Infertility is the inability to produce children for a couple in spite of unprotected sexual co-habitation within one year or more. A large number of couples all over the world including India are infertile.
The causes of infertility may be physical, congenital, disease, drug, immunological or even psychological.
In India, when a couple is childless, the female is usually blamed. But more often, the males are detected to be responsible. However, now, specialized health care units known as infertility clinics are available. They could identify the cause of infertility and take up treatment to remove the disorder.
Causes:
The possible causes of infertility in males, females or both are discussed below:
Male infertility:
(i) Cryptorchidism:
It is a condition in which the testes are unable to descend into scrotal sacs, so that; sperms are not produced (azospermia).
(ii) Oligospermia:
It is a defect with testes due to which very less number of sperms is produced. Due to infections like mumps, infection of seminal vesicle and prostate there is less concentration of spermatozoa in semen, the ovum is not fertilized.
(iii) Alcoholism:
Regular intake of alcohol reduces spermatogenesis.
(iv) Impotency:
In this condition the male is unable to erect and penitrate the penis into vagina of female.
(v) Hormone deficiency:
Deficiency of gonadotropins (LH, FSH) thyroid disfunction may be the cause of male infertility.
(vi) Infertility may be due to prolonged use of antihypertensive and antipsychotic drugs.
(vii) Immotile cilia:
Absence of tail in sperm makes it immotile. Hence, sperms cannot move from vagina to upper portions of genital tract of female.
(viii) Absence of Y-chromosome:
Sometimes, deletion of Y-chromosomes in primordial germ cells leads to sperm production without Y-chromosome. Such sperms cannot form viable zygole.
(ix) Tubular blockage:
Blockage of vasa deferentia and vasa efferentia stops sperm transport.
(x) Antisperm antibodies:
Such antibodies are IgG, IgM and IgA. Sometimes IgG is found in cervical mucous, serum and semen.
(xi) High scrotal temperature:
Due to development of dilated veins in testis (varicocela) scrotal temperature is raised and sperm production is minimized leading to oligospermia.
(xii) Low fructose content and high prostaglandin in seminal fluid lead to sperm destruction.
(xiii) Vasectomy leads to irreversible infertility in males.
Infertility in females:
(i) Ovarian problem:
There may not be normal ovulation in ovary. Sometimes there is failure of corpus luteum formation.
(ii) Hormonal cause:
Decreased level of FSH and LH, drug induced ovulation may not allow fertilization and development of the foetus.
(iii) Uterine factor:
Unfavourable endometrium for implantation, chronic endometritis, fibroid uterus etc. may be the cause of infertility.
(iv) Cervical factor:
In effective sperm penitration, chronic cervicitis, presence of anti sperm antibody and elongation of cervix may be the cause of infertility.
(v) Fimbriae:
Fimbriae of Fallopian tube may not pick up secondary oocyte from ovary.
(vi) Dyspareunia:
Painful sexual intercourse experienced by female may be another cause of infertility.
(vii) Macrophages:
Increased sperm phagocytosis by macrophages may be the cause of infertility.
(viii) Miscarriage:
Early miscarriage before complete development of foetus due to various gyaenic problems may be also the reason of infertility.
(ix) Tubectomy:
Like vasectomy in males, tubectomy in females causes permanent infertility.
Treatment:
At present, the scope of treatment for infertility has been enromously increased. Specialized infertility clinics are available for treatment.
(i) For treatment of oligospermia, vit. B12, vit. E, vit. C follic acid can be tried.
(ii) Use of clomiphene citrate (25 to 50 mg daily for 25 days a month for three months) can improve production of gonadotropins and stimulates secretion of testosterone. Testosterone may also be taken orally.
(iii) Dexamethasone is used to correct the presence of antisperm antibodies in the semen.
(iv) Erectile disfunction is corrected by use of surgery.
(v) In females dextamethasone is used to neutralize antisperm antibodies in cervical mucous.
(vi) Ovulation may be induced by clomiphene citrate.
{vii) Ovarian cyst, fallopian tube blockage and uterine defects are corrected by surgery.
When such treatment is not possible, the couples can go for special techniques called “Assisted Reproductive Technologies” (ART).
Some important techniques are as follows:
1. Test Tube Baby:
The fusion of ovum and sperm is done outside the body of woman to form a zygote which is allowed to divide and grow to form embryo. The embryo is then implanted in uterus where it develops into a normal foetus.
2. Artificial Insemination Technique (AIT):
In this method intrauterine insemination is very common. Just near the time of ovulation, about 0.3 ml of washed and concentrated semen having at least 1 million sperms from husband is introduced artificially through a flexible polyethylene catheter into vagina or into uterus called intra-uterine insemination.
Best results are obtained when the motile sperm count is more than 10 million. The fertilizing capacity of sperms is for 24-48 hours. The procedure may be repeated 2-3 times in 2-3 days. The success result is 20-40%. When husband’s sperms are defective Artificial Insemination Doner method is used. In this method semen is taken from semen bank.
3. Gamete Intra Fallopian Transfer (GIFT):
This method was introduced by Asch and colleagues in 1984. In this method, both sperms and unfertilized oocytes are transferred into fallopian tubes. Fertilization takes place inside the body of the female.
4. Intra Cytoplasmic Sperm Injection (ICSI):
This method was first introduced by Van Steirteghem and his colleagues in 1992 in Belgium. In this technique, one single spermatozoon or even a spermatid is injected directly into the cytoplasm of an oocyte by micropuncture of zona pellucida. This procedure is done under a high quality inverted operating microscope.
Micropipette is used to hold the oocyte while the spermatozoon is injected inside the cytoplasm of the oocyte by an injecting pipette. Fertilization efficiency in this process is 60- 70% and pregnancy rate is, however, 20-40 per cent.
5. Surrogate mother:
A developing embryo is implanted in the uterus of another female. A woman who substitutes the real mother to nurse the embryo is called surrogate mother. Embryo transplants are more useful in animals than in humans.