Infertility affects millions of people of reproductive age worldwide. It has an impact on families and communities. Every human being has a right to enjoy the highest attainable standard of physical and mental health. Individuals and couples have the right to decide the number, timing, and spacing of their children.
Infertility can negate the realization of these essential human rights. Addressing infertility is, therefore, an important part of realizing an individual or couple's right to have a family.
Addressing infertility can also mitigate gender inequality, although both men and women experience infertility. Women are often perceived to suffer from infertility, regardless of whether they are infertile or not.
Infertility has significant negative social impacts on the lives of infertile couples, particularly women, who frequently experience violence, divorce, social stigma, emotional stress, depression, anxiety, and low self-esteem.
Infertility is defined as not being able to get pregnant after one year or longer of unprotected intercourse. Fertility in women is known to decline steadily with age, so women aged more than 35 years are evaluated after 6 months of unprotected intercourse.
As per WHO studies performed, gender distribution and infertility aetiology show that 37% of women, 35% of both men and women, and 8% of men have infertility.
Infertility is of two types: Primary and Secondary.
1) Primary infertility is when pregnancy has never been achieved.
2) Secondary infertility is when at least one prior pregnancy has been achieved.
Causes of male infertility
• Sperm ejaculation problems, either a lack of sperm or a low level of sperm.
• Abnormal shape and movement of sperm. This could be due to hormone disorders produced by the hypothalamus and pituitary, testicular hormones like testosterone, which regulate sperm production.
• Testicular failure to produce sperm due to varicosities, chemotherapy, undescended testis at birth, etc.
• Environmental and lifestyle factors such as smoking, excessive alcoholism, and obesity can also affect fertility.
Causes of female infertility
• Tubes disorders as blocked tubes- caused by STD, unsafe complicated abortions, postpartum sepsis, pelvic surgeries.
• Uterine disorders: inflammation, congenital defects, benign tumours, pelvic infections.
• Ovarian causes: failure of ovulation, PCOS, follicular disorder, endometriosis.
• Endocrine system causes: imbalance of reproductive hormones, hypopituitarism, hypothyroidism, hyperthyroidism.
• Unexplained causes: Those having no known or diagnosed problems in either husband or wife.
When a couple reaches out to a doctor for infertility issues, the doctor takes a history from both partners about their health and sexual history.
Routinely, this can find out the problem of infertility. Most of the time, semen analysis is done, which shows the number, shape, and movement of the sperm. Sometimes, the hormone levels of men are also tested.
In women, the first step is to find out if they are ovulating every month. A history is taken and a few blood tests are done. An ultrasound of the ovaries is done to see ovarian follicles.
For tubal factors, different methods are available. HSG, x-ray of the uterus and fallopian tube is taken after injecting dye into the uterus.
It shows a physical blockade that can cause infertility. A laparoscopy is done to check the ovaries, fallopian tubes, and uterus for endometriosis, scarring etc.
Infertility can be treated with medicines, surgeries, artificial insemination, or assisted reproductive technologies (ART).
In most cases, infertility is treated with medicine or surgery. Specific treatments are based on test results, how long the couple is infertile, health of partners, preference of partners.
The availability, access, and quality of interventions to address infertility remain a challenge in most countries in the world.
Diagnosis and treatment of infertility are often not prioritized in national population and development policies. The level of trained personnel and necessary equipment and infrastructure, the high cost of treatment and medicines are major pressures that need to be addressed in people with infertility.
Assisted reproductive technologies (ART) have been available for more than three decades. These technologies are still unavailable, inaccessible, and unaffordable for many couples, especially from low and middle-income groups.
World Health Organization (WHO) recognizes that the provision of high-quality services for family-planning, including fertility care services, is one of the core elements of reproductive health. Recognizing the importance and impact of infertility on people’s quality of life and well-being, WHO is committed to addressing infertility and fertility care by:
· Collaborating with partners to conduct global epidemiological and etiological research into infertility.
· Engaging and facilitating policy dialogue with countries worldwide to frame infertility within an enabling legal and policy environment.
· Supporting the generation of data on the burden of infertility to inform resource allocation and provision of services.
· Developing guidelines on the prevention, diagnosis and treatment of male and female infertility, as part of the global norms and standards of quality care related to fertility care.
· Continually revising and updating other normative products, including the WHO laboratory manual for the examination and processing of human semen.
· Collaborating with relevant stakeholders including academic centres, ministries of health, other UN organizations, non-state actors (NSAs) and other partners to strengthen political commitment, availability and health system capacity to deliver fertility care globally.
· Providing country-level technical support to member states to develop or strengthen the implementation of national fertility policies and services.
Dr. Rifat Ara,
Professor and Head
PG Department of Gynaecology & Obstetrics,
SKIMS Medical College, Bemina.