Male Infertility on the rise in Cities and rural areas?

Male Infertility

  • Infertility is defined as the inability of a couple to achieve conception after a year of unprotected intercourse, 6 months if the woman is over 35
  •  Most couples assume that once they stop using birth control pills, pregnancy will happen right away.
  • There has been a 20-30% rise in cases of infertility both in men and women in the last five years in India according to Manipal Ankur experts.
  • Most common problems men face are low sperm count, morphology abnormalities and low motility of sperm
  • Earlier, male infertility cases were only limited to cities but now more cases are being reported in rural areas. The situation is so bad, said one doctor, that “we conduct tests first on the men before their wives are tested”.
  • The alarming increase in infertility is blamed on lifestyle changes resulting in stress and obesity caused by lack of physical exercise, changes in eating habits and pollution accompanied by medical disorders like diabetes.
  • “Improvements in lifestyle and diet can help childless men. A good fruit and vegetable diet, moderate physical exercise, decreasing stress levels, yoga and giving up smoking can improve the DNA of sperm and help these men in fathering a child later as the production of free radicals is reduced.
  • “Obesity itself may not cause infertility, but the complications arising out of it like hormonal complications, ovulation issues in women (insulin resistance, women with polycystic ovaries have irregular periods and even sexual compatibility issues) and deterioration in sperm quality in men are serious fertility issues as per a study was done by Dr. Bina Vasan.

How much increase in the problem over the last 2 decades?

  • Analyzing the 2011 Census data, the Population Research Centre of the Bangalore-based Institute for Social and Economic Change found that many southern districts, a significant number of them in Karnataka, have recorded fertility rates lower than the national average.
  • A recent health survey revealed some startling facts — a whopping 46% of Indians, between the ages of 31 and 40, require medical intervention to conceive as one or both partners suffer from fertility problems.
  • While polycystic ovarian disorder was the main reason in women, poor sperm count topped the list in men.
  • MARS conducted a study, in 382 couples from different backgrounds of Bangalore rural region to study the infertility rate. Among them, 272 men (>60%) failed to pass the fertility test. The test was carried out according to the standards fixed by the World Health Organization.

Factors affecting fertility 

  1. Male Infertility:

Male infertility may be caused by a number of factors, including

  1. Problems with sperm production
  2. Obstruction of the sperm delivery system
  3. Problems relating to hormone production
  4. Antibodies against sperm, injury to the testicle
  5. Anatomical problems or the presence of a varicose vein around the testicle
  6. A testicular injury that results in damage to sperm-producing structures
  7. The presence of other diseases, such as diabetes mellitus, central nervous system problems, and pituitary tumors
  8. Hormonal imbalances can also result in infertility

All these factors may affect sperm quality and quantity. Past illnesses, infections, various diseases, and medications can also cause infertility in men.

  1. Female infertility:

Female infertility can be caused by a number of factor including

  1. Endometriosis- This condition results when tissue that normally lines the inside of the uterus travels back through the fallopian tubes into the pelvic cavity and adheres to the outside of the uterus and/or ovaries causing infertility in women.
  2. Luteal phase deficiency, which causes when the ovaries release an egg each month but do not produce enough of the hormone progesterone. Progesterone is responsible for maintaining the lining of the uterus. If progesterone production is insufficient, a fertilized egg will be unable to implant in the uterine wall.
  3. Tubal block. The fallopian tube may be blocked due to various reason, the most common being previous infections ( pelvic inflammatory disease) or previous ectopic pregnancy
  4. Irregular periods – the most common cause of irregular periods is polycystic ovarian syndrome (PCOS). Periods are generally either irregular or absent altogether. However, it is important to note that not all women with polycystic ovaries experience difficulty in conception
  5. Ovarian failure is the absence of follicles and eggs. It is also the cessation of the production of the female sex hormones, estrogen, and progesterone, which are necessary for menstruation and maintaining pregnancy. In some women, there is an acceleration of this process, with egg depletion occurring before age 40. This is called premature menopause or premature ovarian failure.
  1. Egg Quality:

As a woman ages, the quality of her eggs also deteriorates. Eggs from older women do not fertilize as well as those of younger women and are less likely to survive when they do fertilize. Also, because eggs are one of the longest living cells in the body (surviving from birth to the start of menopause), there is an increased risk of abnormal eggs later in life.

  1. Egg and sperm union

Infertility is sometimes caused by factors in either the man or the woman that make it difficult for the sperm and egg to come together. When such circumstances exist it becomes difficult to conceive. This is also caused when sex happens less frequently in marital life. This reduces the likelihood of sperm contact with the egg at the optimal point in a woman’s menstrual cycle. Blocked or damaged fallopian tubes may impact fertility by interfering with the egg and sperm uniting or with proper embryo development and implantation in the uterus thereby causing infertility.

  1. Age factor:
  • Age is not an absolute barrier to pregnancy. However, the ability of a woman conceive does decrease with age. This decline in reproductive function is basically due to a decline in the number of eggs remaining in a woman’s ovaries or a woman’s capacity to reproduce eggs.
  • Maximum fertility for women occurs between the ages of 15 and 24.
  • Many women delay starting a family until they are in their 30’s or 40’s. About one-third of women who defer pregnancy until their mid 30’s will have a problem becoming pregnant and at least half of women over age 40 will have problems conceiving.
  • Because fertility levels decrease and the likelihood of conceiving declines, women over age 35 should wait no more than 6 months before seeking help if a fertility problem is suspected.
  • Age also affects a man’s reproductive potential-The major factors contributing to an age-related decline in fertility are the quality of the ejaculate and the frequency of intercourse.
  • For some men, advancing age is associated with declining testosterone levels, decreased sexual interest and reduced sexual activity. The decreasing frequency of ejaculation adversely affects the ease of conception.
  • Sperm production and sperm motility can also decline with age.
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