INFERTILITY has long been perceived as a female-centric issue. However, of the infertility cases reported, 37 per cent is attributed to the man, 38 per cent to the woman, and the remaining 25 per cent 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.
Discussing the causes for infertility with TechTrail, Dr Nameeta Mokashi-Bhalerao, fertility consultant, Nova IVI Fertility commented,“Reproductive health is exquisitely sensitive to characteristics of an individual’s environment – physical, biological, behavioural, cultural and socio-economic factors. It is strong enough to make and bear a life; and yet, delicate enough for it to easily get impacted. Today, reproductive toxicity – a hazard associated with chemical substances which interfere with normal reproduction, has become a common 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. Being seated for long hours while driving also exposes the scrotum to excess heat from the vehicle.
- Radiation from the 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 sperm quality and quantity in men. 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 actually causes the male hormone, testosterone, to be converted into estrogen, and then this estrogen decreases testicle stimulation. On the other hand, men who are underweight tend to have lower sperm concentrations than those who are at a normal BMI. For women, being underweight and having extremely low amounts of body fat are associated with ovarian dysfunction.
- 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. This, 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 have been associated with a disruption in menstruation, ovulation dysfunction, and increased risk of endometriosis and poor sperm quality”, added Dr Nameeta.
How is infertility diagnosed in patients?
During any fertility check-up, it is mandatory to investigate both partners. A male fertility assessment usually starts with a thorough medical history and a semen analysis that examines the count, motility, and morphology of sperm in the ejaculate. Further testing is based on the results of the analysis. Men with low sperm counts, for example, might require hormonal or genetic testing. If no sperm is found in the ejaculate, a testicular biopsy may be necessary. 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. This is followed by a blood test to examine the hormone levels and ovarian reserve. Based on this, a pelvic examination is conducted 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.
Nova IVI Fertility (NIF) is among the largest service providers in the fertility space and has successfully achieved over 25,000 clinical pregnancies through IVF.