‘Infertility, no longer a female-centric issue’

Dr Nameeta Mokashi Bhalerao, a Fertility Consultant, Nova IVI Fertility, Pune, shares her insights about infertility, how it is triggered and how to diagnose it

All you need to know about female sexual disorders

Infertility is a condition where a couple is unable to conceive naturally despite having unprotected sex for a year. For a long time infertility has been perceived as a female-centric issue.

However, of the infertility cases reported, 37% is related to the man, 38% to the woman, and the remaining 25% to unknown causes. Infertility often brings in one of the most distressing life phases amongst couples who are trying to have children.

The multitude of medical decisions and the uncertainties that infertility brings can create great physical and emotional upheaval in the lives of many.

Reproductive health is exquisitely sensitive to the characteristics of an individual’s environment – physical, biological, behavioural, cultural, and socioeconomic factors.

It is strong enough to make and bear life, and yet delicate for it to get impacted. Today, reproductive toxicity – a hazard associated with chemical substances, which interfere with normal reproduction, has become a contributor to impacting fertility health in most couples.

Present day mundane lifestyle habits have led to the creation of a toxic environment, which is difficult to avoid.

Reproductive toxicity is often triggered by:

Exposure to severe heat

In men, the use of tight undergarments increases scrotal temperature, which can lead to decreased sperm production. While driving, being seated for long hours also exposes the scrotum to excess heat from the vehicle.

Radiation from use of cell phones

Cell phones have become a part of our lives today. Phones emit Electro-Magnetic Waves that can be absorbed by the human body, influence the reproductive system, of men especially, which may interfere with sperm concentration, motility, and volume. Carrying cell phones in pant pockets interrupts the ability of a man’s testicles to produce testosterone.

Excessive smoking, alcohol consumption

The toxins present in tobacco smoke tend to damage the DNA in the sperm and eggs. Passive smoking is almost as damaging as smoking, and women who are exposed to second-hand smoke take longer to conceive than women who are not. Consumption of excessive alcohol lowers testosterone levels and the quality and quantity of sperms. It can also reduce libido and cause impotence.

Weight-related lifestyle factors

“Obesity negatively impacts ovulation and sperm production. While in women, it can cause the overproduction of insulin, which may lead to irregular ovulation and PCOS (Poly-Cystic Ovarian Syndrome); for men, it affects stimulation of the testicles that inhibit sperm production. Excess fat causes the male hormone, testosterone, to convert into estrogen, and then it decreases testicle stimulation. On the other hand, underweight men tend to have lower sperm concentrations than those who are at a normal BMI. For women, being underweight and having low amounts of body fat are associated with ovarian dysfunction,” added Dr Nameeta.

Pollution and environmental toxins

In men, air pollution can reduce sperm production and concentration apart from affecting the quality of sperms, causing damage to DNA, and increasing the risk of testicular cancer.

In women, air pollutants can cause hormonal imbalance, of estrogen in particular, and affect ovulation. It, in turn, reduces the conception rates and also increases the risk of miscarriages leading to reduced live birth rates.

Plastics contain chemical phthalates which decrease fertility rate, alter sperm DNA, and reduce testosterone levels. These toxins induce sperm DNA damage or cause sperm genetic changes. Higher levels of phthalates are associated with the disruption in menstruation, ovulation dysfunction, and increased risk of endometriosis and poor sperm quality.

How is infertility diagnosed in patients?

During any fertility check-up, it is mandatory to investigate both partners. The fertility assessment in men usually starts with a thorough medical history and a semen analysis which examines the count, motility, and morphology of the sperm in the ejaculation.

Based on the results of the analysis further testing is done. Men with low sperm counts, for example, might require hormonal or genetic testing.

A testicular biopsy may be necessary if no sperm is present in the ejaculate. Hormone profile, DNA fragmentation, and scrotal scan with Doppler are done if abnormalities are found. Semen analysis is repeated after three months if the patient has been put on treatment.

Fertility tests for women often begin with a discussion on the patient’s medical history to check for ovulation or menstrual cycle issues.

It is followed by a blood test to examine the hormone levels and ovarian reserve.

Based on this, a pelvic examination is done to check for abnormalities such as fibroids or endometriosis. Minimally invasive procedures, such as ultrasound imaging (sonogram), and surgery may, at times, be conducted to check for structural causes of infertility.