Infertility is defined as a couple’s inability to conceive after one year of unprotected intercourse. Infertility is perceived as a social problem in our country, with various medical manifestations.
Infertility affects 15% of couples worldwide or one in six couples globally. Currently, the number of infertile couples stands at 60-80 million, and the number is increasing every year.
In India, as many as 20% of couples seek treatment for this disorder. Medical reasons for the failure to conceive could be present in either of the partners. In our country, problems of infertility are observed in 35-40% of men, and an equal percentage of women, while, both partners face the problem in 20-30% of cases.
However, advances in medical science have made it possible for infertile couples to experience the joys of parenthood. Since the birth of Louise Brown on 25th July 1978, over 3 million test tube babies have been born, lighting up their parents’ lives.
Infertility affects one in six couple. There are about 60-80 million infertile couples worldwide, and the rate is increasing. Some patients spontaneously achieve pregnancy, but others at some stage experience difficulty in achieving conception and these patients need some kind of assistance in getting pregnant. There is about 3-5% probability of achieving pregnancy in one menstrual cycle. This is called Fecundability; fecundity is the probability that a single cycle will result in a live birth. It is estimated that out 100 couple with female partner's age less than 35 years, approx 80-85% will achieve pregnancy within the first year of unprotected intercourse, 90% will conceive within 18 months, and about 95% will conceive within two years. The remaining 5% rarely achieve pregnancy without some form of assistance.
Infertility may be defined as an inability to achieve pregnancy within two years of having unprotected intercourse, though some clinicians prefer this time limit to be 1year. Women who are more than 35 years should consult an expert after six months of contraceptive-free sexual intercourse when it has not resulted in pregnancy. This difference in the time limit is owing to the declining egg quality with increasing age. In some couples the fertility is impaired to some extent but not completely, these patients may conceive in 3rd year or subsequently without any assistance as there is a delay these patients are called subfertile while sterility is an absolute state of inability to conceive.
The cause of infertility could be in either of the partners (Male factor-35%, Female factor-40%) or 10-15% both partners may be infertile or sub-fertile. Sometimes each could be individually fertile, but as a couple may need assistance to achieve pregnancy the causes could be immunological or genetic, this is called Combined infertility. While in about 10%, the fertility evaluation shows no abnormality, these patients are likely to have problems which are not diagnosed by currently available investigations; this is termed unexplained infertility.
There are several treatment options available for infertility:
Intrauterine Insemination refers to the procedure of insemination at the time of ovulation. This helps in increasing the chances of conception over and above the natural course. It is indicated in cases of mild problems in sperm count/motility, dysovulation, mild endometriosis, unexplained infertility and in cases of donor sperm.
In Vitro Fertilization (IVF) is a process in which eggs are fertilised by sperms outside the womb (uterus). In layman terms, it means a ‘test tube baby’. IVF helps many childless couples achieve parenthood. It is indicated in cases of the tubal block, male infertility, severe endometriosis, unexplained infertility, previous failed IUI cycles, egg donation and surrogacy, etc.
ICSI is a procedure that is used along with IVF. In this procedure, a single sperm is directly injected into an egg
Fertility enhancing Laparoscopy and Hysteroscopy is indicated for the removal of:
- Ovarian cyst,
- Pubal correction
- Septum resection
- Adhesiolysis- division of intrauterine synechiae, etc.
Treatment for Male Infertility:
Depending on the cause, either medical or surgical procedure can be undertaken. In cases of Azoospermia, surgical sperm retrieval followed by IVF-ICSI can be conducted.