Dr Anagha Karkhanis Answers Questions About Fertility You Always Wanted to Ask

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Infertility

Many couples struggle to fulfill their dream of having a baby while many get pregnant even when they do not want to. There are many things about fertility that people should know if they are planning to get pregnant. Infertility is not just a women’s issue as men can also face the problem of infertility. Many factors contribute to infertility in men and women. Some of these factors cannot be controlled but you can control others by changing your lifestyle. Here are some frequently asked questions about fertility, answered by Dr Anagha Karkhanis, IVF Specialist and Director, Cocoon Fertility.

1. How common is infertility among men and women?

Infertility is a widespread problem. The overall prevalence of primary infertility is estimated to be nearly 10-15% of married couples in India. That means 27.5 million couples who are actively seeking children suffer from infertility. While female factor accounts for 40-50%, infertility attributable to male factors is on the rise and constitutes 30-40% of infertility.

2. What is the most common cause of infertility in women?

Most common cause of female infertility is PCOS (polycystic ovarian syndrome). PCOS is a hormone imbalance problem which can interfere with normal ovulation. When ovulation is affected, there are no eggs to be fertilized.

3. How does your lifestyle affect your fertility?

Lifestyle choices have a direct impact on your fertility potential. Weight can affect your chances of becoming pregnant. This holds true for being both under- and overweight.

Also, it’s worth noting that it is not just the woman’s weight that impacts fertility, but research suggests that low sperm count and motility issues also occur more commonly in men who are overweight.

Women who smoke and consume alcohol are less likely to conceive than non-smokers and non-drinkers.  Smoking and alcohol impair sperm parameters too.

Although it is unclear why stress affects fertility, evidence suggests that by reducing your stress levels you can increase your chances of conceiving.

While those using different forms of contraception, get their fertility back almost instantly after coming off the contraception, however valuable years of possible conception may be lost if women use contraceptives for prolonged periods of time. As the age advances, the number and quality of eggs deplete and hence fertility drops.

PCOS is the commonest cause of infertility in women, which affects ovulation. PCOS is worsened by lifestyle choices like irregular and unhealthy food habits, lack of physical activity, smoking and alcohol consumption.

4. Is it possible to treat PCOS by only working out and reducing your weight?

Although there’s no absolute cure for PCOS, it is possible to control its symptoms with some lifestyle changes. Losing as little as 5% excess weight can help women ovulate more regularly and control their menstrual irregularities. Weight reduction along with healthy dietary habits is recommended for treatment of PCOS.

5. What causes infertility in men?

Infertility in men is often caused by various medical conditions. One such condition is known as varicocele in which the veins on a man’s testicles are enlarged, which causes heating up of the testicles, affecting the number or shape of the sperm.

Sometimes the tubes (vas) carrying the sperm outside the body may be blocked, allowing no sperm to reach the egg.

Sometimes a man is born with the problems that affect his sperm. Some issues start later in life due to illness or injury. For example, mumps and cystic fibrosis often cause infertility in men.

Other lifestyle factors like heavy alcohol use, drug, smoking, environmental pollution and toxins, including pesticides, radiation and chemotherapy for cancer can damage the sperm.

6. Can a medical condition affect fertility in women?

PCOS is the most common cause of infertility in women. There are some less common causes of fertility issues in women like a pelvic inflammatory disease which is caused due to infection of the female reproductive tract and causes a tubal blockage. Endometriosis or previous ectopic pregnancy and its surgery can also lead to blocked tubes. Tuberculosis can also affect the reproductive tract in a similar way. Physical problems in the uterus like fibroids and polyps can affect implantation of the embryo.

7. What are the methods used to determine a man’s or a woman’s fertility?

In men, we begin by testing the semen. Semen analysis helps us check the number, shape and motility of the sperm.

In women, the first step is to find out if she is ovulating each month. Ultrasound for follicular tracking and some hormonal blood tests are done to document ovulation. At the same time, the lining of the womb is tracked to monitor its growth to facilitate implantation. The patency of fallopian tubes is checked by Hysterosalpingography, Sonosalpingography or Laparoscopy. It involves passing a fluid through the uterus and documenting its flow out of the tubes. These 4 parameters form the basis of primary fertility evaluation.

8. What are the treatments to improve fertility in men and women?

Infertility in men and women can be treated with medicines like micronutrients, vitamins and amino acids and other hormonal preparations to improve sperm and egg quality.

Specific treatments are recommended based on various test results, the duration of fertility issue, age, health and preference of the partners. Some hormonal tablets and injections are used to induce ovulation in women with ovulatory problems.

Sometimes surgical correction may be needed in the form of removing polyps or fibroids from the womb to improve the chances of implantation.

Further advanced treatments are be offered which include “Artificial Insemination (AI)/ Intra Uterine Insemination (IUI)”, where specially washed and prepared sperm is injected into the womb and “Assisted Reproductive Techniques(ART)/ In Vitro Fertilization (IVF)” where the eggs and sperm are united outside the body and then the resulting embryo is transferred into the womb for implantation to occur.

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