Infertility

DSCN0538Infertility is an increasing health problem in the world. Infertility primarily refers to the biological inability of a man or a woman to contribute to conception. Infertility may also refer to the state of a woman who is unable to carry a pregnancy to full term.

Reproductive endocrinologists consider a couple to be infertile if:

  • the couple has not conceived after 12 months of contraceptive-free intercourse if the female is under the age of 34
  • the couple has not conceived after 6 months of contraceptive-free intercourse if the female is over the age of 35 (declining egg quality of females over the age of 35 account for the age-based discrepancy as when to seek medical intervention)
  • the female is incapable of carrying a pregnancy to term.

Subfertility

A couple that has tried unsuccessfully to have a child for a year or more is said to be subfertile meaning less fertile than a typical couple. The couple’s fecundability rate is approximately 3-5%. Many of its causes are the same as those of infertility. Such causes could be endometriosis, or polycystic ovarian syndrome.

Causes

German scientists have reported that a virus called Adeno-associated virus might have a role in male infertility.

Some minor factors like wearing tight jeans, using motorbike, and laptop may affect the spermatogenesis inversely due to emission of heat.

For a woman to conceive, certain things are necessary: intercourse must take place around the time when an egg is released from her ovary; the systems that produce eggs and sperm have to be working at optimum levels; and her hormones must be balanced. There are several possible reasons why it may not be happening naturally.

In a third of cases, it can be because of male problems such as low sperm count.

Problems affecting women include endometriosis or damage to the fallopian tubes (which may have been caused by infections such as Chlamydia).

Factors that can cause male as well as female infertility are:

  • Genetic Factors
    • A Robertsonian translocation in either partner may cause recurrent spontaneous abortions or complete infertility.
  • General factors
    • Diabetes mellitus, thyroid disorders, adrenal disease
  • Hypothalamic-pituitary factors
    • Kallmann syndrome
    • Hyperprolactinemia
    • Hypopituitarism
  • Environmental Factors
    • Toxins such as glues, volatile organic solvents or silicones, physical agents, chemical dusts, and pesticides.

Lifestyle Causes of Infertility

Weight: can affect a woman’s chances of conceiving include being over- or underweight or her age. Obesity has a strong association with infertility and menstrual irregularities. While some of the ovulation problems and menstrual changes are explainable by women with Polycystic Ovarian Syndrome (PCOS) who are also obese, women who do not have PCOS but are overweight also have the same problems. Group treatment programs that assist obese women with diet and exercise plans have shown return of fertility in many patients. Weight loss of 15 lbs (6.5 kg) has been shown to restore ovulation. It is thought that the improvement in insulin resistance has more to do with restoring ovulation than the actual amount of weight or weight loss itself.

Low weight and weight loss is also associated with ovulatory dysfunction and thus infertility. Even a moderate weight loss of 10-15% under ideal body weight can result in menstrual irregularity. It does not need to be the weight alteration of 30% or more as seen in women with anorexia nervosa or bulimia. Weight gain programs in these underweight women have been shown to restore ovulation and pregnancy in up to 73% of women who were able to achieve 95% of their ideal body weight.

Stress: Even though infertility is very stressful, there is some proof that stress causes infertility. Biologically, the hypothalamus regulates both stress responses as well as the sex hormones; it is easy to see how stress could cause infertility in some women. Excessive stress may even lead to complete suppression of the menstrual cycle.  

 

Smoking: Almost all studies show that smoking decreases fertility. Smoking causes decreased estrogens with breakthrough bleeding and shortened luteal phases. Smokers have an earlier than normal (by about 1.5-3 years) menopause which suggests that there is some toxic affect of smoking on the follicles directly. Chemically, nicotine has been shown to concentrate in cervical mucous and metabolites have been found in follicular fluid and been associated with delayed follicular growth and maturation. Finally, there is some affect on tubal motility because smoking is associated with an increased incidence of ectopic pregnancy as well as an increased spontaneous abortion rate.

Alcohol: is widely consumed all over the globe. In the USA, for example, a report carried out in 2004 found that 50% of the population over the age of 12 years and 11% of pregnant women consumed alcohol, while 7% of the population were heavy drinkers. Different studies have established a relationship between moderate-to-severe alcohol intake and infertility in both men and women and poor obstetric outcome, in a dose-dependent manner. It has been shown to alter estrogen and progesterone levels as well as cause anovulation. Most chronic alcoholics become amenorrheic.

Caffeine:  a total of 80% of pregnant women consume caffeinated beverages. Some clinical and epidemiological studies have suggested delayed conception and increased infertility and miscarriage rates in women that consume caffeinated beverages. The threshold at which caffeine affects fertility is not known. Different studies have proposed levels between over 150 mg (1.5 cups of brewed coffee) and over 500 mg (five cups of brewed coffee) per day.

Age: Female fertility declines sharply after the age of 35. Sometimes it can be a combination of factors, and sometimes a clear cause is never established.

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