Problem of infertility has been present since ancient times. Infertility has been described in medical dictionary, as a condition, when a couple is unable to conceive a pregnancy, after trying to do so for at least one year. It can be of two types – Primary, in which pregnancy has never occurred and secondary, in which the couple could conceive previously but at present, are unable to do so even after a full year of trying. Available data indicates 50 million couples worldwide experience infertility or almost 1 among 4 couples in the developing countries(in some statistical studies, the figures are higher). Of particular concern is the fact, that infertility rate is on the rise. But infertility is not a new problem, it has been present since ages, and mankind has been concerned about the problem, since a very long time & description of this problem has been has been found in tales and stories of different culture with unconventional solutions.
In certain ancient Asian culture, having children (and specially a son) was considered very important ; not just as successor or to take care of parents at an old age, but also to complete rituals needed for peaceful afterlife of people concerned. So if a couple did not have any children and or the husband has died without producing a child, alternative solutions were found, for the women to get pregnant. One of these tradition was Niyoga, in which the woman concerned would request another person(male), who is socially well respected and of good character, to help hear bear a child. The basic principles was that – the arrangement was made, to only have a child and not for passion or lust ; and the child would be considered child of the husband (even if deceased) and the chosen man would not claim any right over the new-born child. This arrangement had social sanctions, as it was believed that, whatever was done, was done for a noble cause.
There are also anecdotes of incidence, where procedures resembling modern Test tube bay were done successfully. Even in Hindu religious epic, Mahabharata, the birth of one of the main characters – Duryodhana and his 100 siblings is supposed to take place from pieces of flesh given birth by his mother, and then divided into pieces and kept in a pots of ghee ( an oily fat compound used for cooking) for two years ; and children coming out of these pots, after a period of two years. Even in Ancient Egyptian mythology – Amun, Sobek, Isis and Bastet are considered gods and goddesses associated with fertility. Mesenet is the goddess of childbirth. The native American Indians also had their own gods of Fertility – Aztec (Tonacatecuhtli, Tonacacihuati), Inca (Mama Ocllo ), Mayan (Goddess I). The Romans also had their goddess of fertility – Bona Dea.
It has been said, that movies often reflect, the reality of our times.The concept of infertility has cropped up often in movies, sometimes as a comedy and sometimes on a serious note. The topic has been touched in Hollywood movies like – Secrets and lies(Drama), Children of men (Science fiction), Raising Arizona(Comedy), The good girl (Romantic Comedy) and Up (Animation). There have been movies in Bollywood like – Parched, Vicky Donor, Filhal, Chori Chori Chupke Chupke ; to name just a few.
Infertility cases are rising in many countries. It is no longer confined to the cities ,but small town and villages are also involved, nor it is just the female population(where blockage of fallopian tube, endometriosis, fibroids and polyps, ovulation disorder and polycystic ovarian syndrome are the most important factor), which is involved ,but men also contribute equally to the problem ;mostly due to low sperm count and low motility. The main cause of rising rate, is because of lifestyle changes and contributing factors are – Smoking and alcohol, stress (affects semen quality), lack of physical exercises and obesity, pollution, increasing incidence of diabetes, change of food habits(increased intake of junk food and nutritional deficiency), increased age of marriage ( & resulting hormonal imbalance), Adulterated Food ( with high oestrogen content causes decreased sperm count in males).
In most cases the couple are examined together and history taken, to find and pin point the cause. In the MALES a hormonal test is done to rule out hormonal imbalance, specially a decreased testosterone level. Semen analysis may be undertaken for sperm count and motility examination. Any presence of STD or defect in reproductive system should be ascertained. Testicular Biopsy may be needed in some cases to identify pathologies contributing to infertility. In the FEMALES also- conditions like Pelvic Inflammatory disease and resultant blockage of tubes, Polycystic Ovary should be excluded and diagnostic examinations like- USG (To confirm Polycystic Ovarian Syndrome and other pathologies ), Hysterosalpingography(to evaluate uterus and fallopian tubes and to check for blockage) and Hormonal assay(to determine ovulating status and impaired hormonal levels) carried out.
There are no measures which can ensure a 100% guarantee from a problem like infertility, but some general guidelines are useful. It is always better to take a healthy balanced diet. Always avoid smoking and alcohol. Be faithful to your partner and avoid STD. Maintain an ideal weight, by exercise and by correct calorie balance.
The exact treatment depends on the cause and treatment will differ from case to case. Some men may benefit from hormonal replacement in case of hormonal deficiency, medications which improves impotency or sperm count & sometimes surgery to correct blockage for sperm transport, or correction of varicocele deformity may be needed. Sperm retrieval is useful, when sperm may be absent in ejaculated fluid or it may serve a purpose in assisted reproductive technique. Some women may find benefit in use of fertility drug, like those who are infertile due to ovulation disorders. Sometimes surgery may be needed; to remove polyps, or in other conditions like endometriosis or for scar tissues in uterus.
1) IVF or invitro fertilisation. It is a type of assisted reproductive technology, which is concerned with extracting multiple mature eggs from the female and fertilizing them with a male’s sperm in an outside environment and implanting the embryos in the uterus 3 to 5 days after fertilization, thereby bypassing the fallopian tubes. Depending on situation modifications can be made like- If there are serious problems with the concerned sperm and eggs, alternate donor sources can be tried.
2) UTERUS TRANSPLANT – This very rare surgery, is a newly invented surgery reserved for those women, who are not born with a functional uterus and want to be pregnant. The first healthy baby, born to a uterus transplant recipient, happened in October 2014 in Sweden, according to British medical journal – The Lancet. The 36 year old Swedish woman, had received a uterus from a live 61 year old donor in 2013. The baby boy was born at about 32 weeks, by caesarean section, after mother developed some pregnancy related complication. The aim of these Uterus Transplants, are to remove the uterus by surgery (by Hysterectomy), after one or two successful pregnancies, to minimise the effects of complications related to immunosuppressive drugs, which all those patients take to avoid rejection of the transplanted Uterus, by the body.
So it is obvious that Infertility is an age old unique problem and it requires an unique solution, directed at the individual concerned. Although some patients, do not get benefits in spite of thorough investigation and treatment, but the recent advances in science has ensured that more and more people, look to the future with hope.