An alarming 15 per cent of the population today faces difficulties or delays in conceiving. It has been estimated that 40 per cent of human infertility has been attributed to female causes, while 40 per cent of it has also been attributed to male causes. The remaining 20 per cent is due to a combination of male and female factors. With growing awareness, the number of couples seeking medical attention has increased.
Due to the easy availability of birth control methods as well as educational and career aspirations, most women delay having kids. As a result, an increasing number of older women go for assisted reproductive technology (ART). However, most couples are not infertile — instead they are sub-fertile. This distinction is critical as there is a chance of conception even without treatment.
The chief causes of infertility in women are ovulatory disorders (25 per cent), tubal diseases, including endometriosis, (25 per cent).
A woman with normal cycles has 12 to 13 ovulations in a year. If a woman ovulates only four times a year, it will take her three times longer to get pregnant. Similarly, if there is a history of pelvic infection or a severe attack of appendicitis, investigations should begin sooner. Once a woman crosses her 35th birthday, investigations are recommended within six months of unprotected intercourse. A woman is born with a fixed number of oocytes (about 1 million per ovary) and only 500 ovulate while the remaining degenerate. Smoking accelerates the age of menopause by two years. By age 37, only 10,000 eggs remain per ovary. A woman’s fertility is therefore thought to decline significantly after the age of 37.
Body weight also affects the initiation of puberty in girls and thus fertility. Women should reduce their BMI to less than 30 before any fertility treatment. Weight loss of five to 10 per cent of body weight can restore fertility.
There is a way out
Time is a critically important factor for couples seeking fertility treatment, as the age of the woman is the number one prognosticator for success. The duration of infertility plays also an important role in considering treatment options. A prompt and efficient evaluation is the most beneficial. Diagnostic assessment is advised for couples who fail to conceive despite 12 or more months of unprotected intercourse. An earlier assessment is recommended for women with irregular menstrual cycles or for those at high risk for tubal disease and endometriosis. Women below the age of 25 have a five-out-of-six chance of conceiving within a year of discontinuing contraception.
The writer is the director of the Infertility Institute and Research Centre, Hyderabad.
* Pelvic inflammatory disease is a spectrum of infections of the female genital tract that leads to infection of the fallopian tubes resulting in a tubal block and infertility. Sexually active women under 25 are at the greatest risk.
* Multiple sexual partners, intercourse at a younger age, previous infection, smoking, intra-uterine devices and vaginal douching are the main causes.
* Lower abdominal pain, vaginal discharge and irregular bleeding are the symptoms.
* Endometriosis is the presence of the uterine lining outside the cavity of the uterus resulting in damage to the organs involved.
* The symptoms include increased pain during menstruation, pre-menstrual spotting and excessive bleeding.
* The exact mechanism is not known but it has been associated with genetic predisposition. Seven per cent of first degree relatives of patients with endometriosis have the disease. Auto-immune diseases like thyroid, allergies and fungal infections are associated. Recent reports have shown that exposure to toxins found in plastic and chemical industries is associated with endometriosis.
* Treatment methods are medical and surgical, mainly laproscopic.