Infertility is the inability to reproduce. When pregnancy does not happen even after one year of trying frequently without using contraceptives it is called infertility. About one-third of the problems are due to the woman involved, another one-third due to the man involved and the rest can be attributed to both partners or no cause can be found. Infertility has been ranked as the 5th highest serious global disability and affects almost 15% of the global population.
Infertility in women may be due to problems with ovulation (e.g. PCOS), reproductive organs or hormones. Sperm health and count are the leading causes of male infertility.
There are many common risk factors for both men and women as discussed below:
- Age: Women under 30 have a higher chance of conceiving quickly than ones in their late 30’s. This indicates that fertility rate decreases gradually until mid-30s and getting pregnant becomes a strenuous problem after 37 years. Men are fertile until 40 years after which fertility rate diminishes.
- Weight: Overweight women often have fertility problems due to their inactive lifestyle whereas sperm count is a major problem in obese men. Infertility is common among underweight women due to their restrictive dietary habits and eating disorders such as anorexia or bulimia.
- Lifestyle issues: Increased alcohol consumption, tobacco use and excessive exercise can be few other hurdles for a woman trying for a baby.
Time for a Doctor’s Visit
If you are trying to conceive unsuccessfully for more than a year, it is always better to visit your doctor. The following conditions definitely need a doctor’s attention and immediate intervention:
If you are a woman- Aged 35 and above, having irregular menstrual cycle and painful periods.
If you are a man-Having low sperm count, family issue of infertility and having small-size testicles.
Women may have problems with ovulating. Treatment options are discussed under PCOS subheading. Clomiphene, hormone injections and insemination may be used when root cause for infertility remains unsolved. Surgery to restore blocked fallopian tubes or laparoscopic surgery to remove endometrial tissue growth is also carried on to treat infertile women.
Assisted reproductive technology (ART) is a common practice nowadays. ART involves procuring sperm through normal ejaculation, surgery or from donors. These sperms are inserted into the female genital tract or used to perform in vitro fertilization (IVF). If high or low levels of hormone are said to be the reason for infertility, hormone replacement therapy or medications for hormone balance can be done. Erectile dysfunction or premature ejaculation can be treated through counseling or medication.
Maintaining a healthy diet, avoiding smoking and drinking, regular exercise and an active lifestyle are major contributing factors in reducing infertility in both men and women.
Polycystic ovary syndrome (PCOS) is a condition in which women have imbalanced female sex hormones and elevated levels of androgen (male hormones). High androgen levels are responsible for excessive hair growth, acne, irregular ovulation leading to irregular periods or absence of menstruation and cysts. PCOS is one of the most common endocrine disorders and affects 2% to 20% of the women in the age group of 18-40 years.
Though the exact cause of PCOS is not known till date, genes and environmental factors are said to play a crucial role in the development of this problem. Many women with PCOS have trouble with pregnancy. Women with this syndrome have less than 9 menstrual cycles per year, heavy or scant bleeding and continuously missed periods for 4 months or longer. Oily skin, acne, hair loss from the scalp and excessive hair growth on the face, chest, back and stomach are typical of PCOS. All these symptoms are further aggravated in obese women.
PCOS is indirectly responsible for many complications like type 2 diabetes, gestational diabetes during pregnancy, mood swings, depression, high blood pressure, endometrial (womb lining) cancer, sleep apnea and cholesterol and lipid abnormalities. Though PCOS cannot be prevented, early diagnosis and accurate treatment help to avoid these complications.
Diagnosis and Treatment
- Lifestyle modifications are the first and best step to treat PCOS. Eat a balanced diet with more of fruits, vegetables and whole grains. Avoid sugary and carbohydrate filled foods such as doughnuts, cookies, soda and fruit juices. Stay healthy with some physical activity daily. Even a 5% weight loss will bring down the androgen levels and improve fertility in women with PCOS.
- Quit smoking.
- Doctors may suggest combination birth control pills (pills containing both estrogen and progestin) to induce regular periods. Also sometimes progesterone tablets are given monthly or every three to four months. These help to reduce the risk of endometrial cancer.
- Medicines like clomiphene and metformin help to induce ovulation in women trying to get pregnant. If this does not work out your doctor may advise medication through injections like gonadotropins (follicle stimulating hormones (FSH)) and luteinizing hormone (LH).
- Hair loss and excessive hair growth can be controlled through medications such as flutamide, finasteride and spironolactone. Eflornithine, a facial cream, can be used to decelerate the growth of facial hair.