Infertility

Understanding Infertility

Reproductive health is not only about preventing unwanted pregnancies or managing diseases — it also includes helping those who wish to have children but cannot. A complete discussion of reproductive health must therefore address infertility, a condition that affects a large number of couples worldwide, including in India.

Infertility is defined as the inability to produce children despite having unprotected sexual intercourse over a period of time. The book's own chapter summary gives the working definition precisely: inability to conceive even after two years of unprotected sexual cohabitation.

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Causes of Infertility

The reasons for infertility are many and varied. They can be grouped into several categories:

• Physical causes — structural problems in the reproductive organs
• Congenital causes — defects present from birth
• Diseases — infections or other medical conditions that affect fertility
• Drugs — certain medications or substances that impair reproductive function
• Immunological causes — the body's immune system attacking its own reproductive cells or tissues
• Psychological causes — stress, anxiety, or other mental health factors

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Diagnosis and Corrective Treatment

Specialised healthcare units, commonly called infertility clinics, can help in two ways:

1. Diagnosis — identifying the specific cause of infertility
2. Corrective treatment — treating the underlying disorder so that the couple can conceive naturally

For many couples, such medical correction is possible and successful. However, when correction is not possible, there are other options.

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Assisted Reproductive Technologies (ART)

When the underlying cause of infertility cannot be corrected through medical treatment, couples can be assisted to have children through special techniques collectively known as Assisted Reproductive Technologies (ART) . The textbook describes several specific ART methods.

1. In Vitro Fertilisation (IVF) — The Test Tube Baby Programme

This is the most well-known ART method. The term "in vitro" means "in glass" — fertilisation occurs outside the body in a laboratory dish, under conditions that closely mimic those inside the body.

The process:

• Ova (eggs) are collected from the wife or a donor female
• Sperms are collected from the husband or a donor male
• The ova and sperms are placed together in the laboratory to form a zygote (fertilised egg)
• The zygote or early embryo is then transferred into the female's reproductive tract

Two types of embryo transfer:

2. GIFT — Gamete Intra Fallopian Transfer

In this method, an ovum (egg) is collected from a donor female and transferred into the fallopian tube of another female who cannot produce her own eggs but can provide a suitable environment for fertilisation and further development. The sperm from the male partner is also placed in the fallopian tube, so fertilisation occurs naturally inside the recipient's body.

3. ICSI — Intra Cytoplasmic Sperm Injection

This is a specialised laboratory procedure used when there are severe problems with sperm quality or quantity. A single sperm is directly injected into the ovum using a fine needle, forming an embryo in the laboratory. The embryo is then transferred into the female's uterus.

4. Artificial Insemination (AI)

This technique is used when:

• The male partner is unable to inseminate the female naturally
• The male has very low sperm counts in his ejaculate

The process:

• Semen is collected either from the husband or from a healthy donor
• The semen is artificially introduced into the female's reproductive tract

Two types of artificial insemination:

• Intravaginal insemination — semen is placed into the vagina
• IUI — Intra Uterine Insemination — semen is placed directly into the uterus …