Is Infertility Really an Epidemic?

An Epidemic is referred to a sudden increase in the number of cases of a disease and Infertility is the inability of a couple to conceive despite regular intercourse (without using contraceptives) for a year or more. Infertility is a serious health issue , affecting approximately 8%–10% of couples worldwide. According to World Health Organization (WHO), one in four couples in developing countries like India is affected by infertility. And this number is on rising trend, thousands of couples add into it annually, contributing to the Infertility Epidemic.

Common reasons of Infertility Epidemic

o Age : One of the important reason for increasing cases of infertility in women is her biological clock , as today couples delay the age at which they try to conceive either because of late marriages or late planning. For women in their early 20’s, only 1 to 2 percent are infertile. In their late 20’s, 16% of women are infertile, and in their mid- to late 30’s, 25 % are infertile. By age forty, more than half of women experiences infertily, and pregnancy beyond age forty-three is very uncommon. This is because increasing age not only decreases the number of eggs left in ovary (ovarian reserve) but also affects its quality. Age affects both sperm quality and quantity in men.

o Environmental and occupational hazards:Some of industrial chemicals, environmental pollutants and radiation are known to cause infertility. Psychological stress in the workplace have negative effect on fertility.

o Mental health : Patients experiencing stress and depression due to home and work environment are very common these days. It affects both male and female fertility in negative sense.

o Lifestyle issues: nowadays lifestyle is moving from active to sedentary lifestyle. Lack of exercise leads to obesity, which contributes to infertility epidemic.It increases menstrual irregularity, anovulation in females.It also decreases sperm count in males.

o Being underweight: Today when zero figure is in trend some women practice extreme dieting and take very low-calorie or restrictive diet. Malnutrition leads to infertility. Women with eating disorders, such as anorexia or bulimia, are also at risk of infertility.

o Tobacco use : Smokers are at increased risk of erectile dysfunction and a low sperm count. Smoking in females is also associated with infertility and abortions leading to secondary infertility.

o Alcohol use:Alcohol addiction can decrease sperm count and motility. Consumption of alcohol and tobacco is in on rising trend in both urban and rural scenario, hence contributing to infertility epidemic.

o Hormonal disturbances like Polycycstic ovarian disease(PCOD): It is a hormonal disorder in which woman has number of small cysts in the ovaries. These cyst inhibits egg production and menstrual irregularities are seen. Number of such patients are increasing day by day. Today it found in 10 per 100 women worldwide.Other hormonal disorders like hypothyroidism, hyperprolactinemia also affects ovulation.

o Fallopian tube damage or blockage is caused by inflammation of the tube : This can result from pelvic inflammatory disease (PID), which is mostly caused by a sexually transmitted infection, endometriosis or adhesions.Sexually transmitted infection, are infections spread from person to person through unprotected sex, is increasing due to multiple partners, Misuse of alcohol or recreational drugs, causing tubal block leading to infertility

o Endometriosis: It is a condition in which endometrial tissue grows outside the uterus, it has a negative effect on the function of the ovaries, uterus and tubes. Women affected by endometriosis is increasing in modern world ,adding to the infertility epidemic.

How to control

A public health strategy focusing on primary prevention (e.g., through removal /minimizing the risk factors for infertility as mentioned above) would reduce the chance of infertility, will also improve health and quality of life.eg:- Chlamydia screening in women, cessation of cigarette smoking , and promoting physical activity and a healthy diet .

Counselling and awareness programs like importance of biological clock for women should be actively conducted. People should be also made aware of the treatment optionswhich are available like Intrauterine insemination (IUI), assisted reproductive technology (ART) which includes IVF(invitri fertilization), ICSI (Intracytoplasmic sperm injection)and freezing of eggs, sperms , embryos.

As primary prevention is important but infertility diagnosis and treatment are also important to public health in their own merit. Early diagnosis and treatment of underlying medical conditions like PCOD, hypothyroidism,diabetes may lead to effective restoration of fertility. Many treatment options such as ovarian stimulation followed by natural conception ,IUI , ART can be used to fight against this Infertility Epidemic.