Globally there are 60 to 80 million couples who are infertile. India bears a large part of the global load of infertility. With the rising incidence, there is a trend to a greater proportion of male factor being responsible for infertility. Earlier female infertility accounted for 50- 60% cases and male infertility was 25%. Rest were due to combined factors. This incidence had increased to 40% in men with 10 % as combined male and female incidence. Semen parameters have shown a decline over the years. By the latest WHO criterion an abnormal sperm count has considered if the count is less than 15 million sperms / ml. Earlier, all sperm counts below 20 million were taken as abnormal.
Infertility in women is also on the rise. One of the causes of this change is social. Women are going in for late marriages and delaying childbirth as they are concentrating on their careers. In India, 8 to 10% of couples are infertile. Incidence increases exponentially as age goes up beyond 35 years. This is because they are born with a fixed pool of eggs: one to two million at birth, 3,00,000-5,00,000 at puberty, which reduces to about 25,000 when a woman turned 37. Not only the number of eggs go down but the quality of eggs becomes poor making chances of pregnancy lower. The effect of age upon men’s fertility is less clear. Another factor for rising infertility is an increased incidence of poor ovarian reserve and premature ovarian failure. Premature ovarian failure is cessation of menstrual function before the age of 40. Genetic factors, oxidative stress and autoimmune factors are commonly held responsible. Incidence of infertility in women has also gone up because of the increasing rise in polycystic ovarian syndrome (PCOS). The cause for this is modern day lifestyle changes. PCOS is now seen in adolescents very often and many of them are obese. Adolescent girls should try and maintain a normal body mass index between 20-23. The right food and exercise can rectify the problem in many. It is important to treat these girls early to prevent infertility and long term morbidity.
Other causes of infertility in women are a tubal blockage, pelvic inflammatory disease, endometriosis, uterine lesions like fibroids, congenital malformations, intrauterine adhesions and infections like tuberculosis and chronic endometritis.
The treatment mainly consists of treating the cause. Reproduction is assisted with ovarian stimulation to produce more eggs and preparing semen to ensure good quality motile sperms which are then introduced in the uterine cavity. If all fails, the next step is invitro fertilization and intracytoplasmic sperm injection where the eggs are taken out and fertilized by sperms outside the body and after two to five days of development, the embryo is inserted into the uterus. The success rates to this technique have improved over the years with better technology, but are age-related with better results at a younger age because of a better quality of eggs.