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Some Qs people asked me on science and my replies to them -Part 140 - Infertility

Q: Dr. Krishna, what is infertility and what causes it?

Krishna: Infertility is defined as not being able to get pregnant despite having frequent, unprotected sex for at least a year or more. 

For women, apart from the above reason, if they have irregular and painful periods, had multiple miscarriages, have been diagnosed with endometriosis or pelvic inflammatory disease or have undergone treatment for cancer, they should consult a doctor to have children.

If you are a man, you should see a doctor if you  have a low sperm count or other problems with sperm,  have a history of testicular, prostate or sexual problems,  undergone treatment for cancer,  have testicles that are small in size or swelling in the scrotum known as a varicocele,  have others in your family with infertility problems. 

In our societies it is common to blame the woman all the time. But only in about one-third of cases, there is an issue with the female. In about one-third of cases, there will be a problem with the male, and in the remaining cases, there are issues with both the male and female, or no cause can be identified.

Causes for male infertility ....

  • Abnormal sperm production or function due to undescended testicles, genetic defects, health problems such as diabetes or infections such as chlamydia, gonorrhea, mumps or HIV. Enlarged veins in the testes (varicocele) can also affect the quality of sperm. Low sperm count: The man ejaculates a low number of sperm. A sperm count of under 15 million is considered low. Around one third of couples have difficulty conceiving due to a low sperm count. Low sperm mobility (motility): The sperm cannot "swim" as well as they should to reach the egg. Abnormal sperm: The sperm may have an unusual shape, making it harder to move and fertilize an egg.
  • Problems with the delivery of sperm due to sexual problems, such as premature ejaculation; certain genetic diseases, such as cystic fibrosis; structural problems, such as a blockage in the testicle; or damage or injury to the reproductive organs.
  • Overexposure to certain environmental factors, such as pesticides and other chemicals in plastics etc., and radiation. Cigarette smoking, alcohol, marijuana or taking certain medications, such as select antibiotics, antihypertensives, anabolic steroids or others, can also affect fertility. Frequent exposure to heat, such as in saunas or hot tubs, can raise the core body temperature and may affect sperm production.

Recently it was found that men who take steroids for muscle growth and sex-appeal, will actually face low testosterone levels in their testes, affecting their fertility.

  • Damage related to cancer and its treatment, including radiation or chemotherapy. Treatment for cancer can impair sperm production, sometimes severely.

Causes for female infertility ...

  • Ovulation disorders, which affect the release of eggs from the ovaries. These include hormonal disorders such as polycystic ovary syndrome. Hyperprolactinemia, a condition in which you have too much prolactin — the hormone that stimulates breast milk production — may also interfere with ovulation. Either too much thyroid hormone (hyperthyroidism) or too little (hypothyroidism) can affect the menstrual cycle or cause infertility. Other underlying causes may include excessive exercise, eating disorders, injury or tumors.
  • Uterine or cervical abnormalities, including abnormalities with the opening of the cervix, polyps in the uterus or the shape of the uterus. Noncancerous (benign) tumors in the uterine wall (uterine fibroids) may rarely cause infertility by blocking the fallopian tubes. More often, fibroids interfere with implantation of the fertilized egg.
  • Fallopian tube damage or blockage, often caused by inflammation of the fallopian tube (salpingitis). This can result from pelvic inflammatory disease, which is usually caused by a sexually transmitted infection, endometriosis or adhesions.
  • Endometriosis, which occurs when endometrial tissue grows outside of the uterus, may affect the function of the ovaries, uterus and fallopian tubes.
  • Primary ovarian insufficiency (early menopause), when the ovaries stop working and menstruation ends before age 40. Although the cause is often unknown, certain factors are associated with early menopause, including immune system diseases, certain genetic conditions such as Turner syndrome or carriers of Fragile X syndrome, radiation or chemotherapy treatment, and smoking.
  • Pelvic adhesions, bands of scar tissue that bind organs after pelvic infection, appendicitis, or abdominal or pelvic surgery.

Other causes in women include:

  • Cancer and its treatment. Certain cancers — particularly female reproductive cancers — often severely impair female fertility. Both radiation and chemotherapy may affect fertility.
  • Other conditions. Medical conditions associated with delayed puberty or the absence of menstruation (amenorrhea), such as celiac disease, poorly controlled diabetes and some autoimmune diseases such as lupus, can affect a woman's fertility. Genetic abnormalities also can make conception and pregnancy less likely.

There are some other risk factors too ...

Age - A woman's fertility gradually declines with age, especially in her mid-30s, and it drops rapidly after age 37. Infertility in older women may be due to the number and quality of eggs, or to health problems that affect fertility. Men over age 40 may be less fertile than younger men are and may have higher rates of certain medical conditions in offspring, such as psychiatric disorders or certain cancers.

Tobacco, drugs and alcohol use - Smoking tobacco or marijuana by either partner reduces the likelihood of pregnancy. Smoking also reduces the possible benefit of fertility treatment. Miscarriages are more frequent in women who smoke. Smoking can increase the risk of erectile dysfunction and a low sperm count in men. Alcohol use increases the risk of birth defects, and may contribute to infertility. For men, heavy alcohol use can decrease sperm count and motility.

Being overweight and underweight -  an inactive lifestyle and being overweight may increase the risk of infertility. A man's sperm count may also be affected if he is overweight. Women at risk of fertility problems include those with eating disorders, such as anorexia or bulimia, and women who follow a very low calorie or restrictive diet.

Exercise - Insufficient exercise contributes to obesity, which increases the risk of infertility. Less often, ovulation problems may be associated with frequent strenuous, intense exercise in women who are not overweight.

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