As ironic as it may be, in a country with the second largest population in the world, fertility issues and conversations around it often take a backseat thanks to the taboo and stigma associated with it. Fertility issues are rising in India, especially in urban regions.
According to the World Health Organisation, when two partners are involved in regular intercourse for more than twelve months without using contraception but are unable to achieve clinical pregnancy, the condition can be termed infertility. There are two kinds of infertility: primary and secondary. The former refers to a situation where two partners have never conceived, while the latter is the condition of being able to get pregnant before, but failing to do so thereafter. Most commonly, couples have primary infertility.
There are around 80 million sufferers of infertility worldwide. That covers up to 15% of the reproductive age cohort. The overall prevalence of infertility in India ranges from 3.9 to 16.8%. It varies from 3.7% in Uttar Pradesh, Maharashtra, and Himachal Pradesh to 5% in Andhra Pradesh and almost 15% in Kashmir.
Though women are often blamed for not being able to get pregnant, the responsibility should be borne equally by both male and female partners. Female infertility contributes to 40-45%, male infertility contributes to 30-40% and in 20% of the cases, both partners are responsible for fertility issues.
While there are numerous factors such as physiological, genetic, anatomical and environmental that can lead to the inability to conceive across all genders, often the causes are multiple and overlapping. In the case of males, most fertility issues arise due to ejaculation problems. On the other hand, in females, infertility is the result of irregularities present in the ovaries, uterus, fallopian tubes or troubles concerning the endocrine (hormones) system as a whole.
In India, as per the data collected by National Family Health Survey, fertility rates have seen a significant decrease since 1971. The rise of infertility in India is concerning considering the fact that there are around 27.5 million couples trying for a baby, but failing to do so due to several underlying reasons.
Research shows that the rise in infertility can be majorly pinned down to the following risk factors across genders:
India has witnessed a prominent shift in attitude towards girls’ education, nuclear families, careers, marriages and pregnancies. The rise in female literacy levels may have contributed to a fall in female fertility. It is estimated that 10-15% of the rise in the use of contraceptive methods is due to females becoming more literate over time. Both male and female partners have started delaying the age at which they marry, especially in urban regions. Even if they marry at an early age, pregnancies are delayed because of various factors like living in nuclear families, focusing on careers and pursuing higher education, among others.
Fertility has a direct correlation with age, it starts declining significantly after 35 years in women and after 50 years in men. Advancing age affects the quality of eggs in women, irrespective of whether the woman has hit menopause or not, and in men, it affects the quality of the sperm leading to further complications.
Our eating habits these days are greatly influenced by our fast-paced life. Excessive consumption of fast foods and packaged foods have affected our dietary needs in recent times. Having unhealthy eating habits and being severely underweight or obese can affect fertility in both males and females. Obesity has seen a rising graph due to the rise in sedentary lifestyle and can be a major cause of below-par sperm concentration and quality in one’s semen. It is recommended that to increase the chances of ovulation and pregnancy, women who are obese and also suffer from Polycystic Ovarian Syndrome (PCOS), lose at least 5% of their current weight. However, women should regulate their diets properly as fertility problems and unfit ovaries can also be the result of being underweight or anorexic.
A stressful lifestyle and unhealthy coping strategies can also have a negative impact on your fertility health. Long working hours, chronic stress, poor work-life balance, and low priority of personal well-being affect ovulation in women and sperm production in men. Stress also hampers hormones, libido, and the performance of our organs. Stigma and taboo associated with seeking professional help to manage stress prevents people from learning healthy coping mechanisms.
Fertility is affected by unhealthy coping mechanisms such as tobacco and alcohol overuse. Unbalanced consumption of alcohol can affect hormonal balance and reduce sperm quality. Smoking releases harmful toxins in the body that affect the production of sperm and depletes eggs and ages ovaries. It also affects the menstrual cycle and leads to poor chances of natural conception.
Chlamydia and gonorrhoea, among STIs, are the most widely prevalent causes of infertility. These are also preventable in nature. In women, if left undiagnosed or untreated, such STIs can lead to Pelvic Inflammatory Diseases (PIDs). The lack of symptoms, while being infected, in case of STDs, often becomes the main challenge. In the case of men, clinical reasons can include hormonal disorder, varicocele, sexual dysfunction and untreated infections.
In India, men infertility is neglected because of societal norms and expectations from men. In women, clinical reasons for sub-optimal fertility include endometriosis, damaged fallopian tubes, PCOS and other pelvic infections. Also, non-communicable diseases like hypothyroidism, diabetes, cancer and hypertension also influence fertility. As NCDs (Non-Communicable Diseases) are on the rise in the 21st century, their impact on fertility cannot be ignored, especially in developing countries like India.
Lifestyle and habits, such as irregular eating and sleeping cycles, can be the reason for several health problems including infertility. Another factor that affects both sperm and egg health has been the deteriorating air quality around us. Inhaling impure air significantly affects multiple organ functions and one’s own well-being.
Infertility, just like any other health condition, can be prevented and treated. All we need is a broader perspective, hope, and the right medical and health services.
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