Infertility has become a common complaint among women who visit the gynaecologist. Infertility is defined as one year of unprotected intercourse without conception. Approximately 85-90% of healthy couples conceive within one year.
The human reproductive process is complex that requires some basic components like a healthy sperm which has the capacity to fertilize eggs, production of the eggs by the female, normal fallopian tubes which allows transport of sperm and eggs and a receptive uterus for the growth of embryo.
The common causes of Infertility can be divided into
1.Male problems (35%)
2.Problems in ovulation (15%)
3.Tubal and pelvic problems (35%)
4.Unexplained Infertility (10%)
5.Unusual problems (5%)
The overall increase in Infertility can be attributed to several factors like greater interest in advanced education and careers among women, late marriage and more frequent divorce, improvement in contraception and access to family planning services and delayed childbearing.
With increasing age woman have problems like decrease in the quantity and quality of oocytes (egg) which results in infertility or increase in risk of miscarriage. Also other disease conditions like pelvic infections, fibroid uterus, endometriosis is greater in older women. The success rates achieved with assisted reproductive techniques also decline as age increases. The chance of having babies with chromosomal anomalies like Downs Syndrome also increase with increasing age.
Life style choices and environmental factors also influence infertility. In women obesity associated with menstrual dysfunction, decreased fertility and increased risk of miscarriage and obstetric and neonatal complications. In men, obesity is associated with abnormal semen parameters and can adversely affect fertility. In short a stressful job, junk food and lack of exercise are today’s problems.
Evaluation of infertility should be done for all couples who have failed to conceive after a year or more of regular unprotected intercourse, but a year of infertility is not pre-requisite for evaluation. Earlier treatment should be done for woman with irregular menstruation, history of pelvic infection or endometriosis, or having a male partner with known or suspected poor semen quality, and also is warranted after 6 months of unsuccessful effort for women over the age of 35 years.
Infertility can be prevented to large extent by conceiving at an early age, leading stress free life and practising healthy life style habits like eating well balanced diet, regular exercise and by avoiding junk food, alcohol and smoking
With proper evaluation and treatment the majority of couples with infertility will achieve pregnancy. For those who failed simpler specific treatments, assisted reproductive techniques (IVF, surrogacy) and adoption are both realistic options.