The average incidence of infertility is about 15% globally. Do you know what can cause infertility? How can it be treated? Infertility is the incapability of a man or a woman to contribute to pregnancy. There could be various reasons that could result in infertility.

The main reason for infertility in women could be ovulation variation, whereas it could be insufficient sperm count or genetic disorder in men. Infertility can be treated through many modern technologies like IVF, GIFT, ZIFT, etc. Let us learn more about the causes and treatment of infertility in this article. Scroll down to learn more!

Define Infertility

Infertility is a failure to conceive within one or more years of regular unprotected sexual copulation. It is also one of the major aspects of reproductive health.

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Fig: Infertility

What are the Types of Infertility?

Infertility is of mainly two types:
1. Primary infertility: It refers to those patients who have never conceived.
2. Secondary infertility: It refers to a situation when a couple had children or achieved pregnancy previously but failed to conceive subsequently. It is more common than primary infertility.

Infertility Causes

Infertility can be caused by defects in the male or the female or both.

The common causes of infertility in males are:

1. Oligospermia: It is a condition in which the sperm count is low, i.e., less than 20 million sperm per 1 ml of semen caused by an acquired infection like mumps and also infection of the seminal vesicle and prostate.
2. Azoospermia: It is a condition in which absence of spermatozoa in semen or failure of formation of spermatozoa.
3. Cryptorchidism: It is a condition in which testes are unable to descend in scrotal sacs so that sperms are not produced.
4. Impotency: It is a condition in which the male is unable to erect and penetrate the penis into the vagina of the female.
5. Obstruction of efferent ducts: It is a condition in which sperm conducting tubes are blocked due to vasectomy or some disease.
6. Gonadotropin deficiency: It is a condition in which low secretion of hormone LH and FSH occur.
7. Excessive temperature: The excessive temperature of testes suppresses spermatogenesis by causing degeneration of spermatogenic cells of seminiferous tubules.
8. Alcoholism: It can cause defective spermatogenesis.
9. Defective or abnormal sperm: Morphologically or physically abnormal sperms are always non-motile. So, the sperm are not able to reach or penetrate the egg of the female.

The common causes of infertility in females are:

1. Anovulation: It is a condition in which no ovulation takes place. It may occur due to hyposecretion of gonadotropic hormones, high BMI, low body weight, excessive exercise, stress, etc.
2. Fertilisation and implantation failure: It may be caused due to endometrial damage, drug use, etc.
3. Gonadotropin deficiency: It is a condition in which low secretion of hormones like GnRH, LH and FSH occur. In the case of women, the lack of gonadotropins means that the ovaries will not release mature eggs, and they will not produce the hormone oestrogen or progesterone, and menstruation will not take place.
4. Ectopic pregnancy: It is a condition in which embryo implants outside the uterus.
5. Polycystic ovary: It is a condition in which multiple cysts occur in the ovary. In the case of polycystic ovary, hormonal imbalance takes place in the body of the women, i.e. the secretion of testosterone increases in the body, so ovulation does not take place, which causes infertility.
6. Blockage of the fallopian tube: It is a condition in which the fallopian tubes may get blocked due to inflammation (salpingitis), congenital tubule obstruction, etc.
7. Vaginal and cervical infection: Bacterial, fungal infections like gonorrhoea, chlamydia may cause infertility. 

Fig: Issues of Male and Female Infertility

Infertility Treatment

The treatment of infertility may include medicine, surgery, artificial insemination, or assisted reproductive technology (ART). The treatments are recommended by the doctors based on the results of the test, the age of both man and woman, the health of the partners, etc.

Infertility in men can be treated in the following ways:

1. In males, the use of vitamin E, vitamin C, folic acid, B₁₂ improves sperm count.
2. Antibiotics for treating any type of genital infection.
3. Testosterone and Clomiphene citrate can be taken to increase the production of gonadotropins and stimulate the secretion of testosterone. 
4. Erectile dysfunction can be treated by surgery required for obstruction of vasa efferentia and vasa deferentia and also for correcting varicocele (widening of the veins in the scrotum) or a blockage in the vas deferens, tubes that carry sperm.
5. Artificial insemination, in-vitro fertilisation (IVF), and intracytoplasmic sperm injection (ICSI) methods can also be used.

Infertility in women can be treated in the following ways:

1. In infertile women, fertility drugs like clomiphene citrate, metformin, gonadotropins, letrozole, bromocriptine were used to regulate or induce ovulation.
2. Fallopian tube blockage and uterine defects can be corrected by surgeries like Laparoscopy, Hysteroscopy, etc.
3. If the above treatments are not possible, then such couples could be assisted to have children through certain special techniques commonly known as assisted reproductive technologies (ART). These are the applications of modern reproductive technology for solving the problems of infertility. The different types of ART and their procedure are described in the table below:

Type of ART	Procedure
In Vitro Fertilization (IVF-ET or Test tube baby program)	Ova and sperms are induced to form a zygote in the laboratory, developed into the embryo stage, and then transferred inside the woman’s uterus immediately after fertilisation of the embryo.
Zygote Intrafallopian Transfer (ZIFT)	Artificially induced zygote/embryo of 8 blastomeres is transferred into the woman’s Fallopian tube.
Intrauterine Transfer (IUT)	Artificially induced zygotes of more than 8 blastomeres are transferred into the woman’s uterus.
Gamete Intrafallopian Transfer (GIFT)	Gametes (sperm and ovum) are collected from donors and transferred into the fallopian tube of the mother. Fertilisation is in vivo.
Intracytoplasmic Sperm Injection (ICSI)	Sperm is directly injected into the cytoplasm of the ova in the laboratory, and later embryo is transferred into the uterus of the woman.
Artificial Insemination (AI)	Semen collected either from the husband, or a healthy donor is artificially introduced into the uterine cavity or female’s cervix for carrying out pregnancy through in vivo fertilisation.
Intrauterine Insemination (IUI)	The transfer of sperms takes place into a woman’s uterus at the time of ovulation with the help of a long narrow tube.

4. Surrogacy is the process in which another woman bears a baby of the couple who is facing infertility issues. Surrogate here acts as the carrier of the baby. In this process, the formation of the baby can occur by the fertilisation of sperm and egg from the couple or the donor sperm and egg. After birth, the surrogate will give the baby to the infertile parents.

Fig: Some of the Treatments to Treat Infertility

Preventive Measures to Reduce Infertility

Sometimes, infertility cannot be prevented. But some precautions should be taken to increase the chances of pregnancy.

Some of the preventive measures taken to reduce male infertility are:

1. Smoking, drug, tobacco and alcohol use should be avoided.
2. Any medications should not be taken without consulting the doctor. Sometimes that may hamper fertility.
3. High temperatures that are found in hot tubs and hot baths should be avoided because it temporarily affects the motility and production of sperm.
4. Exposure to industrial and environmental toxins should be avoided as it may affect sperm production.
5. Moderate exercise and a healthy diet are necessary for improving the quality of sperm.

Some of the preventive measures taken to reduce female infertility are:

1. Smoking, tobacco, and alcohol use should be avoided.
2. A healthy lifestyle should be maintained.
3. Reduce the level of stress.
4. Moderate and regular exercise is important.
5. Both being overweight or underweight affect hormone production and causes infertility.
6. Regular checkups and doctor consultations are required.

Summary

Reproductive health refers to total well-being in all aspects of reproduction, i.e., physical, emotional, behavioural, and social. Infertility happens when a couple cannot conceive or produce children after having regular unprotected sex. Infertility can happen to both men and women. Our daily lifestyle can also be a reason that can lead to infertility, especially stress and an unhealthy lifestyle.

Various methods are now available to help couples who are infertile. IVF is the most common method used in ART. Counselling and awareness about the causes of infertility and its treatment can help any couple to understand that it is just a reproductive disorder rather than a curse.

FAQs on Infertility

Q.1. What is infertility?
Ans: Infertility is a failure to conceive within one or more years of regular unprotected sexual copulation.

Q.2. What are the types of infertility?
Ans: The two types of infertility are primary and secondary.

Q.3. What are the signs of infertility in females?
Ans: The signs of infertility in females are:
(i) Irregular menstrual cycle
(ii) Pain during sex.
(iii) Gonadotropin deficiency

Q.4. What are the treatments of female infertility?
Ans: Some of the treatment of female infertility includes:
(i) In infertile women, fertility drugs like clomiphene citrate, metformin, gonadotropins, letrozole, bromocriptine were used to regulate or induce ovulation.
(ii) Fallopian tube blockage and uterine defects can be corrected by surgeries like Laparoscopy, Hysteroscopy, etc.

Q.5. What are the causes of male infertility?
Ans: The causes of male infertility are:
(i) Oligospermia (Low sperm count)
(ii) Azoospermia (Absence of spermatozoa in semen or failure of formation of spermatozoa)
(iii) Cryptorchidism (Testes are unable to descend in scrotal sacs)

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