It’s time for infertility to come out of the closet

The official definition of infertility: An inability to get or stay pregnant after some time of trying if you are under 35. Twelve percent of reproductive age American women- about 7.3 million are having trouble conceiving up from about 9 percent in 1988 according to centers for disease control and prevention.

Infertility has been considered by the World Health Organisation (WHO) as a public health problem. It is expected that accessibility to infertility treatment and assisted reproduction will be considered one of the greatest challenges of the millennium. The number of cases of infertility is increasing and there are multiple causes for this; they may or may not be associated to anomalies of the male or female reproductive system. Screening should take place in various stages and both male and female should be screened simultaneously. In approximately 30% of cases both partners contribute to the problem.

It is, therefore, important to organise services, techniques and methods in order to improve reproductive health, therefore satisfying the needs of couples throughout their life cycle.

Infertility can be devastating and its time we openly acknowledged that. Going by the statistics, by age 40, a woman has only 5 percent chance of conceiving during each cycle. ‘Regardless of how well you take care of yourself, ovaries age at a constant rate, and there’s nothing you can do to halt it.’ Even by 45, the chance of having a child with your own eggs is 1 percent. But the worst part is our society is not more open about infertility. Everyone has right to privacy, of course, but that secrecy has left so many women to cope alone ,in pain and often uninformed. Recent studies revealed that “When women dealing with infertility can communicate with others in their situation they get through it in a much better state of mind”. It’s not easy to get pregnant and there is no shame in that. Most of the fertility specialists confirmed that couples often conceal their fertility problems. Some couples hid their infertility from family and friends. Nearly half didn’t even tell their mothers. Many women dread hearing what family and friends might say. The sense of being defective can be even stronger among women of “advanced maternal age”- those of 35. Some of them even wonder whether it was even worth it to public with the news of your infertility. Even knowing that you are different in some symbolic reproductive way make you feel very alone. It can also raise issues of shame, since you may believe if you are not successful in reaching your goal of parenthood. Or you may want to share your situation with others but your partner isn’t ready for either of you to go public. It may make you question what is wrong with you. Hiding your infertility from others puts you and your partner in unique role of being each other’s sole emotional support. In short, staying private with your infertility can make you feel lonely and solitary, even as it enables you to have some control in figuring out your own issues without unwelcome intrusions by the others.

Factors contributing fertility

In this era, people are more career conscious and are waiting longer to start families and the older you are, the more likely it is that you’ll have infertility issues like early menopause (when menstrual periods stop permanently) or  a risk of miscarriage. Studies  revealed that some 7 to 10 percent of men are infertile, in about 20 percent of situations, both partners have problems. And the other 10 to 20 percent of infertility is “unexplained ,as there is no medical answer that why you are not pregnant.

Some of the explained causes of infertility are
▪ Later pregnancies (more women decide to start a family after the age of 35).
▪ Increase in the prevalence of sexually transmitted infections
▪ Medication
▪ Physical inactivity
▪ Obesity
▪ Consumption of tobacco/alcohol/drugs
▪ Pollution

The male is responsible for over 50% of cases of marital infertility; of these at least a third are exclusively the responsibility of the male and in the same proportion the responsibility is both male and female. Bearing these results in mind, in addition to a marital anamnesis, it is imperative that the first approach to a couple’s reproductive difficulties should be a sperm analysis.

Male infertility is basically due to two factors: sperm alterations (low sperm count) and impossibility in engaging in the sexual act (erectile impotence or absence of ejaculation).

As far as female infertility is concerned, the main factor responsible seems to be the delay in deciding to fall pregnant, which may cause ovarian dysfunction, compromising the quality and quantity of ovules produced. However, there are other physiological changes and alterations that may be equally and significantly responsible for this dysfunction in women; alterations of the fallopian tubes, uterus and uterine cavity.

Infertility treatment known as medically assisted procreation varies according to the primary cause of the problem. However, the first approach is intrauterine insemination, where sperm is deposited in the uterine cavity. The success rate is approximately 20%.

The following step is in vitro insemination. This procedure has a success rate of approximately 50%. This process passes through several sequential steps: ovarian stimulation; collection of ovules and sperm; fertilisation of the ovules; fertility assessment; culture of the embryos and, lastly, transfer or freezing of the embryos.

Presently, technology in this area is highly differentiated, permitting sequential observation of embryos almost on a permanent basis, while at the same time providing monitoring of various parameters, ensuring safety in the results obtained.

Additionally, it is also possible to diagnose genetic and chromosomal alteration of the embryo, before it is implanted in the female womb. Genetic screening is normally carried out when: abortion is recurrent; when the woman is over 38 years; repeated implant failure; severe problem in the male; karyotype alterations; monogenic diseases (e.g. sickle cell disease, spinal muscular atrophy).