Last modified on August 2022
With inputs from Dr. Uma M - Consultant Family Physician, and Diabetologist
Infertility cases have been on the rise lately in many places around the world, including India. While it was previously considered taboo to speak openly about this condition, couples in India today are willing to seek infertility treatment options without any hesitation.
If you’re thinking about moving forward with infertility treatment, it’s important to fully understand the condition first. This article will throw some light on the causes of infertility and explore some common male and female infertility treatments in India.
We understand that seeking help for infertility during the COVID-19 pandemic especially may be a risky option for some people. That’s why we at MFine, offer online doctor consultations where you can chat with leading specialists in the field through messaging or video calls from the comfort of your own home. Additionally, seek guidance, advice and treatment plans for infertility while minimizing your risk of exposure.
Chapter 1: What is infertility?
According to a glossary definition released by WHO for infertility and fertility care, infertility is, “a disease of the reproductive system defined by the failure to achieve a clinical pregnancy after 12 months or more of regular unprotected sexual intercourse.”
In other words, when a woman is trying to get pregnant for at least a year but does not succeed, despite frequent intercourse, the condition is defined as infertility.
Infertility can be classified into two types—primary infertility and secondary infertility.
- Primary infertility refers to infertility in a couple who has never conceived.
- Secondary infertility is infertility in a couple who has been pregnant before but fails to conceive later.
Infertility in India
Globally, infertility affects up to 15% of reproductive-aged couples. Based on data released by the World Health Organization, the overall prevalence of primary infertility in India ranges from 3.9 to 16.8%.
If we look at the rate of infertility in India, we can see differences across states. The infertility rate is found to be 3.7% in Uttar Pradesh, Himachal Pradesh, and Maharashtra, 5% in Andhra Pradesh, and 15% in Kashmir. The condition of infertility further varies in the same region across tribes and castes.
Although infertility has been thought of as a woman’s problem, that is not the case. Interestingly enough, one-third of the causes of infertility can result from females and one-third from males. The final one third is a combination of female and male factors and other unknown causes.
Before analysing the various conditions and possible infertility treatments in India, let’s take a look at its symptoms in both women and men.
First Signs of Infertility in Women
- Irregular Menstrual Cycle
If the menstrual cycle is too long (over 35 days), too short (less than 21 days), or is irregular or completely absent, it means that the woman may not be regularly ovulating. Ovulation is a process when the ovary releases an egg. Therefore, if the body is not ovulating properly, then a woman might not be able to get pregnant.
Irregular cycles and frequently missing periods are prominent signs of infertility.
- Heavy, Painful, and Long Periods
While some women have a light flow which lasts only for a few days, others regularly experience heavy flow and painful cramps.
Generally, women who experience heavy and painful periods may have endometriosis. It is a condition in which tissues usually present in the womb are present elsewhere in the body. Endometriosis is a known risk factor for infertility, as evidenced by the fact that 30-50% of women with the condition are infertile.
- Dark or Pale Blood Flow
Menstrual blood is usually bright red and may get darker at the beginning or towards the end of the period. If the blood is paler than usual, or very dark, it may be a sign of endometriosis.
- Pain During Sex
Dyspareunia or painful sex indicates an underlying health problem that may impact infertility in women. Some examples of underlying conditions are infections, fibroids, and endometriosis. However, women who suffer from endometriosis and are unable to concieve can be assured that there are many home remedies for endometriosis and infertility that can help reduce symptoms and even cure the dreaded disorder in a healthy way.
- Hormonal Changes
A person may not always notice hormonal changes or know their underlying causes. Some common symptoms of fluctuations in hormonal changes include severe acne, cold feet and hands, reduced or no sexual drive, unexplained weight gain, facial hair, thinning hair, and nipple discharge, among others.
- Other Medical Conditions
Some of the other factors that may affect fertility in women include obesity, PCOS, premature menopause, damage to ovaries or fallopian tubes, and cancer and its treatments.
Common Signs of Infertility in Men:
- Hormonal Imbalances
Men may be affected by a variety of hormonal imbalances which cause infertility. Imbalances in testosterone, a hormone chiefly responsible for male fertility, may lead to male infertility.
- Erectile Dysfunction
This condition interferes with sexual intercourse, and its regular occurrence may become an underlying issue of infertility in men. Psychological factors, hormonal changes, or other physical issues make it difficult to get an erection.
- Ejaculation Dysfunction
Men may experience difficulty in ejaculating or notice changes during ejaculation. This is a common symptom of male infertility. In this case, a man might ejaculate too fast or might experience retrograde ejaculation, a condition where the sperm ejaculates back into his bladder.
- Changes in Testicles
Tender, swollen, or painful testicles are signs of infection, which may further affect the sperm quality and impair male fertility.
Studies indicate a link between obesity in men and fertility. Obesity can affect a man’s fertility due to sexual dysfunction, hormonal imbalance, or sperm quality. In order to increase male fertility, it is advisable to get a spermcheck done in order to assess sperm quality and sperm count if what you are looking for is to improve sperm motility. If sperm motility is what you are suffering from, there are various sperm motility treatments available that you can undergo at any infertility centre.
Other Signs of Infertility in Both Men and Women Include:
- History of sexually transmitted infections
- Smoking tobacco or marijuana
- Drinking alcohol
- Poor diet
Why Should You Do an Infertility Test?
Infertility testing is important for both men and women to determine the health of your reproductive organs and should be done without delay especially if you are showing even the slightest of symptoms. Consider the following factors before doing an infertility test:
- The Age Factor: Doctors mostly recommend that couples up to age 35 should try to get pregnant at least for a year before seeking infertility treatment. If you are above this age limit, you should consider doing an infertility test.
- Ovulation: Infertility testing can evaluate ovulation in women who have been trying to conceive for long, and can also help regulate menstrual cycles.
- Sperm Health and Donation: An infertility test should be opted to evaluate the health of your partner’s sperm. This problem usually occurs when the partner has a history of illness or surgery.
- Timely Sexual Intercourse: Infertility testing can help you understand when you are the most fertile. Having sexual intercourse during the fertile window improves the chances of pregnancy.
– Infertility trends in India indicate that this is a growing concern among many couples. Recognizing the first symptoms in men and women can help you get diagnosed and treated quickly.
– Infertility affects both men and women. In many instances, people do not realise the direct signs of infertility until they try to conceive.
– If a couple is facing difficulties in getting pregnant, a doctor’s consultation will help you identify the root cause and find a suitable treatment.
Consult your city’s top fertility specialists anytime, anywhere!
Chapter 2: Infertility treatments in India for men and women
“There are multiple infertility treatment options in India. Infertility treatment for women includes IVF IUI, Intracytoplasmic Sperm Injection, egg donation, GIFT and ZIFT, Hysteroscopy and egg freezing. For men, infertility treatment in India includes Rectal Probe Electroejaculation, Penile Vibratory Stimulation (PVS), Antibiotics for Genital Tract Infection, Gonadotropin Therapy and Antiestrogens.”
– Dr Uma M, Consultant Family Physician and Diabetologist
If a couple has been facing difficulty getting pregnant despite frequent unprotected intercourse, they should seek medical help to identify and treat any issues which could be preventing conception. Even if they have been able to get pregnant but the woman is unable to carry the pregnancy to term, it might indicate abnormalities which need to be treated in order to achieve a healthy pregnancy. The following are the most common infertility treatments in India. Your fertility specialist will determine the best option for you depending upon your unique factors.
Infertility Treatments in India for Women:
Laparoscopy, a female infertility treatment, is a non-invasive surgical procedure carried out to reconstruct reproductive organs and treat conditions like endometriosis, blocked tubes, or ovarian cysts.
A laparoscope, which is a telescope-like instrument, is fitted with a small camera. When inserted through two or more minor incisions, the laparoscope allows the surgeon to examine the pelvic anatomy of women to look for causes of infertility.
Laparoscopy is one of the many treatments for infertility in india that can assess causes in the uterus, fallopian tubes, and ovaries.
- In Vitro Fertilization (IVF)
The IVF infertility treatment involves the careful selection of follicle-stimulating hormone which stimulates the number of eggs that the ovaries produce. This increases the number of fertilised eggs, which also means a greater choice of embryos for female infertility treatment.
A woman’s eggs are collected using a needle and mixed with the male partner’s (or donor’s) sperm in a laboratory. They are then cultured in an incubator until ready for insemination.
The success rate of an IVF infertility treatment in India is at least 2-20 times higher in a private infertility centre.
A few days after the eggs are collected, the embryos are transferred back into the womb by inserting a catheter into the vagina. In some cases, extra embryos are frozen and saved for later use. This process is known as egg cryopreservation. Studies have shown that freezing your eggs and harvesting eggs on a later date do not hamper the overall health of the pregnancy.
Is it safe to get IVF treatment during the COVID-19 pandemic?
COVID-19 pandemic that wreaked havoc across the globe has added to the woes of couples undergoing an IVF treatment. Several questions have been raised regarding the safety of getting an IVF treatment while the coronavirus diseases lurch around the corner.
According to medical experts, one need not delay getting their IVF treatment solely due to the fear of COVID-19 spread. The majority of patients of reproductive age are not coming under the high-risk group in contracting the virus. However, to be at the safest place, couples can take up teleconsultations for the initial and follow-up treatment. Also, there are not enough clinical trials suggesting that COVID-19 infection and vaccination have any direct impact on fertility.
MFine’s COVID-19 care page provides a plethora of information on various COVID related aspects such as mental health, COVID vaccines, COVID lab tests and online doctor consultations that you can book from the comfort of your own home. Nevertheless, if you do happen to experience symptoms of COVID-19 during your IVF journey it is advised to book an RTPCR test to rule out your diagnosis at the earliest.
- Intrauterine Insemination
IUI, Intrauterine insemination, is a relatively simple treatment that increases the number of sperm cells placed in the uterus.
IUI procedures involve the washing and separating of a semen sample from seminal fluid. This is then inserted directly into the uterus with a thin catheter. Women have stated that IUI injections are usually painless while some women reported mild discomfort. The IUI fertility treatment procedure can be performed with a male partner’s sperm or with a donor’s sperm.
IUI fertility treatment in India is less expensive than IVF treatments. IUI treatments cost anywhere between Rs.4500 to Rs. 5000 in India for a single cycle. Studies have revealed that IUI inseminations are relatively safe and do not seem to increase the risk of birth and developmental defects in your baby. An IUI baby will in most cases be as healthy as a naturally conceived baby or one from an IVF procedure. IUI success rates depends on the number of IUI cycles for example, women have about a 15% chance of conceiving on one cycle of IUI but 80% chance after 6 or 7 cycles. IUI procedures are used in the following cases:
- Unexplained infertility
- Low sperm count
- Multiple failed attempts to improve sperm motility
- Issues with ejaculation or erection
- Issues with the cervix or cervical mucus
- Mild endometriosis
A single woman wishing to get pregnant or a couple not wanting to pass on a genetic defect from the male partner may seek IUI fertility treatment.
- ICSI (Intracytoplasmic Sperm Injection)
ICSI infertility treatment involves the injection of a single sperm directly into a mature egg with the help of a tiny needle, called a micropipette. Once fertilised, the egg (an embryo at this stage) grows in a laboratory for 1-5 days before being transferred to the woman’s uterus.
ICSI is performed simultaneously with IVF. ICSI infertility treatment is commonly used in cases of severe male infertility. Some of these factors include low sperm count, poor sperm motility, the decreased ability of sperm cells to penetrate the egg, or a previous unsuccessful IVF procedure.
- Egg Donation
Donor eggs, sometimes also referred to as donor embryos, allow an infertile woman to conceive a child.
The process of a fertility egg donation involves the retrieval of eggs from a woman with normally functioning ovaries. Later, the eggs are fertilised in the IVF lab. The process may either use the sperm of the partner or a donor.
- GIFT and ZIFT
GIFT and ZIFT are modified versions of the IVF. In Zygote Intrafallopian Transfer (ZIFT), another infertility treatment in India where doctors place the fertilised eggs, which are zygotes at this stage, into the fallopian tubes within 24 hours.
In Gamete Intrafallopian Tube Transfer (GIFT), the sperm and eggs are mixed before a doctor inserts them, with the hope that one of the eggs fertilized inside the fallopian tubes.
In ZIFT, the eggs are placed in the fallopian tubes instead of directly placing them in the uterus. In contrast, with GIFT, fertilization takes place in the body rather than in a petri dish.
In traditional IVF, the embryos are incubated and raised in a laboratory for 3 to 5 days. In comparison, GIFT and ZIFT are quicker.
- Fertility Medicines
Ovulation problems in women are also treated with medicines. Doctors usually prescribe drugs such as clomiphene citrate, gonadotropins, or anti-estrogens, which help to regulate ovulation in women.
Metformin is a type of medication that regulates ovulation in women, especially when women have insulin resistance or PCOS.
A gentle reminder: The cases of ovulation disorder are different in every woman. Avoid taking these medicines without prior medical consultation.
Hysteroscopy in infertility is used to evaluate possible intrauterine changes that hamper implantation or growth, or both. In a typical procedure of hysteroscopy, a hysteroscope is placed into the uterus through the cervix. The procedure is used to remove polyps and fibroid tumours, divide scar tissue, and open up blocked tubes.
- Egg Freezing
Egg preservation or freezing is a suitable option for couples who are not ready to start a family immediately but want to conceive later.
Egg freezing doesn’t require sperm because the eggs aren’t fertilised before they’re frozen. However, you may need to use fertility drugs for ovulation so that multiple eggs are produced for retrieval.
Social egg freezing in India has become a popular fertility option; the egg freezing Freezing eggs cost around 50,000-1.5 lakhs annually, depending on the state and method of storage.
Fertility Treatment Options for Men in India
- Rectal Probe Electroejaculation
Also known as electroejaculation or EEJ, rectal probe electroejaculation is a procedure used to collect sperm. The procedure, used to anally stimulate the prostate, is most often performed under anaesthesia.
- Penile Vibratory Stimulation (PVS)
PVS is a painless procedure that does not require anaesthesia or sedation. It uses a specially designed mechanical vibrator to vibrate the tip and shaft of the penis to help the male get to a natural climax. The vibrator is placed at the base of the glans penis and set at a certain frequency and amplitude.
If enough sperm cells are collected, they are washed and processed in the IVF lab and subsequently used for intrauterine insemination (IUI).
- Antibiotics for Genital Tract Infection
Genital tract infections such as Epididymitis, Orchitis, Urethritis, etc. may cause testicular shrinkage and epididymal duct blockage. Antibiotics are prescribed to treat such conditions.
Infertility due to a genital tract infection is often diagnosed with a semen test. The semen test evaluates the number of white blood cells that make reactive oxygen species (ROS). When in excess, the sperm is unable to fertilise an egg.
- Gonadotropin Therapy
Gonadotropins are injectable fertility medications used in the infertility treatment of men. They are similar to the human pituitary FSH, a crucial hormone for producing mature eggs in the ovaries. In men, gonadotropin therapy can increase production of testosterone and lead to a higher sperm count. It can also increase the male’s sex drive and increase the chances of conception.
Antiestrogens can block or reduce the production of estrogen in men for whom overproduction of estrogen is a key reason for infertility. High estrogen levels in men can lead to erectile dysfunction, growth in breast tissue and can reduce the quality and quantity of sperm produced.
These are some of the most commonly used fertility treatments in India. The most suitable treatment option is chosen only after careful examination of you and your partner to identify the root cause of infertility and evaluate the option that will guarantee the highest success.
– Infertility treatments for women in India include IVF, ICSI, medication to restore hormonal balance, GIFT, ZIFT, and more.
– The various infertility treatments for men in India include rectal probe electroejaculation, anti-estrogen medication and gonadotropin therapy.There are some homeopathic treatments for infertility in males that one can explore as well.
– Make sure you consult carefully with a fertility specialist at the right time.
-Decide on a course of treatment after careful consideration.
Consult with top fertility specialists on MFine to treat your infertility now!
Chapter 3: What risks to anticipate from infertility treatments in India?
While infertility treatments in India are generally effective and can help you conceive, there may still be unwanted and unintentional side effects of fertility treatments that may result either from the treatment or from the fertility drugs.
Here are the most common risks of these treatments in India to watch out for.
- Ovarian Hyperstimulation Syndrome (OHSS)
Ovarian Hyperstimulation Syndrome is the body’s response to excess hormones. OHSS is characterised by enlarged, swollen ovaries and fluid accumulation in the abdomen.
OHSS occurs when women take injectable hormone medications, such as gonadotropins to stimulate egg development in ovaries. OHSS is also common in women undergoing IVF procedures.
The treatment for OHSS depends on the severity of the condition. In mild cases, it improves on its own, while severe cases of OHSS may also require additional treatment and hospitalisation.
- Chances of Multiple Pregnancies
In some treatments in India, multiple eggs are developed to increase the chances of pregnancy. In such cases, it is very likely that a woman delivers twins, triplets, or more. This condition is called multiple gestation.
It is difficult to evaluate or control the number of eggs that will be fertilised during the treatment. Hence, the chances of producing more than one follicle make the likelihood of multiple gestation stronger.
- Chances of Ectopic Pregnancy
Pregnancies that are implanted outside the uterus are called ectopic pregnancies. Since they occur in fallopian tubes, they are also referred to as tubal pregnancies. An ectopic pregnancy occurs due to damage to the fallopian tubes. A fertilised egg may have trouble passing through a damaged tube, thus causing the egg to implant and grow in the tube.
Ectopic pregnancies are risky to the mother. Bleeding from ectopic pregnancies may cause pregnancy-related deaths and are not viable, hence cannot result in a baby. However, women can have normal pregnancy even after a previous ectopic pregnancy.
- Mood Swings
Fertility drugs stimulate a woman’s ovaries to produce multiple eggs, thereby increasing the chances of getting pregnant. Although the exact combination of drugs prescribed depends on the specific fertility issues of each woman, the medicines generally contain high amounts of estrogen, and in some cases gonadotropin-releasing hormone (GnRH) agonist or antagonist, among others. These hormone-modulating drugs cause mood swings and depression and affect anxiety levels.
– Couples looking to conceive must consider the possible side effects and risks followed by fertility treatments, some of which include OHSS, multiple pregnancies, ectopic pregnancies, and mood swings.
– Always consult your doctor for the best treatment options for female infertility to minimise side-effects as much as possible.
Schedule an instant appointment with top fertility specialists to know the risks of infertility treatment
Chapter 4: Home remedies for fertility
A number of lifestyle and environmental factors can contribute to infertility. If you are undergoing or planning to undergo treatments for infertility in India, then there are a number of natural steps you can take to support your treatment and increase your chances of conceiving. Even if you are not actively trying to get pregnant yet, you can add these healthy and natural home remedies for endometriosis and infertility to your routine, diet and lifestyle.
- Get Regular Exercise
Getting regular exercise works wonders for your mental and physical health. For couples who are struggling with health issues such as obesity or PCOS, getting the right amount of exercise regulates hormones and insulin sensitivity, thereby boosting fertility.
Choosing moderate physical activities instead of a sedentary lifestyle also helps in maintaining a healthy weight. Unhealthy weight is linked with irregular menstrual cycles, which can impact your fertility.
- Switch to a Healthy Diet
Eating healthy foods alleviates fertility problems in women. Eating a whole-food diet stimulates fertility and also increases your overall well-being. There are weight loss diet plans that can help shed your extra weight. You can also adopt the diet for PCOD that can do wonders for your physical health.
By increasing your fibre intake, you allow your body to remove excess hormones, while also maintaining your blood sugar levels.
Include fruits and vegetables, beans, grains, and other foods enriched with vitamins E and C in your diet. While high-fat dairy products may boost fertility, it’s best to avoid trans-fats and junk food as they impact ovulation.
- Avoid Alcohol and Smoking
Studies determine a connection between alcohol and infertility. Excess alcohol consumption is bad for your body and also for fertility.
Couples who smoke also take longer to conceive than non-smokers. Studies have found a link between cigarette smoking and male reproductive health. Men who smoke had lower sperm counts, semen volumes, and lower percentage of motile sperm compared to non-smokers.
- Increase Iron Intake
A healthy intake of iron is especially important for women in their reproductive years. Iron-rich foods and iron supplements improve ovulation and fertility, thus lowering the risk of ovulation disorder in women.
- Take Prenatal Vitamins
If you’re thinking about starting a family, start taking prenatal vitamins. They contain folic acid, vitamins A, C, and D, as well as those all-important omega-3 DHA fatty acids.
- Avoid Stress
Studies associate high levels of stress to infertility. If you and your partner are trying to get pregnant, you should actively try to reduce your stress levels. Oftentimes, the worry about infertility can increase your stress levels, making it harder to conceive. To break this vicious cycle, make sure you indulge in stress-busting activities like meditation. You can also reduce stress by taking up a new hobby or starting a new bonding activity with your partner.
Yoga asanas to boost fertility or keeping a gratitude journal can also lower your stress levels and help you stay positive.
– Although modern medicine offers a plethora of options to treat infertility, couples can try to support their treatment by following natural home remedies for fertility to improve their chances of pregnancy.
– Paying attention to diet and exercise and avoiding smoking, alcohol, and stress will boost you and your partner’s fertility.
To learn about home remedies for infertility, consult top fertility specialists on the Mfine app!
Chapter 5: Causes of infertility in women and men
In general, the causes of infertility in women and men take time to diagnose. While it’s possible for couples to conceive without treatment after trying for two years, it’s important to discover the various causes and address them for timely treatment.
Common Causes of Infertility in Women
- Ovulation Disorder
Ovulation is when a mature egg moves down the fallopian tube after being released from the ovary, where it is fertilised.
At least 1 in 4 infertile couples endure the ovulation disorder, which means either that the ovulation is irregular or absent altogether.
Failure to ovulate can result from several conditions, such as:
- Ovarian conditions, such as primary ovarian insufficiency (POI) or polycystic ovary syndrome (PCOS)
- Ageing, which causes diminished ovarian reserve, or a low number of eggs
- Problems with the hypothalamus or endocrine disorders, such as thyroid disease
- Lifestyle and environmental factors
- Polycystic Ovary Syndrome (PCOS)
Polycystic Ovary Syndrome (PCOS) causes hormone imbalance and affects ovulation.
With PCOS, the ovaries, and in some cases, the adrenal glands, produce more androgens than normal. High levels of these hormones impair the development of ovarian follicles and hamper the release of eggs during ovulation.
Common symptoms of PCOS are sacs or cysts that develop within the ovaries. Furthermore, insulin resistance, obesity, abnormal hair growth on the face or body, and acne can also be the result of PCOS.
In endometriosis, the tissue that normally grows in the uterine cavity, called the endometrium, grows outside the uterus instead. This extra tissue growth, and the surgical removal of it, causes scarring.
The scarring in the fallopian tube obstructs and affects the release of the egg after ovulation. Endometriosis further affects the lining of the uterus, thus disrupting the implantation of a fertilised egg.
- Uterine Fibroids and Polyps
Uterine fibroids are common noncancerous growths inside a woman’s uterus. Usually, those that are larger than 6 cm in diameter may impair fertility. Moreover, uterine fibroids located in the uterine cavity against those within the uterine wall also affect your chances of pregnancy.
Some women with fibroids are unable to get pregnant naturally or may suffer multiple miscarriages or preterm labour.
Uterine polyps are growths in the inner wall of the uterus that extend into the uterine cavity. Due to the overgrowth of such cells in the lining of the uterus (endometrium), they are also known as endometrial polyps. Although these polyps are usually benign, i.e. noncancerous, some can be cancerous. Surgical removal of the polyps increases the chances of pregnancy.
Several uterine or cervical issues are known to impact fertility. Benign polyps or fibroids in the uterus block fallopian tubes or interfere with implantation, thus impairing fertility. However, many women become pregnant in spite of fibroids or polyps.
- Menstrual Problems
The female menstrual cycle prepares the body for pregnancy and includes several stages. If issues occur at any one of these stages, it may lead to infertility or create difficulties in getting pregnant.
- Primary Ovary Insufficiency (POI)
Also known as POI, it is a condition in which a woman’s ovaries stop producing hormones and eggs at a young age. In such a condition, women ovulate irregularly, if at all. They may also have abnormal levels of ovarian and pituitary hormones.
- Hypothalamic Dysfunction
Follicle-stimulating hormone (FSH) and luteinising hormone (LH) are produced by the pituitary gland to stimulate ovulation every month.
Irregular or absent periods are some common signs of ovulation disorder. High physical or emotional stress, fluctuations in body weight, or substantial weight gain or loss affects hormone production and, in turn, ovulation.
- Structural Problems With the Reproductive System
This usually involves the growth of abnormal tissue in the fallopian tubes or the uterus. If the fallopian tubes are blocked, the eggs cannot move from the ovaries to the uterus, and the sperm can’t reach the egg for fertilisation. Scarring due to injury or surgery increases the risk of miscarriage and interferes with implantation, thus leading to infertility.
- Excess Prolactin
In some cases, the pituitary gland may produce excess prolactin (hyperprolactinemia). This further results in lower estrogen production and may cause infertility. Although this is usually a problem related to the pituitary gland, it can also occur due to the intake of medications against a disease.
- Damage to Fallopian Tubes (Tubal Infertility)
Damaged or blocked fallopian tubes do not let sperms reach the egg or block the passage of the fertilised egg into the uterus.
Damage or blockage to the fallopian tube may be caused due to:
- Pelvic inflammatory disease
- Past surgery in the abdomen or pelvis
- Pelvic tuberculosis
- The Inability of Eggs to Mature and Implantation Failure
Ranging from PCOS to obesity and a lack of specific proteins, there are several reasons that the woman’s eggs may not mature.
Moreover, timing is crucial during ovulation: an immature egg may sometimes not be released at the correct time, may not reach the fallopian tubes, or may not be fertilised.
Implantation failure occurs when a fertilised egg does not implant in the uterine wall to stimulate pregnancy. Possibilities of implantation failure include:
- Genetic defects in the embryo
- Progesterone resistance
- Thin endometrium
- Scar tissue in the endometrial cavity
- Other Medical Conditions
Endometriosis scarring or inflammation within the uterus also affects implantation. Uterine abnormalities since birth, such as an abnormally shaped uterus, may also cause fertility problems.
Cervical stenosis, or the narrowing of the cervix, occurs due to an inherited malformation or damage to the cervix. In some cases, the cervix is unable to produce the best type of mucus, which does not allow the sperm to travel into the uterus.
- Unexplained Infertility
In some cases, the cause of infertility in women is never found. Unexplained infertility may be a combination of several minor factors present in both partners. Sometimes, such a problem also corrects itself with time. This shouldn’t, however, be the reason to delay unexplained infertility treatment..
Common Causes of Infertility in Men
- Sperm Deficiency
The disorder includes a range of problems related to the sperms, such as abnormal sperm, its production, shape, and quality.
Other crucial factors that determine infertility in men include:
- The sperm count, i.e. the number of sperms
- The motion of the sperm
- Transportation of the sperm through the tubes of the male reproductive system
A sperm deficiency may include a sperm that is not fully grown, is oddly shaped, is made in very low numbers (oligospermia), is not made at all (azoospermia), or does not move the right way.
Azoospermia causes and treatment:
Azoospermia may occur due to inborn traits, lifestyle choices such as smoking, drinking alcohol, and intake of certain medications. Health conditions and long-term illnesses such as kidney failure are also known to impact sperm count. Furthermore, damage to the reproductive system also causes low or no sperm. A male fertility test or a spermcheck are helpful ways to identify irregularities in sperm behaviour or sperm count in men.
Several treatments can help in azoospermia cure. Medicine for azoospermia come in many forms, the most common non obstructive azoospermia treatments include hormonal drugs such as Letrozole, Clomid, FSH injections, or hCG injections.
Varicoceles refer to swollen veins in the scrotum. They impair sperm growth by blocking normal blood drainage. The condition also causes blood to flow back into the scrotum from the belly, thus impacting sperm count.
- Retrograde Ejaculation
Retrograde ejaculation is the backward travelling of the semen into the body. It flows into the bladder instead of emerging from the penis. Although men experience sexual climax, they produce very little or no semen. This is why retrograde ejaculation is sometimes also called a dry orgasm.
Retrograde ejaculation isn’t harmful to a man’s health, but it can cause male infertility.
- Hormonal Imbalance
A sound balance of hormones in a man’s body is crucial for the successful functioning of the male reproductive system. Male infertility is a result of low testosterone or gonadotropins; these include follicle-stimulating hormone (FSH) and luteinising hormone (LH).
Hormones made by the pituitary gland enable the testicles to produce sperm. As a result, low hormonal levels cause poor sperm growth.
- Immunologic Infertility
In some cases of surgery, injury, and infection, a man’s body creates antibodies that impact sperm growth. Although an uncommon cause of male infertility, studies haven’t ruled out the possibility of antisperm antibodies resulting in lower infertility in males.
In some cases, sperm can be blocked due to repeated infections, surgery such as vasectomy, or swelling. Some developmental defects may also cause blockage in the male reproductive tract and keep the sperm from emerging during ejaculation.
- Other Problems
The causes of male infertility occur due to sexual problems such as premature ejaculation, genetic diseases like cystic fibrosis, structural problems like a blockage in the testicle, or injury to the reproductive organs.
Intake of certain medications may impact sperm production, function, and delivery. A regular dosage of medicines to treat health problems like arthritis, cancer, high blood pressure, infections, depression, and digestive problems may cause infertility in men.
- Environmental Factors
Overexposure to chemicals like pesticides and radiation are known to cause infertility in men. Frequent exposure to heat, such as in saunas or hot tubs, increases body temperature and affects sperm production.
Consumption of alcohol, marijuana, anabolic steroids, and smoking also leads to infertility in men. Taking medications to treat bacterial infections, high blood pressure, and depression may affect fertility. Plus, sperm production is severely impaired due to treatments such as radiation or chemotherapy.
– Some of the causes of female infertility include: PCOD, uterine fibroids, damage to fallopian tubes, and problems with the regular menstrual cycle.
– Some of the causes of male infertility include: sperm deficiencies, variocoeles, retrograde ejaculation, hormonal imbalances and blockages.
– Remember, just because you have these conditions does not mean you may never get pregnant or improve sperm motility or sperm count. Addressing these issues and getting timely treatment can resolve these issues and help you conceive.
Book an appointment with a fertility specialist to evaluate causes of your infertility
Chapter 6: Frequently Asked Questions on Infertility Treatments in India
- How is infertility diagnosed?
If you have not able to conceive after a year of unprotected sex, it is advised to seek medical help. Imaging, blood, and urine tests determine the causes of infertility. In men, a sperm analysis evaluates sperm count and overall sperm health.
- Do we both need to be tested?
Yes, almost always. Infertility is caused by factors in both men and women. Infertility testing, in the initial stages, are less invasive, such as a semen analysis, or a test for blocked fallopian tubes in women with a pelvic infection.
- What if all our infertility tests are normal?
In such cases, the diagnosis is determined as ‘unexplained infertility’. In 10-15 per cent of couples, tests evaluate no reproductive troubles.
In cases of unexplained infertility, you may want to ask your doctor if you can take up other tests, or you may also take a second opinion. Having unexplained infertility may not always mean that no problem exists.
In some cases of unexplained infertility, couples conceive without any treatment, especially if they are younger. In general, couples with unexplained infertility succeed with unexplained treatments for infertility just as much as couples who are undergoing treatment for fertility.
- If I had a baby once, is it possible I will be infertile in my next attempt?
Yes, the condition is called secondary infertility. In this condition, a couple cannot get pregnant but have been pregnant and given birth in the past. There are secondary treatments for infertility that are available for couples who belong in this category.
In some cases, an infection with the last birth may have damaged the reproductive organs, or it may be the increased age, the reasons could be several, and need to be diagnosed.
- How long does IVF take?
Prior to egg retrieval, the process of in vitro fertilisation may last anywhere from 4- 6 weeks. After 2- 5 days, the embryo(s) are implanted. The first IVF attempt is not successful in all cases. It is common for patients to go through multiple IVF cycles.
Not all patients get pregnant on their first attempt; in fact, it is common for patients to go through multiple IVF cycles before finally becoming pregnant.
- If we don’t get pregnant in our first IVF attempt, when can we try again?
Doctors usually advise the patients to wait for one or two full menstrual cycles before resuming another IVF cycle.
- How can I find out which IVF centre is the best in my city?
IVF centres in India are in demand due to growing awareness of IVF, and the cost-effective treatment. Before deciding on an IVF centre for your treatment, you may want to evaluate the following parameters:
- Location (the city and the state)
- Effectiveness (patient satisfaction, success rates, and treatment techniques)
- The team (experience of the doctors, their clinical success, national/international recognition, word of mouth)
- The hospital (its ratings/ year of establishment)
- Value for money (affordability, quality of treatment)
In the earlier decades, the inability to conceive was a taboo with only a few couples willing to speak openly about their infertility. With an increasing number of infertility cases in India, people have become more open to medical help and treatments for infertility in India .These days, advances in infertility treatment can make it possible to conceive a child even if you are unable to get pregnant naturally. Make sure you consult with a fertility specialist to evaluate your options and decide on the best course of treatment
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