Signs of Infertility in Indian Men and Women: Causes, Diagnosis, and Treatment

The World Health Organization defines infertility as “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.” Since infertility is also connected with age, women above the age of 35 should seek professional help if they have not been able to get pregnant after 6 months of unprotected intercourse.

Studies have shown that at least 50 million couples around the world are dealing with problems of infertility. Another interesting observation is that it is more common for couples to experience secondary infertility, or the inability to conceive after having at least one biological child compared to primary infertility, which refers to women who have not had biological children before.

Incidence of infertility

In India, the conventional assumption is that women must be solely affected by infertility. However, in reality, both parties are equally likely to be affected. In fact, one study on infertility in India found that less than 30 percent of Indian males had normal semen characteristics, meaning that up to 70 percent could have issues with fertility.

Let us try and understand how infertility manifests in both genders.

Signs of infertility in Indian men:

Abnormalities in semen is almost always a reliable indicator of infertility in men. Common infertility signs in men include low sperm count, abnormalities in the function of sperm or blockages that do not allow sperm ejaculation.

Signs of infertility in Indian women:

Some of the signs of female infertility include advancing age, physical conditions, presence of STDs, and fibroids in the uterus. However, the most common indicator of infertility in women continues to be irregularities in the menstrual cycle. Women whose periods are irregular, too long, too short, or absent, might have trouble ovulating.

History of STDs

Women who have had infections like chlamydia and gonorrhoea are likely to have weak or damaged fallopian tubes.

FAQs:

Q1. What is infertility?

Infertility can be explained as a disease or disorder that can prevent the conception of a child or decrease the chances of carrying a child to term. Couples who have been trying unsuccessfully to get pregnant for at least a year may need a complete checkup to diagnose any underlying issues.

Q2. What factors influence fertility?

Some of the main factors that influence fertility are sexual health, age, diet and lifestyle habits. Excessive smoking, drinking, STDs and advancing age can reduce fertility levels of individuals.

Q3. How common is infertility?

According to a study by the Indian Society of Assisted Reproduction, approximately 10-15% of couples in India have fertility issues. Moreover, couples in urban cities are more likely to face infertility than couples in rural areas.

Q4. Is infertility a condition in men or women?

About one-third of the cases can be traced to male factors of infertility, while another third can be caused due to factors in females. Among the remaining third, most cases are attributed to combined causes, and a few cases are unexplainable.

Q5. At what age are women most fertile?

Women are usually fertile between the ages of menarche and menopause. If one were to predict at what age are women most fertile, it would be between 15 and 30.

Q6. Does infertility affect health?

While there are no health complications that can arise from infertility, couples face psychological issues like depression, anxiety, fear, isolation, and rejection. In some cases, infertility can arise from pre-existing health conditions such as PCOS and STDs. Infertility and PCOS are often seen together, so if you have symptoms of PCOS, you should try to manage the condition to bring it under control.

Q7. What is secondary infertility?

Secondary infertility refers to the couple’s inability to conceive a child after having already given birth to one. There are many causes of secondary infertility. There might have been issues with the previous pregnancy or birth, damage to fallopian tubes or decreased sperm production.

In most cases, couples only realize they might be suffering from infertility after they actively try to conceive a baby and fail to do so. Often, certain conditions can lead to infertility, so it’s important to look out for symptoms of infertility to get timely treatment.

Here are some signs of infertility in Indian men and women.

Infertility in Women

Several factors can play a role in contributing to infertility in women. Some female infertility symptoms include:

• Menstrual indicators: Problems in the menstrual cycle are among the strongest signs that show infertility in Indian women. Some abnormalities in menstrual cycles include heavier or lighter bleeding during periods, irregular intervals in between periods, complete cessation or absence of periods, or intense pain in the back, pelvis, and abdomen during the period.
• Hormonal indicators: Hormonal imbalances are also among female infertility symptoms. Observable changes to the body due to hormonal imbalance include skin texture changes, break-outs of acne, growth of thick, dark hair on the chin, chest, and around the lips, unexplained weight gain, and loss of sex drive.
• Other indicators: Certain other indicators may also be signs of infertility in Indian women. These include unusual pain during and after intercourse and/or a milky discharge noticed from the nipples, even though you may not be breastfeeding.

Infertility in Men

It is even harder to notice male infertility symptoms unless you get yourself examined. Common signs in Indian males can also be attributed to certain conditions that cause infertility in the first place. Here are some of the factors:

• Males with firm or small testicles may need to get tested for infertility. Some may also experience scrotal swellings or painful lumps in their testicles.
• Erectile dysfunction and problems with ejaculation are some other commonly observable male infertility symptoms.
• Observable changes in sex drive are prominent signs of infertility in Indian men.
• Males may experience changes in the texture and growth of hair. Thinning hair and baldness may also be indicators of infertility in men.

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Risk factors for infertility

Infertility in both men and women does not typically manifest as visible symptoms. It is, sometimes, hard to detect/predict if you may have such an issue on your own unless you are planning a pregnancy. While it may be hard to determine the cause of the condition, some factors increase the possibility of infertility in both men and women. These include:

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FAQs:

Q1. What are the symptoms of infertility?

There are no classic symptoms for infertility in either males or females. You may notice symptoms that are typical to certain conditions that may cause infertility. However, you cannot be sure unless you get yourself checked after trying to conceive for a considerable period.

Q2. What are the signs of infertility in Indian women?

Women who have hormonal problems, menstrual irregularities, pain during their period, milky discharge from their nipples, or pain during intercourse could be at risk for infertility. However, further tests need to be conducted for a conclusive diagnosis.

Q3. Can erectile dysfunction be a sign of infertility in males?

Problems with erections, ejaculation and libido are among the signs of male infertility. It is best to have yourself checked if you seem to have these symptoms.

Q4. Are there any signs of fertility in women?

Although there are no typical fertility signs in women, those who experience regular menstrual cycles with normal bleeding, have minimal to no pain, and have hormone levels within the normal range are more likely to be fertile.

Q5. Are hormonal changes a likely indicator of infertility in males?

Hormonal changes can affect fertility in males, however, these changes are difficult to identify. Loss or thinning of hair due to hormonal imbalances can sometimes be a sign of infertility.

Q6. Can men and women both be infertile?

It is rare, but possible for both partners to have problems with their fertility.

Q7. If a woman experiences pain during intercourse, does it mean she is infertile?

Pain during sex is among the signs of female infertility. However, it does not necessarily mean that the woman is infertile. Tests need to be conducted to confirm infertility.

Q8. Does endometriosis cause infertility?

Endometriosis is a painful condition where the uterine lining tissue grows outside the uterus. This can result in heavy blood flow and severe cramps. If you’re wondering, ‘can endometriosis cause infertility?’, the answer is yes. Endometriosis can make it difficult to conceive and to carry a pregnancy to term.

It takes a healthy male and female, as well as the right environment and timing, to be able to get pregnant. With so many factors in play, it may require some time and effort to conceive a baby. Either partner can lower the chances of conception if they face reproductive health issues or any other disorder. Here are some leading causes of infertility in men and women.

Male infertility causes:

• Sperm production and function: Men may experience problems with the production and function of sperm due to genetic causes, health conditions like mumps and diabetes, or infections like HIV, gonorrhoea, and chlamydia. Men who have undescended testicles will also experience problems with sperm health. Sperm production problems may include the complete absence of sperms, low sperm count, mobility and motility issues, improperly formed and shaped sperms, and underdeveloped sperms. Varicocele is one of the common male infertility causes that results in swelling in the scrotal veins. It can also lower sperm count.
• Sperm delivery: Genetic issues like cystic fibrosis can impact the delivery of the sperm. Blockages in the testicles, damaged reproductive organs, or injury can also cause problems in sperm delivery. Conditions like premature ejaculation are other causes of infertility in men. Sometimes, men may suffer from what is called retrograde ejaculation. This occurs when ejaculated semen goes back into the body of the male and the
  bladder. This prevents the delivery of sperm into the vagina. Causes of oligospermia include excessive heat around the testicles, issues with ejaculation and varicoceles.
• Damage from medical treatment: Sometimes, men receiving treatment for health conditions like cancer, depression, digestive disorders, high blood pressure, and infections may experience reproductive health problems. Exposure to radiation and chemotherapy is also among the reasons for infertility.
• Hormones and chromosomes: Low hormone levels could lead to a decreased production in sperm. Changes in chromosome structure and sperm motility can also impact fertility.
• Environment and lifestyle: Lifestyle choices like smoking, drinking, substance abuse, and certain medication can impact fertility. Increased exposure to heat can also reduce sperm count.

Female Infertility Causes

• Ovulation problems and menstrual complications: Ovulation problems form the largest cause of infertility in women. Polycystic ovary syndrome, oversecretion of prolactin, imbalance in thyroid function, and tumours may also impact ovulation and menstrual health. Other reasons include eating disorders and excessive workouts, which can disturb the delicate hormone balance of the body.
• Cervical and uterine complications: An improperly formed or shaped uterus, polyps, or benign tumours in the uterus, and abnormalities found in the cervix may affect female reproductive health. Issues include blocked fallopian tubes or the inability of an embryo to implant itself in the uterine wall. Causes of blocked fallopian tubes include previous ectopic pregnancies, endometriosis, fibroids or sexually transmitted infections. Cervical stenosis or blocking of the cervical canal can prevent the sperm from reaching the uterus.
• Adhesions and blockages: These may be found in the fallopian tubes or the uterus. Causes of blocked fallopian tubes can include scar tissue due to surgery, infections, and disease, or STDs. Adhesions and blockages are among the common reasons for infertility.
• Premature ovarian insufficiency: This is what we commonly refer to as early menopause, which occurs in women below 40. This may occur due to genetic causes, Fragile X or Turner syndrome, radiation, and chemotherapy, or the existence of an autoimmune disease. Early menopause causes the ovaries to stop egg production.
• Endometriosis: This condition may hamper the health and function of fallopian tubes, uterus, and ovaries. It is caused when the endometrial tissue begins to grow outside the uterus.
• Cancer: Treatment for cancer, including radiation and chemotherapy, can impact fertility. Cancers of the reproductive system can also cause infertility in women.

FAQs:

Q1. What causes infertility in men?

Sperm health is among the major causes of infertility in men. Other complications include genetic, environmental, and lifestyle factors. Side effects of medical treatment can also contribute to infertility. Knowing what causes infertility in men can help plan the necessary treatment.

Q2. What causes infertility in women?

Age, hormonal imbalance and lifestyle factors are some of the main causes of infertility in women. A woman’s risk of infertility increases with age because the quality of her eggs starts to deteriorate. Hormonal or reproductive issues like PCOD and endometriosis can also make it more difficult to get pregnant. Excessive smoking and drinking can reduce fertility in women.

Q3. What causes blocked fallopian tubes?

Blocked fallopian tubes can be a result of an inflammation caused by STDs, adhesions, and endometriosis. Studies on what causes blocked fallopian tubes have revealed pelvic inflammatory disease as the most common cause.

Q4. Can abortion cause infertility?

Elective abortions are not known to cause complications or issues with future pregnancies. Sometimes, when the termination of pregnancy is done at a stage later than 12 weeks, or if there is a requirement of a repeat surgical procedure, there are chances of developing Asherman syndrome (formation of scar tissue in the uterus) which can be a likely cause of infertility after abortion.

Q5. Do women get infertility in PCOS?

Infertility and PCOS do appear to have a strong connection. PCOS is among the most common reasons for infertility. It is a condition that causes irregular periods, cysts in the ovaries and can impact the egg’s development and release during ovulation.

Q6. Can ovarian cyst cause infertility?

Ovarian cysts are common. They do not impact fertility unless they get infected, triggering a series of potential problems, including pelvic infections and fallopian tube scarring.

Q7. Is ovulating with PCOS possible?

Hormonal imbalances caused due to PCOS make it difficult for women to ovulate regularly and naturally. However, female infertility treatment and certain medications available today, make ovulating with PCOS possible.

Q8. Can a yeast infection cause infertility?

Yeast infection does not by itself cause infertility. The condition is usually very simple to treat through topical treatments and by maintaining proper hygiene.

Q9. Can fibroids cause infertility?

Fibroids are usually harmless and do not cause infertility in women. In some cases, however, where the fibroids are very large and are present within the uterus, they can affect the fertility of a woman.

Q10. Can chlamydia cause male infertility?

Chlamydia can result in changes in the structure of sperm, which can lead to infertility in males. It’s vital to get treatment for chlamydia in the early stages itself to prevent complications.

It is important to get a good, timely diagnosis of infertility to improve your chances of having a baby. Diagnoses for both men and women begin with a medical examination and understanding of their medical history. Following this, a series of diagnostic tests are conducted to help understand the reasons for not ovulating or conceiving, suggesting suitable treatment plans after that.

Diagnostic tests for men in India

Depending on your medical history and your physical examination outcome, your physician may ask to undergo one or more of the following tests:

• Semen analysis: An important test in evaluating quality and number of sperm produced. You will be required to provide a semen sample for testing. Urine is also sometimes tested to check for the presence of sperm.
• Hormone testing: Levels of testosterone are almost always checked as changes in its levels can lead to male infertility. Imbalances in testosterone and other male hormones are tell-tale signs.
• Genetic testing: These can reveal the role of genes and their defects that may cause infertility.
• Biopsy of testicles: This can reveal abnormalities causing infertility. It is also conducted as a treatment method in retrieving sperm for procedures like IVF.
• Images: MRIs of the brain, ultrasounds of the scrotum, and a vasography or test of the vas deferens are some common tests prescribed.
• Special tests: If any of the above tests prove inconclusive or insufficient, additional sperm tests may be conducted to evaluate its quality and check its DNA for abnormalities

Diagnostic tests for women

A physical examination and some fertility tests can help provide an accurate diagnosis of infertility and suggest the right course of action.

• Ovulation testing: A simple blood test to check if you are ovulating by testing the hormone levels, such as FSH and LH.
• Hysterosalpingography (HSG Test): This test uses X-rays and contrasts to check the condition of the uterus and fallopian tubes and to identify blockages, adhesions or fluid spills.
• Ovarian reserve testing: This helps check the number of eggs that are available for ovulation.
• Hormone tests: Checks the levels of the FSH, LH, estrogen, progesterone and other hormones that play a significant role in reproduction.
• Images: Saline infusion sonograms are sometimes used when regular ultrasounds cannot provide enough information. An ultrasound of the pelvis is also taken to check for disorders in the uterus or ovaries.

FAQs:

Q1. What is a fertility test?

A fertility test can help couples understand and identify any underlying problems leading to infertility issues. It also suggests the most fertile windows that can allow couples the best chance of getting pregnant. To know what is a fertility test that can help you conceive, check with your physician.

Q2. How can you determine the reasons for male infertility?

It is possible to ascertain the reasons for male infertility through several diagnostic tests available, including semen analysis and testicular biopsy. Your doctor can suggest the right diagnostic tests following a consultation.

Q3. What are the female infertility causes?

Reasons for female infertility can be determined through several tests available, such as hormone tests and HSG tests. Following a consultation with your OB, you will receive a list of suggested tests to help get you an answer.

Q4. How can ovulation problems be diagnosed?

Ovulation problems are diagnosed using tests that check hormone levels to know if you are ovulating. Further investigation, including hormone testing and imaging, may also be suggested.

Q5. Do both individuals need to be tested?

A preliminary consultation with your physician will help you decide if both of you need to be tested, or if only one of you needs an evaluation.

Q6. How long will it take for us to have an answer?

You will need to wait for at least a month to get the results of all your tests. In some cases, repeated tests may need to be conducted, which may make the wait longer.

Q7. What if all the tests are normal?

In some cases, all your tests may come back normal. This does not mean the absence of a problem. You may want to ask for more tests or consider getting a second opinion.

Infertility treatment in women is determined only after the doctor conducts a complete examination and identifies the best course of action. You may even need a combination of female infertility treatment options to help you have a baby. The course of treatment is chosen depending on age, causes, and duration of infertility and personal preferences.

Treatment options

Fertility drugs:

Prescription of certain fertility drugs forms the first course of treatment, especially for women with ovulatory disorders. Some commonly prescribed drugs for ovulatory disorders include clomiphene citrate and Gonadotropins. The purpose of these drugs is to induce ovulation. It is important to discuss the options carefully with your doctor since almost all of them have risks and side effects.

Surgery:

Surgery can help treat conditions that impede the chances of having a pregnancy. Procedures can help remove scar tissues, polyps, adhesions, endometriosis, fibroids, and septum. Your doctor may choose to perform laparoscopic or hysteroscopic surgery, depending on the condition you have.

Assisted reproduction:

Assisted Reproductive Technology (ART) is a treatment option that handles sperms and the egg in various ways. IVF is among the most common forms of ART. It may involve combining a sperm and egg outside the woman’s body allowing fertilization, assisting implantation and hatching of the embryo in the uterine lining, using donor eggs, or seeking a gestational carrier’s assistance.

Possible treatment complications

No procedure comes without risk. Some complications with fertility treatments include:

Multiple pregnancies:

Fertility treatments commonly lead to multiple pregnancies, with twins, triplets, or even more babies in the uterus. This can lead to greater risk to the mother and babies, premature labour, developmental complications, gestational diabetes, and complications during delivery.

Ovarian hyperstimulation syndrome (OHSS):

This is a common complication of ART. Painful and swollen ovaries typify this condition. You may also experience nausea, bloating, and abdominal pain if you get pregnant. These symptoms are likely to last for about a week. In some rarer cases, the woman may experience shortness of breath and rapid weight gain, which may require emergency care.

Infection and bleeding:

In certain rare cases, bleeding and infection may be noticed when invasive forms of treatment have been used.

FAQs:

Q1. How can you treat ovulation disorders?

The best course of treatment for ovulation disorders will be determined by your doctor. In general, treatment will include medication to induce ovulation and surgical procedures if the cause of infertility can be surgically remedied.

Q2. What is IVF in medical terms?

In Vitro Fertilization or IVF can be explained as fertilizing the female egg with the male sperm outside the female body. Fertilization occurs in a laboratory dish when the sperm attaches to and enters the egg.

Q3. What insurance covers IVF?

Not every insurance plan covers IVF. Some plans may cover IVF, but not fertility injections. Other plans may only cover a certain number of attempts. If you are waiting to begin female or male infertility treatment, check carefully to determine what insurance covers IVF and just how much you will be protected.

Q4. What is the procedure for IUI?

Intrauterine insemination or IUI involves transferring specially washed semen into the uterus through a catheter.

Q5. Who is a gestational carrier?

A gestational carrier may be suggested when a woman’s uterus cannot carry the baby to term, especially in congenital malformations of the uterus. The embryo is placed in the uterus of another woman to carry the baby.

Q6. How much does the treatment for infertility cost?

Costs vary significantly depending on the course of treatment involved. It is important to get a proper estimate of treatment costs and check your insurance plan for coverage.

Q7. What options exist apart from treatment?

In case of treatment is not an option, you may discuss available choices with a counsellor. Adoption is among the most preferred options for couples who cannot have children.

Men have an equal chance of having issues with fertility. However, there are several treatment options available today, which can significantly improve their chances of having a baby.

Infertility treatment in men

Treatment options for male infertility can be classified into the following two types:

Non-surgical methods:

• Lifestyle modifications, including exercising, quitting smoking, reducing alcohol consumption, reducing stress, discontinuing particular medication with side-effects on fertility, and improving timing and frequency of intercourse are some of the simple techniques for infertility treatment in men.
• Medication for symptomatic treatment of conditions like CAH, genital tract infection, retrograde ejaculation, ROS, and immunologic infertility.
• Hormone therapy for men with higher or lower levels of hormones related to reproductive health.
• IVF and ICSI to help fertilize using the male sperm and implant the egg into the uterine lining.
• Rectal probe electroejaculation, a condition performed under anaesthesia to help collect the sperm.
• Penile vibratory stimulation to help stimulate the penis and collect semen through a naturally obtained climax.

Surgical methods:

• Varicocele surgery to remove enlarged veins in the scrotum and improve blood flow to the reproductive organs.
• Treatment of azoospermia or the absence of sperm in the semen with Assisted Reproductive Technology or ART to surgically extract sperm for fertilization
• Vasovasostomy or vasoepididymostomy which are surgical procedures that reverse the effects of a vasectomy

FAQs:

Q1. What is fertility treatment?

The use of medical procedures to help treat infertility using assisted reproductive technology defines fertility treatment. Different forms of treatment are devised for males and females.

Q2. How can male fertility doctors help?

Male fertility doctors can help test you for infertility and enable you to understand your condition, its cause, and possible treatment options.

Q3. How is infertility in men treated?

Close to 90 percent of infertility cases in males are treated with conventional forms of therapy like drugs and surgery.

Q4. How is IVF used in male fertility treatment?

The IVF procedure collects the sperm from the male and uses a special washing technique to obtain the most potent sperm for fertilization.

Q5. What is ICSI?

Intracytoplasmic sperm injection or ICSI forms a part of the IVF treatment. The process involves injecting a single, healthy male sperm into a mature egg to help them fertilize.

Q7. Can a vasectomy be reversed?

Vasectomies can be reversed to help couples have children through a surgical procedure called vasovasostomy.

Q7. How can varicocele infertility be treated?

The only course of varicocele treatment is surgery. Medication may be prescribed to relieve pain. Temporary respite may be sought through embolization or the temporary blocking of veins. If you are experiencing varicocele infertility, then your doctor might recommend these methods to you.