Infertility is a disease of the male or female reproductive system defined by the failure to achieve a pregnancy. Infertility may be caused by several different factors either in the male or female reproductive systems. To understand its causes and cure, Rising Kashmir’s senior health correspondent, M Peerzada interviews Dr Rukhsana Sami , Assistant Professor, Obstetrics and Gynaecology, Lal Ded Hospital Srinagar who speaks about the issues and way forward.
1) What is infertility?
Infertility is the inability to conceive for one year after marriage without any aid or medication. This condition can arise just after marriage or even after initial normal conception which could have resulted in an abortion, tubal pregnancy, or even live birth. The former is primary and the latter is secondary infertility. The risk of infertility increases as you age.
2) What causes infertility among women?
Infertility in a couple can arise because of various conditions in either partner or both. Low fertility potential in both partners can increase the chances of infertility in the couple. Both partners need to be counselled and examined alone and together to know the cause of infertility in the couple and investigate with various tests accordingly.
Types of infertility include:
Primary infertility: When a woman cannot get pregnant and can’t conceive after one year (or six months if you’re 35 or older) of regularly trying to concieve.
Secondary infertility: When a woman cannot get pregnant again after having at least one successful pregnancy.
Unexplained infertility: Fertility testing hasn’t found a reason that a person or couple is unable to get pregnant.
Factors of Infertility:
1) Tubal factors
2) Uterine Factors
3) Peritoneal factors including endometriosis, adhesions
4) Ovarian factors
5) Cervical factors
6) Immunological
8) Genital infections like PID, Genital TB
9) Endocrine-Hypothalamic, Pituitary, Hyperprolactinia, Diabetes
10) Unexplained (10-15%)
3) Are late marriages a cause for it?
One of the biggest causes of infertility in women these days is late marriage. The fertility potential of women normally decreases with age and more so if the women is suffering from diseases like PCOS (Polycystic Ovarian Syndrome) where in the number and quality of female gamete cells (ova) decreases with age.
Is junk food a cause of infertility?
Junk food is one of the causes of infertility these days. Regular consumption of junk food can cause obesity which leads to PCOS and then infertility.
What should such women do?
Eligible couples should be sensitized about causes, consequences and after-effects of late marriage.
We have seen in many cases that IVF has not been successful in many women, what is the issue?
Unsuccessful Vitro Fertilization: Pregnancy is a complex process and some specific factors have been identified to lead to unsuccessful IVF, such as:
1) Egg abnormalities.
2) Problems with egg retrieval and embryo transfer
3) Embryo selection method.
4) Abnormal sperm.
5) IVF techniques used in Lab and skill of specialist specialists
7) There is also a lack of infertility clinics here, so where women can go?
There is also a lack of infertility clinics here, so where women can go?
If a woman thinks something is wrong and she is not able to conceive she should consult nearby gynaecologists so that she can get basic education regarding that and all her baseline investigations and if needed, she will be referred by her gynaecologist for further treatment at an infertility centre.
How many women suffer from infertility in JK?
Some 13% of women are infertile in J&K and actual figures may even be more: Figures of infertility in Kashmir may increase by more than 13% in future if we wouldn’t fight against this cause.
How much are our women aware regarding personal hygiene, prevention of sexually transmitted diseases (STDs) and infections?
STD’S are also an important reason for tubal infertility. Most of our women are not aware regarding personal hygiene, prevention of sexually transmitted diseases (STDs) and infections. Educating people about lifestyle and behavioral modification, effects of smoking and alcohol, sexual characteristics like multiple sexual partners, exposure to sexually transmitted infections and effects of late marriages can have a very big impact on female infertility.
There is social stigma related to not having a baby? How should women manage such situations?
Biggest myth surrounding infertility is that infertility is a women’s problem. And the fact is that 50 percent of the problems are related to male factors related to sperm disorders like sperm count, shape, concentration, morphology. Infertile women face social and self-stigma which threatens their psychosocial wellbeing and self-esteem. Women should be free to decide if she want to conceive or not and she should not be judged for her decision.
Why do women face more and more vomiting during their first months of pregnancy?
Women face more and more vomiting during the first months of pregnancy because of an increase in hormone called BHCG and progesterone which cause’s decreased gastric motility. Other factors include dietary deficiency like deficiency of vitamin B1, B6 and low protein diet and low carbohydrate reserve.
How should women manage their menstrual hygiene?
Menstrual hygiene management is very important to keep the diseases and infections at bay.
1) Wash your hands before and after use of the rest room and menstrual products.
2) Change your sanitary pads and tampons after every 4-6 hours.
3) Discard disposable menstrual products properly.
4) Wear light weight, preferably cotton underwear.
5) Keep your genital area clean.
6) Don’t use the chemical vaginal wash that may change the PH of vagina.
7) Drink plenty of water.
8) Track and monitor your menstrual cycle.
Women along with their partners go through a lot of challenges. Do we have facilities in the government sector to treat infertility issues?
We have only basic facilities in the government sector to treat infertility issues.
Many couples can be helped but we need IVF and advanced centers to help many more.
Women face a lot of problems and challenges regarding infertility and most importantly those who can’t afford to visit the much costly infertility clinics of the corporate world.
Government should open infertility wings particularly in government medical colleges of Kashmir so that unprivileged people will be also benefited. Nowadays infertility should not be a nightmare as due to IVF success rate of becoming parents have been increased by 80%
Government can help out those couples by opening infertility clinics in every district followed by counselling clinics so that these people get benefited so they can say we don’t have nightmares anymore.
Is there any test recommended for partners before getting pregnant?
Recommendations for women:
• Test before pregnancy
• Pre-conceptional counselling is important before getting pregnant
• Counselling regarding safe sex practice
• Effects of HIV and treatment of disease in pregnancy
• Advice for eliminating alcohol, cigarette smoking and illicit drug use
• Prophylaxis for opportunistic infections
• Immunization
• Folic acid administration
• Partner testing and counselling
• Serology and VDRL to be done
• Genetic counselling and testing if some genetic disorders
• Other tests like TSH, HBA1c. If belonging to high-risk group
How does blood group affect pregnancy?
Blood group is important for pregnancy specifically if the mother is from RH negative group and father from RH positive and she is carrying a RH positive fetus in her womb. There is a risk of ISO immunization which may not affect the baby but will be hazardous for future pregnancies.
