in males

The process of conception involves the fertilization of the egg with the sperm. The fertility factor in male depends on the production of normal sperm and the delivery of it to the vagina of the female. The sperm production and development is under the control of hormones, the body temperature and an appropriate genetic environment. The sperms are stored in the epididymis and are pushed through the vas deferens and urethra during ejaculation. Conditions that affect the number of sperm and the quality of sperms are the cause of infertility in males. So the causes of male infertility are:

• Sperm related disorders- The most common cause of male infertility is decreased number of the sperms. This is called oligospermia. Sometimes there is total absence of sperm. This is called Azoospermia. There are three important variables while evaluating the sperm:
  
  • Count: the number of sperm present in the ejaculate.
    
  • Motility: The ability and percentage of the sperm moving in a forward direction.
    
  • Morphology: The shape of the sperm head and tail.
    
    
• Infections- The sperms are produced in the testis. Infection of the testis and the male reproductive organs can affect the production of the sperms. This can cause infertility. E.g the most common infection of testis is by the Mumps virus. Medical conditions, such as diabetes, Sexually transmitted diseases, such as gonorrhea or Chlamydia are also very common causes.
  
  
• Genetic factors- The formation of the sperms depends upon the genetic make up of the individual. Any genetic abnormality affects the production of sperms. This can cause infertility.
  
  
• Environmental factors- The environment has a vital influence on the human body. Exposures to certain pollutants, chemicals and toxins have shown to affect the reproductive health in the males. Smoking is one of the known causes of infertility in males. The nicotine decreases the blood circulation in the scrotum; this decreases the optimum temperature required for maturation of sperms.
  
  
• Anatomical Causes- Obstructions in the genital tract can affect the normal flow seminal fluid during an intercourse. This can cause infertility in males. The obstruction can arise due to inflammation of the epididymis or the vas deferens which in turn arises from infection or inflammation of the urinary tract.
  
  
• Hormonal causes- The male hormone testosterone is responsible for the formation and maturation of the sperms. The pituitary gland and hypothalamus in the brain control the production of testosterone. Diseases of the pituitary and the hypothalamus can cause deficiency of testosterone. This can cause infertility.

Causes of infertility in females

Pregnancy is the result of a chain of events. A woman must release an egg from one of her ovaries (ovulation). The egg must travel through a fallopian tube toward her uterus. A man's sperm must join with (fertilize) the egg along the way. The fertilized egg must then become attached to the inside of the uterus. While this may seem simple, in fact many things can happen to prevent pregnancy from occurring. So the causes of infertility in females can be:

• Impact of Age- Generally, age and fertility are inversely related, and aging of the reproductive system plays a key role in female infertility. A woman's 35th year, therefore, serves as the horizon beyond which reproductive function is irreversibly lowered.
  
  
• Chromosomal Disorders- Infertility can arise in disorders where there are an abnormal number of sex chromosomes. For example, a missing X chromosome results in a condition known as Turner's syndrome, which affects females only.
  
  
• Ovulatory Causes- Failure of ovulation is the most common cause of infertility in females. Over 40% of women who are infertile have an ovulatory problem. The ovaries release an ovum or egg through a process of ovulation. The female hormones especially the follicular stimulating and the Luteinizing hormone control the ovulation. The secretion of these hormones is influenced by GnRH (gonadotropin-releasing hormone) from the hypothalamus, and by circulating levels of oestrogen and progesterone. Ovulatory disorders are most often caused by deficiency in one of the controlling hormones. However, problems can also arise if the ovaries themselves are resistant to normal levels of hormones. In addition, absent, damaged or diseased ovaries will also prevent ovulation.
  
  
• Disorders of the female reproductive system- There are certain birth defects which are present in certain females and due to that they are unable to conceive. For e.g. absence of ovaries, absence of uterus, under-developed uterus.
  
  
• Problems related to Female sex organs- Disorders of the female sex organs are much more common than those of the male. This is especially true of infection and inflammatory conditions. E.g Vulvitis and vaginitis are very common infections, Sexually transmitted diseases (STDs), endometriosis, Pelvic inflammatory disease (PID), ovarian cysts, damaged or blocked fallopian tubes, causes infertility.
  
  
• Hormonal imbalances- Any sort of hormonal imbalance can affect the fertility. Most often, it will cause annovulation, or in simple words the lack of ovulation. Sometimes it can affect the lining of the uterus and prevent a fertilized egg from getting implanted. E.g. seen in individuals suffering from thyroid disorders.
  
  
• Stress problem- Excess of stress may cause problems in conceiving. This is due to the successive changes occurring out of stress and tensions.

Did You Know? 1 in 10 Couples Seeks Treatment

That translates into more than 6 million people who have trouble conceiving and bearing a child. And the chances of conceiving in any month are only 25 percent without fertility issues.