Infertility

Introduction

Infertility is the state of failure of fertilization( read more about embryogenesis here) in the prospective couple. It is one of the growing concerns around the world from the past 3 decades. It affects both men and women however, women are the victims often. People from various countries come to India under medical tourism visa as India is providing a wide range of fertility services. There are many infertility clinics in our country. Infertility is generally preventable by measures such as awareness programs and counselling services about reproductive health. The phenomenon is closely linked with lifestyle, the general health status of the individual and nutritional status of women. Women suffering from prolonged mental stress is one of the major factors of infertility. The majority of the cases are present with the history of late marriage or age of conception beyond 35 years in women and 45 for men.  The condition is also seen in women with uterine defects and other reproductive tract infections. 

 

Risk factors of infertility 

Infertility is associated with poor physical health, congenital diseases( birth defects), systemic infections, prolonged substance abuse,  smoking and alcoholism, addiction to illegal drugs, immunological issues and the family history of infertility. 

 

Specific Causes of infertility

  1. Abnormal structure or function of sperm resulting in the poor quality of sperm with reduced motility .

  2. Low sperm or ovum count

  3. Overweight or obesity may reduce the chance of conceiving.
  4. Genetic defects of reproductive organs

  5. General medical problems such as diabetes or infections such as chlamydia, gonorrhoea, mumps, and HIV.

  6. Low sperm and ovum count.

  7. Varicocele is the scrotum. Varcicoceles are the enlarged veins causing poor blood supply to the testes.

  8. Excessive heat and other environmental factors

  9. Prolonged work history in the radioactive, mining and some chemical industries are the occupational factors that can cause infertility.

  10. Toxic effects related to tobacco, marijuana, or other drugs

  11. Inadequate diet intake associated with extreme weight loss or gain

  12. Diseases and defects of uterus, ovaries, and other sexual organs.

  13. Past history of abortion or medical termination of pregnancy.

  14. Exposure to certain harsh chemicals like Pesticides may increase the risk.

 

Strategies of Infertility management through assisted reproduction techniques (ART)

ARTs are the artificial methods of fertilization in which the artificial insemination (introducing semen to the uterus) is used with the help of assistive devices. This is a preferred method in those women with serious anatomical defects in the uterus and cervix.  In the case of men, most predominant factors are the low sperm count, sperms with low motility, and erection problems. ARTs are a good choice for those victims affected by the retrograde ejaculation -a condition in which sperms are deposited into the women`s bladder instead of  ovaries. ARTs can also be used in case of uterine infections, injuries, and scars in the cervix.

 

Types of ARTs

A. In vitro fertilization: During an IVF cycle, a doctor collects a matured and healthy ova (egg) from the woman. Before fertilization, egg will be safely stored in an external environment similar to the mother’s uterus. Followed by this Fertilization is induced artificially and then the doctor carefully implants the fertilized embryo back into the woman’s uterus.

B.Intrauterine insemination ( IUI): This is the more affordable option when compared to the IVF but its success rate is low. During an IUI the sperm is implanted into the woman’s uterus by using a probe.

C.Intra fallopian transfer: It is a method in which the doctor transfers fertilized egg into the uterus through fallopian tubes. The egg is fertilized in an external environment before placing them into the fallopian tube. Intra fallopian transfers are good options for couples complaining of unexplained infertility, men with sperm mobility issues, or the woman suffering from fallopian tube issues.

D.Gamete intra-fallopian transfer (GIT): In this case, the doctor transfers sperm and eggs into a woman’s fallopian tube in order to fertilize sperm with the target egg under the supervised conditions.

E. Zygote intra-fallopian transfer (ZIT): It is similar to IVF in which eggs are removed from the woman’s body and fertilized in an external lab setting, then transferred into the woman’s body when the embryo starts growing.  

F.Intracytoplasmic sperm injectionIn this case, a mature egg is injected with a single healthy sperm outside the uterus. When the eggs develop normally, they are transferred back to the woman’s body.

 

Further reading

1       

 Structure and functions of sperm                            

2

Embryogenesis

3

human reproduction

4

reproductive health

 

Questions

  1. Explain the causes of infertility

  2. What are the different methods of artificial fertilization?

  3. In which method does a doctor transfers sperm and eggs into a woman’s fallopian tube in order to fertilize?

  4. What is intrauterine insemination?

  5. What are the indications of artificial fertilization in women?

 

 



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