Infertility: Causes and Prevention

    

Many today experience the problem of infertility, many more are at risk of becoming infertile. What is infertility? What are the causes of infertility? What are the preventive measures that can be taken against infertility? In this write up, I will take you through some helpful tips on how to prevent the risk of infertility or say how to reduce the risk of infertility to the nearest minimum. But before we go any further, let us take a quick view on the meaning of infertility and the accompanying terms.

Infertility: Failure to achieve a live birth over a 12-month period of unprotected intercourse. Infertility is the inability of a person, animal or plant to reproduce by natural means. It is usually not the natural state of a healthy adult organism, except notably among certain eusocial species (mostly haplodiploid insects).

In humans, infertility may describe a woman who is unable to conceive as well as being unable to carry a pregnancy to full term.

Primary infertility: Never having had a live birth

Secondary infertility: Failure to achieve a live birth after having had a live birth previously.

CAUSES OF INFERTILITY

ŠNon-preventable: Anatomical, genetic, hormonal or immunological problems;

– Do not vary much across countries/ within countries

– Account for a core of 5% of infertile couples

ŠPreventable: Responsible for observed variations across/ within countries

PREVENTABLE CAUSES

ŠInfections

 Sexually transmitted diseases: Chlamydia, Gonorrhea, syphilis etc. (the infertility belt in Sub-Saharan Africa is induced by high prevalence of STDs in these areas).

 Infectious and parasitic diseases: Tuberculosis, schistosomiasis, Malaria, sickle cell disease.

Preventable causes

– Unhygienic obstetric practices

– Septic abortion and their complications

– Postpartum and post-abortal complications

Preventable Causes

ŠExposure to potentially toxic substances in:

– Environment: Arsenic, aflatoxins, pesticides

– Diet: Caffeine, tobacco, alcohol.

Pelvic inflammatory disease (PID)

ŠPID: Infection of the pelvic organs that cause severe illness and may lead to tubal blockage and pelvic adhesions leading to infertility. A common sequela to STDs, post-partum and post-abortal infections and some systematic infections e.g. tuberculosis, schistosomiasis.

The gender Dimension of infertility

Men are responsible for 50% cases

Women may bear the sole blame and lowers their social status.  

A socially acceptable basis for divorce in most of the societies

TREATMENT AND MANAGEMENT OF INFERTILITY

ŠTreatment : A costly and less effective process

ŠPrevention- More effective, less expensive

Medical treatments

Medical treatment of infertility generally involves the use of fertility medication, medical device, surgery, or a combination of the following. If the sperm are of good quality and the mechanics of the woman's reproductive structures are good (patent fallopian tubes, no adhesions or scarring), a course of ovarian stimulating medication maybe used. The physician or WHNP may also suggest using a conception cap cervical cap, which the patient uses at home by placing the sperm inside the cap and putting the conception device on the cervix, or intrauterine insemination (IUI), in which the doctor or WHNP introduces sperm into the uterus during ovulation, via a catheter. In these methods, fertilization occurs inside the body.

If conservative medical treatments fail to achieve a full term pregnancy, the physician or WHNP may suggest the patient undergo in vitro fertilization (IVF). IVF and related techniques (ICSI, ZIFT, GIFT) are called assisted reproductive technology (ART) techniques.

ART techniques generally start with stimulating the ovaries to increase egg production. After stimulation, the physician surgically extracts one or more eggs from the ovary, and unites them with sperm in a laboratory setting, with the intent of producing one or more embryos. Fertilization takes place outside the body, and the fertilized egg is reinserted into the woman's reproductive tract, in a procedure called embryo transfer.

Other medical techniques are e.g. tuboplasty, assisted hatching, and Preimplantation genetic diagnosis.

In vitro fertilization

IVF is the most commonly used ART. It has been proven useful in overcoming infertility conditions, such as blocked or damaged tubes, endometriosis, repeated IUI failure, unexplained infertility, poor ovarian reserve, poor or even nil sperm count.

Intracytoplasmic sperm injection

ICSI technique is used in case of poor semen quality, low sperm count or failed fertilization attempts during prior IVF cycles. This technique involves an injection of a single healthy sperm directly injected into mature egg. The fertilized embryo is then transferred to womb.

Tourism

Main article: Fertility tourism

Fertility tourism is the practice of traveling to another country for fertility treatments. It may be regarded as a form of medical tourism. The main reasons for fertility tourism are legal regulation of the sought procedure in the home country, or lower price. In-vitro fertilization and donor insemination are major procedures involved.

ŠControlling Reproductive Tract Infections

– Educating people about links between RTI and infertility

– Promoting use of condom

– Counseling high risk individuals

– Promptly treating infected individuals and partner notification

– Increasing access to RTI services

Reducing the burden of infertility

ŠPreventing postpartum and post-abortion infections

– Safer birth practices

– Promote family planning

– Access to safe abortion services

Treating infertility:

ŠInsist men be evaluated as well as women

ŠSensitive counseling to avoid inappropriate treatment and to discourage fromseeking help at multiple clinics

ŠAdvising about timing of intercourse and other behaviors -smoking and alcohol

ŠHelping couples to cope with social and psychological burdens of infertility

ŠHelping couples to consider non-medical options such as adoption

ŠSurgical techniques: Repairing tubal scarring, correcting other abnormalities of reproductive organs

Artificial insemination: Using husband’s or donor’s semen In vitro fertilization techniques: Recovering mature ova, fertilizing them in lab, and then re-implanting in uterus.

Below is an extraction from a journal by SHERMAN J. SILBER, M.D.

INFERTILITY CENTER OF ST. LOUIS

Even Men Who Don’t Make Sperm Can Have Children

In 1985, a young couple, both 22 years of age, from New York, came to see me in St. Louis because he had azoospermia (no sperm in the ejaculate) and needed a testicle biopsy to see whether he had an obstruction that could be corrected with microsurgery. In those days, we always prayed that the biopsy would show normal sperm production, because our success rate with microsurgery to correct obstruction in male infertility was over 95 percent. But we could do nothing at that time for couples if the men weren’t making sperm at all.

His biopsy revealed what we call “maturation arrest.” This means that the early precursors for sperm production were present in the testicle, but there was no continuation of sperm production beyond these early stages. This man was by all definitions 100 percent sterile, and it was my unfortunate job to explain to this otherwise wide-eyed, cheerful young couple (who were looking forward so much to having a family) that they couldn’t have children. But this couple never gave up hope. Ten years later, they came back after they had heard about ICSI. By now we were having exciting success in using ICSI for men with extremely poor sperm counts, and in men with irreparable obstruction requiring retrieval of testicular sperm from a blocked but otherwise normally functioning testicle. But could it possibly work for men who were apparently not making any sperm at all? This determined couple helped us embark upon a new theory with startling consequences.

Even in men with zero sperm in the ejaculate, and apparently no sperm production, if one looked carefully throughout the testicular specimens, an occasional sperm precursor could be found that had the same number of chromosomes and the same basic appearance as a normal sperm. Based on this finding, this couple was our first case of a man who appeared to be making no sperm but in whom we were able to find just a few sperm “hiding” in his testicles. We injected these hidden sperm into his wife’s eggs, and normal fertilization occurred. They had a happy baby girl who is now a healthy young woman who is having her own children now. Another patient treated around the same time had, as a child, undescended testicles that were brought down surgically into the scrotum very late in his childhood. As is often the case with such men, he was clearly producing no sperm. When we operated on his testes to see if any sperm could be found (under the same theory, that any man with a testicle may have some sperm somewhere), indeed we were again able to find just a few sperm. We injected his wife’s eggs with those testicular sperm and again obtained normal fertilization and pregnancy. This young man had been known to be sterile ever since he was a teenager. Yet during extensive exploration of his testicles, we found sufficient sperm to perform ICSI, and he could now have a normal family.

The question that might occur to every such couple is, will my baby be normal? The fear might arise that abnormal sperm in men with low sperm counts will cause a higher risk of producing abnormal babies. We have now studied this in over seven thousand such children born through the ICSI procedure as we per-formed it, and the news is great.  The children are normal, and there is no greater incidence of chromosomal or congenital abnormalities than in the children of normally fertile couples conceiving without any kind of reproductive treatment. There may be occasional exceptions, but they are related to the age of the wife, not the IVF or ICSI treatment. The offspring are more likely to be infertile (like their parents) but are otherwise normal, healthy children.

Poor sperm production represents up to half of the infertility cases in the world, and in the past it prompted couples to undergo billions of dollars’s worth of ineffective, unscientific, and frankly stupid surgical and hormonal treatment. ICSI now solves that problem in most couples, but a genetic cure would still be preferable. Our research, in conjunction with the human genome project, the Howard Hughes Institute at MIT, the University of Amsterdam, and the Kato Clinic in Tokyo, thus far indicates that sperm production in men is controlled genetically by many different genes on the Y chromosome and elsewhere in the genome. We have now completely sequenced the Y chromosome and have located the areas on the Y chromosome where sperm production in these men is regulated, and we have identified many of the genes that control spermatogenesis. This discovery means that in the future we may have a genetic cure for male infertility, i.e., replacing the missing gene (or genes) so that these men will be able to resume normal spermatogenesis, thereby in the future eliminating the need for ICSI.

NOTE: Please seek medical attention or assistance from a qualified medical personnel as we will not be responsible for any outcome of actions taken outside medical line.