Infertility, or the inability to have a child, strikes a significant percentage of the world’s population, cutting across racial, ethnic and socio-economic differences. Thankfully, there are ways to overcome it, finds Behnaz Sanjana.
Human reproduction is such a natural life event that one seldom stops to think how complex and almost miraculous the whole process is. When a woman has attained an age of physical maturity, and is mentally ready to nurture another being, her body will naturally undergo the required changes to do so. But the path can be strewn with several roadblocks on the way. Dr Sudharani Bairraju, obstetrics and gynaecology/IVF consultant at Bahrain Specialist Hospital, is here to help with the basics.
What causes infertility in women?
There are many factors which may contribute to difficulties in becoming pregnant, Dr Sudharani tells us. “Problems in the female genital tract like blocked fallopian tubes due to infection, endometriosis, fibroids in the uterus, adhesions inside the uterine cavity or abnormal development of the uterus can all lead to difficulty in conception,” she says. Hormonal problems are another reason. She goes on to say that a woman’s age and stress also contribute to infertility. “An unhealthy lifestyle has a negative bearing on fertility by causing hormonal imbalances which interfere with the formation of mature eggs, thus leading to difficulties in getting pregnant,” says Dr Sudharani.
Asked if other medical conditions can also account for the problem, she adds: “Radiation and chemotherapy cause acute ovarian failure. There will be loss of ovarian follicles [eggs], leading to infertility and premature menopause.”
In some women infertility is unexplained, known as idiopathic infertility. This is when standard medical tests have not found the underlying reason for the failure to get pregnant.
What’s age got to do with it?
“Age is the single most important factor affecting a woman’s fertility. Women are born with a limited number of eggs in the ovaries and as age advances, this ovarian reserve decreases. Fertility starts declining in the late 20s. A woman’s best reproductive years are in her 20s,” says our expert.
As age advances, the ovaries do not continue to produce healthy, mature eggs and do not respond as favourably to the hormones that trigger ovulation. That is not to say that someone in her 30s or beyond cannot fall pregnant, although it may need medical intervention.
What about men?
When it comes to men, their fertility does not decline at the same rate as their female counterparts with age; although the older a man, the lesser the chances of easily conceiving. A man’s fertility depends on the quantity and quality of his sperm. Usually, fertility problems in males are related to sperm production and motility.
“Male infertility is as common as female infertility. Therefore men should also get tested,” says Dr Sudharani.
So, is there a problem with me?
“Women who fail to become pregnant after one year of unprotected intercourse should see a doctor. If the woman is 35 years old or more, she should seek help after six months of unsuccessfully trying to conceive,” advises Dr Sudharani.
A good start
It is quite common for young girls to suffer from polycystic ovary syndrome (PCOS), which is a common cause of infertility. It is a hormonal imbalance which disrupts the process of ovulation (the growth and release of eggs from the ovaries) without which pregnancy cannot happen. Dr Sudharani says: “Inculcating a healthy lifestyle in young girls will prevent most fertility- related problems later in life. A healthy diet, regular exercise, avoiding exposure to environmental toxins, avoiding smoking, alcohol, avoiding stress and prevention of obesity will arrest hormonal and ovulation related problems.”
The plan of action
In women, blood tests to check the relevant hormones, a test to check the fallopian tubes are clear and an ultrasound to check the uterus and ovaries are carried out. In men, simple semen analysis is the first line of investigation.
Treatment depends on the cause of infertility; whether it’s tubal, ovarian, uterine or something else, says our expert. “Treatments vary from simple ovulation induction with medicines to intra uterine insemination [IUI] and in vitro fertilization [IVF]; depending on the type of infertility. Women with ovulation problems can simply be treated with medicines which help in production of an egg and its release.”
In IUI, treated semen is placed inside the uterus during the time of egg release. It is the treatment of choice in couples who have unexplained infertility and men who have ejaculation problems or low sperm count. “The success rate of each cycle is 10 to 15 per cent, increasing up to 60 to 70 per cent with repeated cycles,” informs the doctor.
“IVF is a procedure where the fusion of sperm and egg is made to happen in an artificial tubal environment of a laboratory. The female partner is given around 10 days of daily injections to stimulate the ovaries to produce the optimal number of follicles. Then all these follicles are aspirated into a tube under ultrasound guidance. These are combined with her partner’s sperm in a dish. The resulting embryos are transferred back to the uterus between two and five days later. Success rates vary according to the patient’s age, type and duration of infertility,” says Dr Sudharani. This treatment sees a 35 to 40 per cent success rate and is the treatment of choice for those with bilateral blocked tubes, severe male factor infertility, unexplained infertility with failed IUIs and in women with a poor ovarian reserve.