Understanding female infertility

For a woman who has been planning to start a family and hoping to conceive, a negative pregnancy test result could take a toll on her mental health. Getting periods around that time can be very stressful and overwhelming. The inability to conceive could lead to feelings of disappointment, guilt, and sometimes even rage.

Thirty-five-year-old Vidya, a resident of Mysuru had severe depression and even quit her job because she could not conceive despite planning for it for three years. That’s just the slice of a shocker which female infertility can bring in.  Speaking to Happiest Health, she said, “I worked for an IT company as a manager, and I was very career oriented. Due to this, I kept delaying my marriage. However, after I found the right partner, I got married to him. I was 32 then. I knew that I was settled in life, and I could start a family. But despite us trying for three years, I couldn’t conceive. I faced a lot of pressure from my family who later started to blame me for delaying my marriage.”

She lived in a joint family. During the pandemic, when she had to work from home, a bout of depression further affected her, when she had to answer family members’ queries about why she wasn’t pregnant yet. “I went into depression and started to hate myself for putting my career first. I felt I was too selfish and now everyone is suffering because of me and I’m not able to give a child to my husband and a grandchild to my parents and my in-laws. I had so much rage, anger and hatred towards myself. I even quit my job six months ago,” she said.

Going to a fertility clinic was still a very tough decision for her to make as she was afraid of the stigma attached to it. “I somehow overcame the fear and approached a fertility clinic in June where the doctor not only counselled me but also helped me with the right treatment. Now, I know that I had a uterine issue that can be solved and treated,” she said.

“It is common to experience infertility and it could happen because of many reasons. There could be problems with the uterus, ovulation, fallopian tubes and the quality and number of eggs apart from age and lifestyle factors like smoking and excess weight,” said Dr Rohit Gutgutia, medical director, Nova IVF Fertility, Eastern India.

He says that there are two types of female infertility:

• Primary: Where a woman who has never been pregnant is unable to conceive after a year of not using birth control.
• Secondary: Where a woman is unable to conceive after at least one successful pregnancy.

According to an article published in the Journal of Reproduction and Infertility, as a woman ages, her likelihood of infertility rises. In India, about eight per cent of currently married women experience infertility, with secondary infertility being the most common type (5.8 per cent).

Dr Vidya V Bhat, the medical director of Radha Krishna Multispecialty Hospital, Bengaluru said that the recent phenomenon of reduced fertility among Indian women is caused by delayed marriages, obsession regarding one’s career and use of modern contraceptives.

Dr Bhat said that as age increases, the chances of getting pregnant reduce significantly. “This is due to the decreased frequency of sexual intercourse, lower quality of uterus and ageing egg cells that lead to poor-quality embryos. There is a reduction in the intrinsic fertility potential of egg cells after the age of 35. The decline in fertility begins around 32 years and becomes rapid around 37,” she added. Dr Bhat suggested that women should bear children between 25 to 33 years to avoid complications.

Stigma and stress

The stigma surrounding infertility is a problem linked to different psychological and social issues, particularly for women. The stigma is connected to a sense of secrecy and shame that is sometimes forced on women.

Dr Gutgutia said that to assist people in coping with the psychosocial effects of infertility stigma, doctors offer fertility counselling to those (individuals and couples) who are contemplating or receiving reproductive treatments.  He said that the burden of not conceiving naturally falls highly on women. “In times like these, counselling them about their fears and tension is important as stress too can affect fertility and the fertility treatment itself,” he added.

Genetics play spoilsport

According to Dr Gutgutia, about ten per cent of female infertility is thought to be genetically influenced. He further explained, “large chromosomal abnormalities, sub-microscopic chromosome deletions and duplications, and DNA sequence variations within genes that control many biological processes involved in oogenesis (development of ovum), ovarian reserve maintenance, hormonal signalling and the anatomical and functional development of female reproductive organs are among the genetic abnormalities that cause infertility in females.”

He adds that female infertility causes can result from hormonal imbalances too. These imbalances can interfere with ovulation, hinder the uterine lining from thickening and also prevent a pregnancy from developing.

According to Dr Gutgutia, medical conditions like celiac disease, kidney disease, pelvic inflammatory disease, pituitary gland disorders, such as Cushing’s syndrome, sickle cell anemia, uterine problems, thyroid disease and cancer are some of the severe medical conditions that can cause infertility in women. Lifestyle factors, such as age, dietary habits, weight, exercise, mental distress and environmental and occupational exposures can have a significant impact on both male and female fertility.

What happens if pregnancy is delayed?

Delayed pregnancies could be the reason for rising in cases of gestational diabetes among pregnant women, which sometimes even turns into type 2 diabetes, said Dr Bhat. She also pointed out that:

• Women who have late pregnancies have higher chances of suffering from chronic hypertension from the beginning of the pregnancy.
• They may also face issues during labour, such as non-progression of labour and non-descent of the fetal head.
• There is also an increased risk of spontaneous abortion in women above 35, apart from chromosomal anomalies being found in the baby.
• Obesity causes a lot of problems concerning fertility. Women who put on a lot of weight during pregnancy may face metabolic syndrome and even recurrent loss of pregnancy.

Female infertility treatment options

Dr Gutgutia said that treatments are identical whether infertility is primary or secondary. Treatments include:

• Medications to trigger ovulation in women with ovulatory disorders.
• Intrauterine Insemination (IUI), where sperm is surgically inserted into a woman’s uterus. Donor sperm may be used during IUI.
• In vitro fertilisation (IVF), which entails daily injections to the ovaries to stimulate them, a surgical operation to remove the eggs, lab-based egg fertilisation to create embryos, lab-based embryo growth and lab-based embryo transfer into the uterus. Donors of eggs or sperm may be used during IVF.  Gestational surrogacy involves using a woman who is not the intended mother to carry the pregnancy to term.
• Surgery to treat female patients with uterine issues. Doctors can fix structural issues by removing fibroids, polyps and scar tissue from the uterus.
• Women with infertility who want to have a family may also have options such as gestational surrogacy and adoption.

Apart from proper medication and treatment for medical conditions, couples who are trying to conceive should:

• Not smoke, use drugs or consume too much alcohol.
• Eat a balanced diet to maintain a healthy weight.
• Reduce their exposure to toxins.
• Continue to be physically active, but not overdo it.