Female infertility | Rise of Kashmir
posted on March 01, 2022 | Author Dr. Rifat Ara,
Infertility affects millions of people of reproductive age around the world. It impacts families and communities. Every human being has the right to enjoy the highest attainable standard of physical and mental health. Individuals and couples have the right to decide the number, timing and spacing of their children.
Infertility can deny the realization of these essential human rights. The fight against infertility is therefore an important element in the realization of the right of an individual or a couple to found a family.
Addressing infertility can also alleviate gender inequality, although both men and women experience infertility. Women are often perceived as suffering from infertility, whether they are infertile or not.
Infertility has significant negative social impacts on the lives of infertile couples, especially women, who frequently experience violence, divorce, social stigma, emotional stress, depression, anxiety, and low self esteem.
Infertility is defined as the inability to get pregnant after a year or more of unprotected sex. Fertility in women is known to decline steadily with age, so women over the age of 35 are assessed after 6 months of unprotected sex.
According to the studies carried out by the WHO, the distribution by sex and the etiology of infertility show that 37% of women, 35% of men and women and 8% of men are infertile.
Infertility is of two types: primary and secondary.
1) Primary infertility is when pregnancy was never achieved.
2) Secondary infertility is when at least one previous pregnancy has been achieved.
VScauses of male infertility
• Problems with ejaculation of sperm, either a lack of sperm or a low level of sperm.
• Abnormal sperm shape and movement. This could be due to hormonal disturbances produced by the hypothalamus and pituitary, testicular hormones like testosterone, which regulate sperm production.
• Testicular failure to produce sperm due to spider veins, chemotherapy, undescended testicles at birth, etc.
• Environmental and lifestyle factors, such as smoking, heavy drinking and obesity, can also affect fertility.
VScauses of female infertility
• Tubal disorders such as blocked tubes – caused by STDs, unsafe complicated abortions, postpartum sepsis, pelvic surgeries.
• Uterine disorders: inflammation, congenital malformations, benign tumours, pelvic infections.
• Ovarian causes: failed ovulation, PCOS, follicular disorder, endometriosis.
• Causes of the endocrine system: imbalance of reproductive hormones, hypopituitarism, hypothyroidism, hyperthyroidism.
• Unexplained causes: Those with no known or diagnosed problem in husband or wife.
When a couple contacts a doctor for infertility issues, the doctor collects health and sexual history from both partners.
As a rule, this can uncover the problem of infertility. Most of the time, a semen analysis is done, which shows the number, shape and movement of sperm. Sometimes men’s hormone levels are also tested.
In women, the first step is to know if they are ovulating every month. A history is taken and some blood tests are done. An ultrasound of the ovaries is done to see the ovarian follicles.
For tubal factors, different methods are available. HSG, x-ray of uterus and fallopian tubes is taken after injection of dye into uterus.
It shows a physical blockade which can cause infertility. A laparoscopy is performed to check the ovaries, fallopian tubes, and uterus for endometriosis, scarring, etc.
Infertility can be treated with medication, surgery, artificial insemination, or assisted reproductive technology (ART).
In most cases, infertility is treated with medicine or surgery. Specific treatments are based on test results, couple’s duration of infertility, health of partners, partner preference.
The availability, access and quality of interventions to combat infertility remain a challenge in most countries of the world.
The diagnosis and treatment of infertility are often not a priority in national population and development policies. The level of qualified staff and necessary equipment and infrastructure, the high cost of treatments and drugs are major pressures to be faced among infertile people.
Assisted reproductive technologies (ART) have been available for over three decades. These technologies are still unavailable, inaccessible and unaffordable for many couples, especially for low and middle income groups.
The World Health Organization (WHO) recognizes that the provision of high quality family planning services, including fertility care services, is one of the essential elements of reproductive health. Recognizing the importance and impact of infertility on people’s quality of life and well-being, WHO is committed to addressing infertility and fertility care by:
· Collaborate with partners to conduct global epidemiological and etiological research on infertility.
· Engage and facilitate policy dialogue with countries around the world to frame infertility within a supportive legal and policy environment.
· Support the generation of data on the burden of infertility to inform resource allocation and service delivery.
· Develop guidelines on the prevention, diagnosis and treatment of male and female infertility, within the framework of global norms and standards of quality care related to fertility care.
· Continually revise and update other normative products, including the WHO Laboratory Manual for the Examination and Processing of Human Semen.
· Collaborate with relevant stakeholders including academic centers, ministries of health, other UN organizations, non-state actors (NSAs) and other partners to build political commitment, readiness and capacity health system to provide fertility care worldwide.
· Provide technical support at the national level to Member States to develop or strengthen the implementation of national fertility policies and services.
Dr. Rifat Ara,
teacher and chef
Pg Department of Gynecology and Obstetrics,
SKIMS Medical College, Bemina.