Infertility refers to a set of diseases that affects a couple making it difficult for them to conceive even after a year of unprotected sex. Despite there is a lot of awareness surrounding infertility, many couples are still unsure on when to consult a specialist. To understand more about this issue, MedPiper Technologies, JournoMed and Qura Diagnostics and Research Centre, Bhopal, along with IRIA Kerala and IRIA Bhopal conducted an interactive session as a part of National Infertility Awareness Week. In this talk, Dr Priya Bhave Chittawar, infertility expert and gynaecologist and Dr Somya Dwivedi, radiologist went into detail about this prevalent issue and the possible treatment options, aiming to raise awareness regarding infertility.
While most couples are to consult a specialist if they are not able to conceive within a year of trying, women and couples beyond the age of 35 are to visit if the conception does not happen within 6 months. Most of the older couples are not infertile, rather they are subfertile. Hence, even minimum medication and treatment can help these couples achieve pregnancy.
Is infertility a women’s problem alone (a myth in India)? If not, how does infertility affect men?
“Although the woman carries the child and gives birth, the man contributes 50% towards conception” says Dr. Bhave. Infertility affects both men and women equally. Around 30% of the infertility cases in India are due to combined issues in both men and women, and 20% of the infertility cases are due to male infertility. Both Dr. Bhave and Dr. Dwivedi suggests couples who are suffering or who suspect that they might be suffering from infertility to immediately consult a specialist together as a couple.
Common reasons for infertility in men and women?
In urban areas, female infertility is higher due to the rising incidence of PCOS and endometriosis. Both these disorders contribute to around half of the infertility cases in women. In rural areas, male infertility is on the rise. This is attributed to the use of fertilisers and chemicals causing farmers to have lower semen parameters. Tuberculosis of the uterus also predisposes female infertility.
“The semen analysis is like a report card for not only the reproductive health but also the overall health of a man” states Dr. Bhave. This is because the parameters on the semen analysis report are affected by various factors such as:
- Working conditions: exposure to radiation or high temperature affects sperm morphology (sperms are temperature sensitive)
- Viral illnesses
- Systemic disorders like hypertension, diabetes, obesity, etc.
- Thyroid hormonal imbalance.
- Smoking and excessive alcohol consumption (affects sperm morphology)
When is the ideal time for a couple to start adopting healthy lifestyle habits before conception?
Pregnancy planning does not stop at childbirth. Preparing for pregnancy includes giving a good future to the child. “The moment you decide to become a parent, that is when you should start following a healthy lifestyle,” says Dr. Bhave. This is also because once a couple starts trying to conceive, there is no set time frame for conception. They may become pregnant within a month, after a long period of time or sometime in between.
If a woman has already had a child via a healthy pregnancy, and she is unable to conceive a second time, is she still considered infertile?
This phenomenon is called as secondary infertility and is normally seen after a miscarriage, tubal pregnancy or a healthy childbirth. It occurs due to three major reasons:
- Fertility decreases as one ages. (a woman’s fertility declines faster than a man’s)
- The process of miscarriage, tubal pregnancy or healthy birth may be accompanied by certain diseases or conditions which causes tubal blockage.
- Lifestyle changes, stress and weight gain after the first pregnancy may adversely affect a man’s semen profile.
Some basic tests to determine infertility in a couple?
The specialists mainly check for the status of the sperm, the egg, the fallopian tubes (the site of fertilisation) and the uterus. Hence, after obtaining a complete patient history, they will perform a semen analysis and hormone profiling tests. They will also check for other parameters that will affect both the mother’s and the baby’s health which include: thyroid levels, rubella antibody levels, thalassemia status, etc.
Dr. Dwivedi explains how an internal scan can help determine the endometrial lining, ovarian reserve, masses or cysts that may impede implantation etc. The scan also helps to find out if there are any anomalies in the structures surrounding the uterus which may affect foetal growth.
Can low sperm count and sperm motility be treated with medication alone?
If the sperm count is extremely low or zero, then it is near impossible to treat as there is a genetic reason behind it. In borderline cases, when there is motility in 20-25% of the sperms (the WHO states that progressive motility should be present in 32% of the sperms in the ejaculate), the specialists can pinpoint the reason and treat it accordingly.
Note: The results of taking these medications will only be seen after three months as it takes that much time for sperms to develop.
Different treatment options for infertility?
The first stage of treatment includes treating the cause, helping restore fertility through medication, and relieving any obstructions. If normal treatments have failed even after multiple rounds of medication (i.e. the tubes have not opened up or the motility has not improved) then the specialists go for procedures like Intrauterine Insemination (IUI) or In-Vitro Fertilisation (IVF). In couples with severe infertility, the doctors directly suggest IVF as treatment.
While many couples consider IVF as an ‘unnatural procedure’, Dr Dwivedi says that IVF is assisting in nature and it is there to help couples. She says that the procedure is as natural as it gets as the fertilised embryo is placed into the mother’s womb for implantation.
Diseases/Disorders associated with infertility
“Indian families tend to hyperfocus on a woman’s reproductive health, and oftentimes end up ignoring a man’s reproductive health, which is just as important”, Dr. Bhave states. If a man’s testicles have not descended into the scrotum, have undergone varicocele, hydrocele or hernia surgeries, have suffered from torsion or injury to the testes or have taken any kind of unnecessary testosterone supplementation, he should get a semen analysis done.
Women who suffer from PCOS, fibroids, endometriosis or have had a tuberculosis infection, should visit a doctor to get evaluated for infertility. While it is a concerning condition, 30% of PCOS patients conceive naturally, and only around 10% of the patients need IVF or hormonal stimulation. Follicular studies can help track follicular growth and help PCOS patients to conceive.
Difference between IUI and IVF?
Human reproduction has three major bottlenecks:
- The exact time of ovulation is not clear and causes couples to miss the time of egg release.
- The sperm (5μ in length) has to traverse 15-20cm of the uterus to fertilise the egg in the fallopian tube. Sometimes, the sperm may not be motile enough or the uterine conditions may not be favourable.
- Even after the embryo is formed, it may not stick to the uterine lining (implantation)
IUI is a procedure of timing. In this procedure, the sperm is put into the uterus at the time of follicular rupture (which will reduce the distance). IUI has lower success rates and may not work if the sperm motility is low or if the tubal conditions are unfavourable. IVF goes an extra step and the specialists fertilise the egg and the sperm outside the uterus. IVF has slightly higher rates of success but may not ensure implantation.
Freezing eggs: does it really work?
For many people in their 30s who do not have a stable partner, do not want to conceive just yet, or suffer from medical issues, freezing their eggs and embryos is an extremely viable option. However, the chances of live birth from one frozen egg is around 2-5% and a woman needs to freeze more eggs. While egg freezing is not a panacea, and does not guarantee pregnancy, it offers a strong backup option. Dr. Bhave suggests that freezing the embryos is a better choice as the chances of live birth is around 10-15%. She also says that couples should use up the eggs within 5-10 years of freezing them.
What is the PGT test?
PGT or Preimplantation Genetic Testing explains the genetic profile of the embryo. This procedure is normally performed before implanting the embryo into the uterus (i.e. the last step of IVF) and is essential for couples who carry mutations for any kind of genetic disorders. PGT will help to find out the mutated embryos and transfer the healthy embryos into the uterus implantation. It also helps to prevent future spontaneous abortions.
However, this test is invasive, expensive and requires a high level of skill set. “Despite all these setbacks, PGT is a boon and is a strong solution to preventing possible cognitive, genetic and metabolic disorders”, says Dr. Bhave.
Infertility can leave couples feeling despondent and hopeless. Both Dr. Bhave and Dr. Dwivedi offers hope to these couples as there is a lot of support in the form of doctors, infertility specialists, gynaecologists and radiologists who will help them by figuring out the root of the problem, thus ensuring healthy and successful pregnancies.
Dr Priya Bhave Chittawar is a Reproductive Medicine Specialist, Gynecologic Endoscopic Surgeon and Youtuber. She graduated from Gandhi Medical College, Bhopal and was the first gynaecologist from Central India to hold superspeciality qualification in reproductive medicine from CMC Vellore. She had also helped bring more than 2000 babies into the world via IVF.
Dr. Soumya Dwivedi is a Radiologist who has specialised in Foetal Imaging, Ovarian Tumour Analysis, NT/NB Scans and Pre-Eclampsia Screening, FOETAL ECHO, Foetal Abnormalities and Advanced Obstetric Ultrasound. She is also the Director and Chief Radiologist at Qura Diagnostics and Research Centre, Bhopal.
Author: Parvathi Nair