Understanding Infertility: Causes, Emotional Impact, and Treatment
Infertility is defined as the inability of a couple to achieve conception after one year of unprotected coitus. 10 to 15% of marriages prove to be childless. More couples are seeking fertility treatment early due to changes in the social scenario - the age of marriage of women is increasing and postponing pregnancy due to studies and careers. Lifestyle changes in both men and women give rise to infertility problems. In men because of the widespread increase in social habits of smoking and drinking. Similarly, infertility in women can also be attributed to lifestyle changes, including increased consumption of junk food and decreased physical activity, leading to issues such as polycystic ovaries, irregular periods, and ovulation problems.
1) Decrease in sperm count and motility
2) Straining of Interpersonal relationships and sexual activity.
Infertility in women is more common, because of increased intake of junk food and decreased physical activity, and childhood obesity is on the rise. This gives rise to Polycystic Ovaries / Irregular periods and Ovulation problems.
Because of the increase in promiscuity and increased sexually transmitted diseases, tubal block is more common.
Though infertility is a medical problem it has many strings attached to it. In fact in all cultures infertility (involuntary childlessness) is recognized as crises that have the potential to threaten the stability of individuals, relationships, and communities.
The problem of infertility can be compared to the tip of the iceberg.
The emotional trauma and suffering of infertility is compared to that of Aids and Cancer. This is due to the war between society and self-esteem.
In these days, the role that husbands play throughout pregnancy is becoming more and more important. When their spouses are having mental or physical problems, they are reassuring their presence. When the parents talk to the one growing inside the womb, a unique link forms, and the experience of being pregnant is enhanced and made more fulfilling. Pregnancy has many benefits, despite the possibility of physical discomfort, hormonal changes, and societal demands for the expectant mother. Eating a balanced diet rich in nutrients and ensuring the baby grows and develops normally are critical for both mother and fetal health.
What is unique about the pain of infertility?
The problem of infertility itself has two unique characteristics which are no other medical condition or disease.
1) This is an open secret, unlike diseases like BP, Sugar where others come to know only when we reveal it. Here when we go out to a function or in the workplace others will know about it. This makes the infertile couple embarrassed to freely mingle with known people.
2) Another important aspect is society's involvement in this problem. Society ill-treats such couples most of the time so there is a cold war going on between self-esteem and society. So the pain of infertility is unbearable. Infertility, including infertility in women, often leads to societal mistreatment and stigma, creating a constant battle between self-esteem and societal norms. Consequently, the pain of infertility becomes particularly unbearable.
Apart from correcting physical and functional conditions only when emotional balance is restored does the function of conception occur.
PHYSICAL FACTORS
For a basic understanding of the female reproductive system let us know this. The uterus has two tubes (fallopian tubes) arising from it at the end of the tube in fimbriated (delicate finger-like ends to catch the ovum/egg) near the fimbrial end on each side there is an ovary that contains eggs.
The function of Menstruation and Conception:
Every month usually 1 egg (occasionally more develops and gets released (ruptured) the fimbrial end of the tube picks it up so after intercourse the sperms enter the uterus fimbria through its opening (cervix) the sperms swim across the uterus passes through the tubes and reaches the egg and unite with it to form the embryo. The fertilized embryo journeys through the tube and enters the uterus and gets implanted in it. This coordinated action (executive function) of the uterus tube and ovary occurs under the control of the Hypothalamus – pituitary - ovarian axis (controlling function). The premenstrual and menstrual symptoms reflect the status of executive function. Emotions and beliefs influence the HPO axis.
The basic tests done to identify the physical problems are
1) FOLLICULAR STUDY
2) HYSTERO SALPINGIO GRAPHY (H.S.G)
3) HORMONE ANALYSIS
4) SEMEN ANALYSIS
FOLLICULAR STUDY:
The follicular study is done from the 11th or 12th day of the cycle daily / alternate days depending on the size of the follicle and follicle grows and ruptures at the optimum size of 20-30 mm if the follicle growth is not adequate drugs will be given to improve ovulation and we will ask them to have intercourse in and around the time follicle rupture.
HYSTERO SALPINIGO GRAPHY (H.S.G)
If one tube is blocked the prospective mother can conceive easily if one ovary or tube is removed for some reason surgically also she can conceive easily. HSG is done on the 5th to 9th day of periods after stopping bleeding. It shows the uterus if any guidance of anomalies of uni / bicornuate /septate / fibroid pressing the endometrial cavity. A tubal outline is seen and the free peritoneal spill indicates the patency of the tubes. There can be corneal/fimbrial block. Corneal block can be cleared by cannulation by fluoroscopy / Hysteroscopy fimbrial block can be tackled in some cases by fimbrioplasty or salpingolysis by laproscopy. If the tube is dilated and filled with fluid is called hydrosalpinx it is due to the late effect of infection. In the case of hydrosalpinx, it prevents conception and the chances of tubal pregnancy are higher. If both tubes are damaged the choice is to go for IVF (Test tube baby). Tubercular tubal disease (Hydrosalpinx / tubo ovarian mass / ascities) is also sometimes seen
5) SEMEN ANALYSIS
If the sperm count is low we have to see the scan for the scrotum if there is any atrophy of the testis we should ask for a history of any viral infection/pumps in the past history. If there is any varicocele which is severe. The person has to undergo varicocelectomy.
If there is any undescended testis it has to be seen by a urologist. We also have to rule out D.M. Semen culture to be done for any infection smoking and alcohol cause a decrease in sperm count and motility. Environmental exposure to pesticides exposure to heat, radiation, and tight undergarments have deleterious effects. Hormone tests also have to be done alone (FSH, LH, T4, TSH, and Prolactin). Low sperm count treated with medicine, diet (sprouts, dry fruits, fresh fruits, plenty of water), and positive support of wife is also necessary.
The problem of low sperm count was difficult to treat and it used to take a long time to improve counts that too in a minority of cases. It was a frustrating problem. I observed in 2 cases after dropping out of treatment for 1 year due to various reasons when they came back the count had substantially increased spontaneously. I wondered whether that could also have an underlying emotional cause.
Once a couple came for treatment the husband's semen count was persistently low varying from 2 to 4 million, motility only 5% constantly. He had been receiving treatment in a city for 4 years and there was no improvement in the count. It never improved beyond 4 million. After seeing the reports I told them frankly I would treat them for a short while, if there was no improvement I would refer them for ICSI (Test tube baby) treatment. They agreed. After 2 weeks of their first visit, they brought the wife who was depressed because she lost her brother in an accident. I referred her to a psychiatrist. After 2 months once again they brought the wife in a similar state. I asked whether the depression didn’t get controlled. He said she was slowly coming out of depression but for the past 10 day she was not eating properly and vomiting. I thought it was better to rule out any brain problem which causes vomiting. So I referred her to a physician and he rang up and told me that she was 10 days overdue for her periods and to get a urine pregnancy test. Then he would investigate. With great reluctance, I did the urine pregnancy test to find it to be positive. I was shocked and couldn’t believe it. After 3 months when the pregnancy was viable and stable, I asked her how she could conceive. She also said it was a surprise to both of them she was only depressed about the demise of her brother and she was slowly coming out of it with the help of drugs. Her husband also was very supportive and caring. They had only one time participated in intercourse. It was more for relaxation because they never thought of pregnancy. Previously when they were trying for pregnancy the truth of low count used to weigh them down and during intercourse they would silently feel it would not be successful because of low count. Then I understood when intercourse was carried out with the aim of pleasure with more thought of pregnancy during and after intercourse, pregnancy occurred as rather a side effect. That means the quality of intercourse is superior in the sense when the couple experience (orgasms) the uterus opening (cervix) sucks the sperm and the tubes move rhythmically which helps in transporting the sperm to the ovum thereby facilitating conception. But whereas when they participate in intercourse the goal is pregnancy the sexual act becomes mechanical and later stressful.
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