Infertility is defined as the inability to conceive despite having frequent, unprotected sex for at least a year for most couples. Infertility may result from an issue with either partner or a combination of factors that prevent pregnancy.
What is the ratio of infertility worldwide?
The World Health Organization (WHO) estimates that approximately 8-10% of couples experience some form of infertility problems. On a global scale, this means that 50-80 million people suffer from infertility. However, the incidence of infertility may vary from region to region.
Is fertility exclusively a female problem?
No. The incidence of infertility in men and women is almost identical. Infertility is exclusively a female problem in 30-40% of cases and exclusively a male problem in 30-40% of cases. Problems common to both partners are diagnosed in 10-15% of infertile couples. After thorough medical investigations, the causes of infertility remain unexplained in only a minority of cases (5-10%). This is known as unexplained infertility.
What are the most common causes of infertility?
The most common causes of female infertility are ovulatory disorders and anatomical abnormalities, such as damaged fallopian tubes. Less frequent causes include endometriosis, hyperprolactinemia, and thyroid-related problems. In developing countries like India, infections of the womb, such as gonorrhea, chlamydia, and tuberculosis, significantly contribute to infertility.
Causes of male infertility can be divided into 3 main categories:
1. Sperm production disorders affecting the quality and/or quantity of sperm.
2. Anatomical obstructions preventing the transport of sperm.
3. Other factors, such as immunological disorders.
Approximately one-third of all cases of male infertility can be attributed to immune or endocrine problems, as well as the failure of the testes to respond to hormonal stimulation that triggers sperm production. However, in many cases of male infertility caused by inadequate spermatogenesis (sperm production) or sperm defects, the origin of the problem remains unexplained.
Ectopic Pregnancy:
When a pregnancy occurs outside the uterus, it is called an Extrauterine Pregnancy (EUG) or ectopic pregnancy. The most common site for an EUG is the fallopian tube, but sometimes it can occur in the cervix, ovary, or abdomen. EUG is a rare condition, occurring in approximately 1% of all pregnancies. The risk increases with in vitro fertilization (IVF) treatment.
Risk factors for EUG include:
• A history of infection in the fallopian tubes (salpingitis).
• Chlamydia infection.
• Pelvic Inflammatory Disease (PID).
• Genital tuberculosis.
• Previous ectopic pregnancy.
• Surgery on the fallopian tubes or lower abdomen.
• Endometriosis.
• Appendicitis.
The symptoms of an ectopic pregnancy are often similar to those of a miscarriage and may include a positive pregnancy test with or without vaginal bleeding and abdominal pain. Although not common, EUG should be considered in patients with these symptoms, especially if they have one or more risk factors.
Diagnosis is made through a combination of:
• A detailed medical history.
• Physical examination.
• Vaginal ultrasound.
• Laboratory tests, especially serum beta-hCG (BHCG) levels.
Treatment options:
Depending on the size and location of the ectopic pregnancy, different treatments can be used:
1. Surgical removal – Most ectopic pregnancies can be removed laparoscopically without opening the abdomen.
2. Medical treatment – In some cases, Methotrexate injections may be used.
3. Expectant management – If the pregnancy is very small and the patient can be closely monitored, a "wait and watch" approach may be recommended.
4. Direct drug injection – Under transvaginal ultrasound guidance, medication can be injected directly into the ectopic pregnancy using a thin needle.
Seeking Support & Counseling
Infertility can be a stressful journey. Support groups, therapy, and open communication with your partner can help manage emotional challenges. Remember, you are not alone—Care & Cure professionals and fertility specialists are here to guide you toward your parenting dreams.
