BLOGS | Infertility: Why it happens and how to address the problem

BLOGS | Infertility: Why it happens and how to address the problem

By Tarali Kalita

Infertility refers to a couple who fails to conceive after six months or one year of regular intercourse without using contraception. Infertility also refers to an inability of a female that cannot carry a pregnancy for full term. Rough estimate suggests that in India nearly 30 million couples suffer from the problem of infertility, making the incidence rate 15 percent. Although, our social setup blame women for not having a child, but men are equally in need of treatment.

CYCLE OF LIFE 

It is because, human life begins from a single cell called zygote which is formed by the fertilization of female gamete (egg) by the male gamete (sperm).Apart from the anatomical problems, hormonal imbalance and genetic defect in both male and female, the quality and quantity of the gametes are critical factors of infertility.

The potentiality of male gamete is determined by the semen analysis following standard protocol. The abnormalities with male gametes may be as follows-reduced motile sperm (Asthenozoospermia), increased abnormal sperm (Tetrazoospermia), decreased number of sperm (<10 million/ml) in semen (Oligospermia), no sperm in the semen (Azoospermia) or abnormalities in sperm morphology. More than 90% of the male infertility cases are due to low sperm count, poor sperm quality or both.

INFERTILITY: WHO TO BLAME?

Smoking and alcohol consumption are considered as the top culprits in affecting the sperm count which are most common among the young generation. Alcohol and tobacco can lower the testosterone level, causes erectile dysfunction and decrease the sperm count. Besides, overheating of testicles (by excessive use of laptops, frequent use of sauna or hot tubs), exposure to industrial chemicals, heavy metals and radiation, toxicity in food, illicit use of drugs, emotional stress and obesity are other leading factors which are contributing to augmenting the incidence of male infertility. On the other hand, while a woman’s age is an important factor in conception, the father’s age also matters.

It is established that the volume of semen and sperm motility decrease continually between the ages of 20 and 80. It is also important to note that children with fathers age 40 or older than that hold five times more chances to have an autism child than children fathered by men age under 30.

In case of female, she is born with about 2 millions of eggs into her ovaries. After, 1st menstruation, every month about 500 eggs come out of ovaries for maturation from which only one egg is matured and ovulated, the remaining eggs get destroyed. So, it is natural that due to limited number of eggs reserved and loss of few from them in every cycle, the number of eggs decreases with the increase of age. The quality and quantity of female gamete are determined by the estimation of serum level of Anti Mullerian Hormone (AMH).

The other causes of female infertility include absent, blocked or diseased fallopian tube, sperm antibody in wife’s serum, endometriosis, PCOS, problems with ovulation due to hormonal imbalance, stress, obesity, alcohol or drug use. The intensity of female infertility is more in urban areas and a recent study in nine cities of India has found that 46% of the couples who landed up infertility clinics belong to the age group 31-40 years. This can be related to the fact that with aspirations for attaining higher educational level, job security and promotion, the marriage is delayed and as a result not only the egg quality and quantity but also the body efficacy for pregnancy also decrease.

HOW TO COPE WITH THE PROBLEM?

Now the question is how to cope up with this problem. Ok, living a healthy life, avoid of alcohol and tobacco, meditation to control stress may be a fruitful attempt to conserve both the quality and quantity of gametes. But what about the older age of marriage. It may be easy to say that family life and carrier can be run equally if you are efficient enough which is not practically right to some extent. So, should we control our ambition regarding our career? No, science has answer for this. Advanced medical science has offered provisions for preserving the gametes in its best quality.

For preservation of male gametes the preferred age is 20-40 years. Before depositing the semen sample, one has to go for some routine checkup, HIV test and semen analysis. If everything goes normal the semen to be preserved is deposited into the laboratory and then they preserve it in -1960C liquid nitrogen by the technique of cryopreservation. Although the cost varies from clinic to clinic in India the average cost for sperm preservation is 10000/-/year.

The procedure of egg preservation is started with the stimulation of ovary to produce multiple eggs in a single cycle. For this, extra hormone like recombinant FSH, highly purified HMG or U-HMG injection is given from 2nd or 3rd day of menstrual cycle. Regular monitoring of maturity of eggs is done by ultrasound examination or hormone assay. Normally maturation of eggs requires 7-15 days from the very first day of ovarian stimulation. When the follicles are matured, 100 units of HG or 1 mg of Leuprolode Acetate is injected. This causes the final maturation of eggs and ovulation occurs 36-40 hrs after HG injection. Therefore, the eggs are collected 34-35 hrs after HG injection i.e. just before ovulation. Egg retrieval procedure is done transvaginally under general anesthesia. It is sometimes also called egg harvesting, egg pick up or oocyte pick up. The egg thus obtained are placed into a culture media and then processed for cryopreservation. The average cost for egg preservation is 20000/-/year (up to 10 oocytes). The best part for gamete preservation is that the quality of gametes is retained as it is for millions of years.

The technique of gamete cryopreservation is gaining so much popularity among new generations. In 2014 Facebook is the first major tech firm to offer to freeze eggs for both its female employees and spouses of staffers. After that Fb has inspired several high profile tech firms like Google and Apple to support egg freezing for the employees’ benefit. So, build your carrier, earn money, enjoy life but keep the possibility of getting the most precious gift from God. Because becoming parent is the most beautiful feeling in this earth.

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(The writer is an Assistant Professor, Department of Zoology, Cotton University. She can be reached at  taralikalita.tihu@gmail.com or Pn no. 887666476)

 

 

 


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