“A STUDY ON THE AWARENESS OF

INFERTILITYAMONG PEOPLE”

INVESTIGATORY PROJECT REPORT

Submitted by

“SABARI SRINIVAS A”
“BH12B407”

12 – “B4”

in partial fulfilment for the biology practicals

of

AISSCE PRACTICALS 2021’22

DEPARTMENT OF BIOLOGY

VELAMMAL VIDHYASHRAM SURAPET

CHENNAI - 600 066

Page1
 VELAMMAL VIDHYASHRAM SURAPET

CHENNAI - 600 066

BONAFIDE CERTIFICATE

Certified that this investigatory project report titled, “A STUDY ON THE

AWARENESS OF INFERTILITY AMONG PEOPLE” is the bonafide work of “SABARI

SRINIVAS A” of Grade 12 in the academic year 2021’22, who carried out the project

under the guidance of “TEACHER NAME”.

Place : Chennai

Date :

TEACHER INCHARGE

INTERNAL EXAMINER EXTERNAL EXAMINER

Page2
 ACKNOWLEDGEMENT

I am extremely grateful to my mentor “TEACHER NAME”, Department

of Biology, Velammal Vidhyashram Surapet, Chennai, for “his/her” valuable
guidance and kind help during the course of my project.

I wish to express my gratitude to “CHITRA ” Principal, “BHARATHI”,

Velammal Vidhyashram Surapet, Chennai for her continuous support for the successful
completion of this project work.

I express my deep gratitude to my parents, friends and my family members

for their great support and patience.

“Sabari srinivas A”

Page3
 TABLE OF CONTENT .

CHAPTER TOPIC PAGE.NO

NO.

1 CERTIFICATE

2 ACKNOWLEDGEMENT

3 ABSTRACT

4 INTRODUCTION

5 AIM AND OBJECTIVE

6 METHODOLOGY

7 ANALYSIS OF DATA

8 SUMMARY AND CONCLUSION

9 REFERENCE

10 APPENDIX

Page4
ABSRTRACT

The Infertility is prevailing among our society over a long period of time , but the cause was
unknown. In recent times researchers found the actual cause for infertility . Every cause is not
same , but for these entire problems one of the major reasons is lifestyle modification ,
unprotected sexual habitations. A normative survey was taken in my area among 20
individuals , among them everyone had different knowledge or ideas about this infertility .
the sample data collected was analysed on percentage basis . the present study aim that the
level of understanding among people aim of this survey was to understand the awareness
among people about infertility .The study conclude that 55 per of people had exact
knowledge and females had more knowledge than that of males and mostly the age groups of
20-40 had more knowledge.

INTRODUCTION

DEFINITION

Infertility can be defined in different means differently , According to WHO - Infertility is a

disease of the male or female reproductive system defined by the failure to achieve a
pregnancy after 12 months or more of regular unprotected sexual intercourse. Infertility
affects millions of people of reproductive age worldwide – and has an impact on their
families and communities. Estimates suggest that between 48 million couples and 186 million
individuals live with infertility globally. In the male reproductive system, infertility is most
commonly caused by problems in the ejection of semen , absence or low levels of sperm, or
abnormal shape (morphology) and movement (motility) of the sperm. In the female
reproductive system, infertility may be caused by a range of abnormalities of the ovaries,
uterus, fallopian tubes, and the endocrine system, among others.

One definition of infertility that is frequently used in the United States by reproductive
endocrinologists, doctors who specialize in infertility, to consider a couple eligible for
treatment is:

 a woman under 35 has not conceived after 12 months of contraceptive-free intercourse.

Twelve months is the lower reference limit for Time to Pregnancy (TTP) by the World
Health Organization.

Page5
 a woman over 35 has not conceived after six months of contraceptive-free sexual
intercourse.

Updated NICE guidelines do not include a specific definition, but recommend that "A woman of
reproductive age who has not conceived after 1 year of unprotected vaginal sexual intercourse, in the
absence of any known cause of infertility, should be offered further clinical assessment and investigation
along with her partner, with earlier referral to a specialist if the woman is over 36 years of age."

Infertility is the inability to sustain a pregnancy in a woman with regular (2–3 times per
week) unprotected sexual intercourse for a period of 1 year. This is a major public health
problem that remains under-.[Thomas Obinchemti Egbe].
“The infertility problem in India is huge, and whatever genetic studies have been reported
from Europe and elsewhere do not match with observations in Indian population. We did
extensive analysis using additional markers and other methods and have found there is unique
combination of deletions in Y chromosome of infertile Indian men and also they occur with
high frequency. This is different from what has been found elsewhere,” [Dr Kumarasamy
Thangaraj].

Types of infertility

Infertility can be classified into different types by different means they are as follows;

 Primary infertility is defined as the absence of a live birth for women who desire a
child and have been in a union for at least five years, during which they have not used
any contraceptives. The World Health Organization also adds that 'women whose
pregnancy spontaneously miscarries, or whose pregnancy results in a still born child,
without ever having had a live birth would present with primarily infertility.

Fig.1 percentage of couples having secondary inferility.

Page6
  Secondary infertility is defined as the absence of a live birth for women who desire a
child and have been in a union for at least five years since their last live birth, during
which they did not use any contraceptives. The percentage of infertility is given in
fig.1 .

INFERTILITY TYPEWS BASED ON SEX

Infertility in this are classified as male infertility , female infertility , combined

infertility etc.. however in this classification whatever the cause and treatment for
males are not same as for females .

INFERTILITY IN MALES

Male infertility is defined as the inability of a male to make a fertile female pregnant, for a minimum of at
least one year of unprotected intercourse. There are multiple causes for male infertility. These
include endocrine disorders (usually due to hypogonadism) at an estimated 2% to 5%), sperm transport
disorders (such as vasectomy) at 5%, primary testicular defects (which includes abnormal sperm
parameters without any identifiable cause) at 65% to 80% and idiopathic (where an infertile male has
normal sperm and semen parameters) at 10% to 20%. Clearly the difference between abnormal sperm the
reason for male infertility and normal sperm is given in fig.2.

Fig.2 Male infertility due to deformed male.

Page7
INFERTILTIY IN FEMALES

The following causes of infertility may only be found in females. For a woman to conceive,
certain things have to happen: intercourse must take place around the time when an egg is
released from her ovary; the system that produces eggs has to be working at optimum levels;
and her hormones must be balanced.

For women, problems with fertilization arise mainly from either structural problems in the
Fallopian tube or uterus or problems releasing eggs. Infertility may be caused by blockage of
the Fallopian tube due to malformations, infections such as Chlamydia and/or scar tissue. For
example, endometriosis can cause infertility with the growth of endometrial tissue in the
Fallopian tubes and/or around the ovaries. Endometriosis is usually more common in women
in their mid-twenties and older, especially when postponed childbirth has taken place.

Another major cause of infertility in women may be the inability to ovulate. Malformation of
the eggs themselves may complicate conception. For example, polycystic ovarian syndrome
is when the eggs only partially developed within the ovary and there is an excess of male
hormones. Some women are infertile because their ovaries do not mature and release eggs. In
this case synthetic FSH by injection or Clomid (Clomiphene citrate) via a pill can be given to
stimulate follicles to mature in the ovaries. The problems may also be due to problems in
female reproductive tract which numbered on fig.3 .

Fig.3 Female infertility due to problems in different region in female reproductive

organ.

Page8
Other factors that can affect a woman's chances of conceiving include being overweight or
underweight, or her age as female fertility declines after the age of 30.

Sometimes it can be a combination of factors, and sometimes a clear cause is never

established.

Combined infertility

In some cases, both the man and woman may be infertile or sub-fertile, and the couple's
infertility arises from the combination of these conditions. In other cases, the cause is
suspected to be immunological or genetic; it may be that each partner is independently fertile
but the couple cannot conceive together without assistance.

Unexplained infertility

In the US, up to 20% of infertile couples have unexplained infertility. In these cases,
abnormalities are likely to be present but not detected by current methods. Possible problems
could be that the egg is not released at the optimum time for fertilization, that it may not enter
the fallopian tube, sperm may not be able to reach the egg, fertilization may fail to occur,
transport of the zygote may be disturbed, or implantation fails. It is increasingly recognized
that egg quality is of critical importance and women of advanced maternal age have eggs of
reduced capacity for normal and successful fertilization. Also, polymorphisms in folate
pathway genes could be one reason for fertility complications in some women with
unexplained infertility. However, a growing body of evidence suggests that epigenetic
modifications in sperm may be partially responsible.

Natural infertility

Before puberty, humans are naturally infertile; their gonads have not yet developed

the gametes required to reproduce: boys' testicles have not developed the sperm cells required
to impregnate a female; girls have not begun the process of ovulation which activates the
fertility of their egg cells (ovulation is confirmed by the first menstrual cycle, known
as menarche, which signals the biological possibility of pregnancy). Infertility in children is
commonly referred to as Prepubescence (or being prepubescent, an adjective used to also
refer to humans without secondary sex characteristics).

The absence of fertility in children is considered a natural part of human growth and child

development, as the hypothalamus in their brain is still underdeveloped and cannot release

Page9
the hormones required to activate the gonads' gametes. Fertility in children before the ages of
eight or nine is considered a disease known as precocious puberty. This disease is usually
triggered by a brain tumor or other related injury.

CAUSES

FOR MALES

The main cause of male infertility is low semen quality. In men who have the necessary
reproductive organs to procreate, infertility can be caused by

 Low sperm count due to endocrine problems,

 drugs,
 radiation,
 Infection,
 testicular malformations,
 hormone imbalance,
 blockage of the man's duct system.

Although many of these can be treated through surgery or hormonal substitutions, some
may be indefinite. Infertility associated with viable, but immotile sperm may be caused
by primary ciliary dyskinesia.

FOR FEMALES

Common causes of infertility of females include

 Ovulation problems (e.g. polycystic ovarian syndrome, PCOS, the leading

reason why women present to fertility clinics due to anovulatory infertility)
 Tubal blockage
 Pelvic inflammatory disease caused by infections like tuberculosis
 Age-related factors
 Uterine problems
 Previous tubal ligation

Page1
0
  Endometriosis
 Advanced maternal age,
 Adenomyosis

Fig.4 Two major causes of female infertility.

Above are the some causes for female infertility among which adenomyosis and
endometriosis are the major cause for female infertility . fig.4 shows the diagram of such
cause.

Delayed puberty

Delayed puberty, puberty absent past or occurring later than the average onset (between the
ages of ten and fourteen), may be a cause of infertility. In the United States, girls are
considered to have delayed puberty if they have not started menstruating by age 16 (alongside
lacking breast development by age 13). Boys are considered to have delayed puberty if they
lack enlargement of the testicles by age 14. Delayed puberty affects about 2% of adolescents.

Most commonly, puberty may be delayed for several years and still occur normally, in which
case it is considered constitutional delay of growth and puberty, a common variation of
healthy physical development. Delay of puberty may also occur due to various causes such
as malnutrition, various systemic diseases, or defects of the reproductive
system (hypogonadism) or the body's responsiveness to sex hormones.

Immune infertility

Antisperm antibodies (ASA) have been considered as infertility cause in around 10–30% of

infertile couples. In both men and women, ASA production are directed against surface

Page1
1
antigens on sperm, which can interfere with sperm motility and transport through the female
reproductive tract, inhibiting capacitation and acrosome reaction, impaired fertilization,
influence on the implantation process, and impaired growth and development of the embryo.
The antibodies are classified into different groups: There are IgA, IgG and IgM antibodies.
They also differ in the location of the spermatozoon they bind on (head, mid piece, tail).
Factors contributing to the formation of antisperm antibodies in women are disturbance of
normal immunoregulatory mechanisms, infection, violation of the integrity of the mucous
membranes, rape and unprotected oral or anal sex. Risk factors for the formation of antisperm
antibodies in men include the breakdown of the blood-testis barrier, trauma and surgery,
orchitis, varicocele, infections, prostatitis, testicular cancer, failure of immunosuppression
and unprotected receptive anal or oral sex with men.

Sexually transmitted infections

Infections with the following sexually transmitted pathogens have a negative effect on
fertility: Chlamydia trachomatis and Neisseria gonorrhoeae. There is a consistent association
of Mycoplasma genitalium infection and female reproductive tract syndromes. M.
genitalium infection is associated with increased risk of infertility.

Genetic

Mutations to NR5A1 gene encoding Steroidogenic Factor-1 (SF-1) have been found in a

small subset of men with non-obstructive male factor infertility where the cause is unknown.
Results of one study investigating a cohort of 315 men revealed changes within the hinge
region of SF-1 and no rare allelic variants in fertile control men. Affected individuals
displayed more severe forms of infertility such as azoospermia and severe oligozoospermia.

Small supernumerary marker chromosomes are abnormal extra chromosomes; they are three
times more likely to occur in infertile individuals and account for 0.125% of all infertility
cases. See Infertility associated with small supernumerary marker chromosomes .

Other causes

Factors that can cause male as well as female infertility are:

DNA damage

 DNA damage reduces fertility in female ovocytes, as caused by

smoking, other xenobiotic DNA damaging agents (such as radiation or

Page1
2
 chemotherapy) or accumulation of the oxidative DNA damage 8-hydroxy-
deoxyguanosine
 DNA damage reduces fertility in male sperm, as caused by oxidative DNA
damage, smoking, other xenobiotic DNA damaging agents (such as drugs or
chemotherapy) or other DNA damaging agents including reactive oxygen species,
fever or high testicular temperature. The damaged DNA related to infertility
manifests itself by the increased susceptibility to denaturation inducible by heat or
acid or by the presence of double-strand breaks that can be detected by the TUNEL
assay.

General factors

 Diabetes mellitus, thyroid disorders, undiagnosed and untreated coeliac

disease, adrenal disease

Hypothalamic-pituitary factors

 Hyperprolactinemia
 Hypopituitarism
 The presence of anti-thyroid antibodies is associated with an increased risk of
unexplained subfertility with an odds ratio of 1.5 and 95% confidence interval of 1.1–
2.0.

Environmental factors

 Toxins such as glues, volatile organic solvents or silicones, physical agents,

chemical dusts, and pesticides. Tobacco smokers are 60% more likely to be infertile
than non-smokers.

German scientists have reported that a virus called adeno-associated virus might have a role
in male infertility, though it is otherwise not harmful. Other diseases such as chlamydia,
and gonorrhea can also cause infertility, due to internal scarring (fallopian tube obstruction).

Alimentary habits

 Obesity: Obesity can have a significant impact on male and female fertility.
BMI (body mass index) may be a significant factor in fertility, as an increase in BMI

Page1
3
 in the male by as little as three units can be associated with infertility. Several studies
have demonstrated that an increase in BMI is correlated with a decrease in sperm
concentration, a decrease in motility and an increase in DNA damage in sperm. A
relationship also exists between obesity and erectile dysfunction (ED). ED may be the
consequence of the conversion of androgens to estradiol. The enzyme aromatase is
responsible for this conversion and is found primarily in adipose tissue. As the
number of adipose tissue increases, there is more aromatase available to convert
androgens, and serum estradiol levels increase. Other hormones including inhibin B
and leptin, may also be affected by obesity. Inhibin B levels have been reported to
decrease with increasing weight, which results in decreased Sertoli cells and sperm
production. Leptin is a hormone associated with numerous effects including appetite
control, inflammation, and decreased insulin secretion, according to many studies.
Obese women have a higher rate of recurrent, early miscarriage compared to non-
obese women.

Low weight: Obesity is not the only way in which weight can impact fertility. 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 and infertility and they have a higher risk for preterm
birth. Eating disorders such as anorexia nervosa are also associated with extremely low
BMI. Although relatively uncommon, eating disorders can negatively affect
menstruation, fertility, and maternal and fetal well-being.


DIAGNOSIS

IN MALES

 General physical examination and medical history. This includes examining your

genitals and asking questions about any inherited conditions, chronic health problems,
illnesses, injuries or surgeries that could affect fertility. Your doctor might also ask
about your sexual habits and about your sexual development during puberty.

 Semen analysis. Semen samples can be obtained in a couple of different ways. You

can provide a sample by masturbating and ejaculating into a special container at the

Page1
4
 doctor's office. Because of religious or cultural beliefs, some men prefer an alternative
method of semen collection. In such cases, semen can be collected by using a special
condom during intercourse. Some other analysis of sperm in semen by doctors basis
given in fig.5 page 11

Fig.5 Semen analysis

Scrotal ultrasound. This test uses high-frequency sound waves to produce images inside
your body. A scrotal ultrasound can help your doctor see if there is a varicocele or other
problems in the testicles and supporting structures.

Transrectal ultrasound. A small, lubricated wand is inserted into your rectum. It allows
your doctor to check your prostate and look for blockages of the tubes that carry semen.

Hormone testing. Hormones produced by the pituitary gland, hypothalamus and testicles

play a key role in sexual development and sperm production. Abnormalities in other
hormonal or organ systems might also contribute to infertility. A blood test measures the
level of testosterone and other hormones.

Post-ejaculation urinalysis. Sperm in your urine can indicate your sperm are traveling
backward into the bladder instead of out your penis during ejaculation (retrograde
ejaculation).

Genetic tests. When sperm concentration is extremely low, there could be a genetic cause. A
blood test can reveal whether there are subtle changes in the Y chromosome — signs of a

Page1
5
genetic abnormality. Genetic testing might be ordered to diagnose various congenital or
inherited syndromes.

Testicular biopsy. This test involves removing samples from the testicle with a needle. If the
results of the testicular biopsy show that sperm production is normal your problem is likely
caused by a blockage or another problem with sperm transport.

Specialized sperm function tests. A number of tests can be used to check how well your
sperm survive after ejaculation, how well they can penetrate an egg, and whether there's any
problem attaching to the egg. These tests aren't often used and usually don't significantly
change recommendations for treatment.

IN FEMALES

Fertility tests might include:

Ovulation testing. An at-home, over-the-counter ovulation prediction kit detects the surge in
luteinizing hormone (LH) that occurs before ovulation. A blood test for progesterone — a
hormone produced after ovulation — can also document that you're ovulating. Other
hormone levels, such as prolactin, also might be checked.

Hysterosalpingography. During hysterosalpingography (his-tur-o-sal-ping-GOG-ruh-fee),

X-ray contrast is injected into your uterus and an X-ray is taken to check for problems inside
the uterus. The test also shows whether the fluid passes out of the uterus and spills out of
your fallopian tubes. If any problems are found, you'll likely need further evaluation.

Ovarian reserve testing. This testing helps determine the quality and quantity of eggs
available for ovulation. Women at risk of a depleted egg supply — including women older
than 35 — might have this series of blood and imaging tests.

Other hormone testing. Other hormone tests check levels of ovulatory hormones as well as
thyroid and pituitary hormones that control reproductive processes.

Imaging tests. A pelvic ultrasound looks for uterine or fallopian tube disease. Sometimes a
sonohysterogram, also called a saline infusion sonogram, or a hysteroscopy is used to see
details inside the uterus that can't be seen on a regular ultrasound.

Page1
6
Laparoscopy. This minimally invasive surgery involves making a small incision beneath
your navel and inserting a thin viewing device to examine your fallopian tubes, ovaries and
uterus. A laparoscopy can identify endometriosis, scarring, blockages or irregularities of the
fallopian tubes, and problems with the ovaries and uterus.

Genetic testing. Genetic testing helps determine whether there any changes to your genes
that may be causing infertility. Example of it given in fig.6 page 13.

Fig.6 Diagnosis of female infertility to test genetic problem

TREATMENTS

Treatments for male infertility include

Surgery. For example, a varicocele can often be surgically corrected or an obstructed vas

deferens repaired. Prior vasectomies can be reversed. In cases where no sperm are present in
the ejaculate, sperm can often be retrieved directly from the testicles or epididymis using
sperm retrieval techniques.

Treating infections. Antibiotic treatment might cure an infection of the reproductive tract,

but doesn't always restore fertility.

Page1
7
Treatments for sexual intercourse problems. Medication or counseling can help improve
fertility in conditions such as erectile dysfunction or premature ejaculation.

Hormone treatments and medications. Your doctor might recommend hormone

replacement or medications in cases where infertility is caused by high or low levels of
certain hormones or problems with the way the body uses hormones.

Assisted reproductive technology (ART). ART treatments involve obtaining sperm through

normal ejaculation, surgical extraction or from donor individuals, depending on your specific
case and wishes. The sperm are then inserted into the female genital tract, or used to perform
in vitro fertilization or intracytoplasmic sperm injection.

Treatments for infertility in females

Medications that regulate or stimulate ovulation are known as fertility drugs. Fertility drugs
are the main treatment for women who are infertile due to ovulation disorders.

Fertility drugs generally work like natural hormones — follicle-stimulating hormone (FSH)
and luteinizing hormone (LH) — to trigger ovulation. They're also used in women who
ovulate to try to stimulate a better egg or an extra egg or eggs.

Fertility drugs include:

Clomiphene citrate. Taken by mouth, this drug stimulates ovulation by causing the pituitary
gland to release more FSH and LH, which stimulate the growth of an ovarian follicle
containing an egg. This is generally the first line treatment for women younger than 39 who
don't have PCOS.

Gonadotropins. These injected treatments stimulate the ovary to produce multiple eggs.

Gonadotropin medications include human menopausal gonadotropin or hMG (Menopur)
and FSH (Gonal-F, Follistim AQ, Bravelle).

Another gonadotropin, human chorionic gonadotropin (Ovidrel, Pregnyl), is used to

mature the eggs and trigger their release at the time of ovulation. Concerns exist that
there's a higher risk of conceiving multiples and having a premature delivery with
gonadotropin use.

Page1
8
Metformin. This drug is used when insulin resistance is a known or suspected cause of
infertility, usually in women with a diagnosis of PCOS. Metformin (Fortamet) helps improve
insulin resistance, which can improve the likelihood of ovulation.

Letrozole. Letrozole (Femara) belongs to a class of drugs known as aromatase inhibitors and

works in a similar fashion to clomiphene. Letrozole is usually used for woman younger than
39 who have PCOS.

Bromocriptine. Bromocriptine (Cycloset, Parlodel), a dopamine agonist, might be used

when ovulation problems are caused by excess production of prolactin (hyperprolactinemia)
by the pituitary gland.

AIM AND OBJECTIVE .

AIM

In recent days are increasing number of infertility cases though some don’t have proper
knowledge regarding the infertility and Infertility is misunderstood by many people and they
tend to make wrong opinions which lead to many negative effects, the govt. of India has
provided many facilities and many allowance for it, though due to some religious factor and
emotional factor and social factor people does not come front for it . we can see there is an
increasing no. of fertility clinics is due to increasing no. of cases of infertility due to some
factors. This project is to check the awareness among a small group of people and to provide
the exact reason and best treatment methods and what everyone else have understood about
it.

OBJECTIVE;

 To study about infertility and causes of it with treatment techniques.

 To spread awareness among people on infertility and prevent them from judging
infertility wrong.
 To compare awareness among females and males
 To compare awareness among different age groups

Page1
9
 METHODOLOGY .

METHOD

In the present study , normative survey method was used . The normative survey method
studies, describes and interprets what exist at present among people.

SAMPLE

The primary data required for the study were collected from people in my area. A total
number of 20 samples were collected from my area . the sample were by questionnaire in
gforms , the sample is represented in pi chart with percentage which depicts the awareness
among people on infertility. The sample forms a representive sample of the entire population.

TOOL USED

The survey was conducted with the help of a questionnaire based on infertility and to check
awareness among those people and their opinions regarding causes , treatments and effects.

The survey was taken in Gforms and was comprised into pi chart for ease of understanding.
The survey was also made by casual questions and The most priored techniques and causes
given by experts were given below in the survey from the people chose their opinion on it.

STATISTICAL TECHNIQUES USED

For the analysis of data , percentage analysis was used as the statistical technique

DATA COLLECTION PROCEDURE

The data was collected in the following manner

1) Gforms were created based upon different categories of topics to check awareness
among them,
2) The response were concluded together and the data was compressed to pi chart in
percentage basis
3) Survey was open among all in my area, and considered the first 20 responses as my
data which represents the entire population.
4) All the results were studied in detail and properly analysed and discussed

Page2
0
 5) The total time takenfor my survey is 1 day.

ANALYSIS AND INTERPRETATION .

The sample data collected were analysed by percentage analysis And categorised into the
following based on the questionnaire number.

AWARENESS ABOUT INFERTILITY

.
HIGH LOW AVERAGE

8%

39%

54%

Figure 7 AWARENESS ABOUT INFERTILITY

In figure 7, Among that 20 people who have been surveyed , 38% of the people have high
knowledge towards infertility and 54% poor knowledge and 8% average knowledge.

AWARENESS AMONG DIFFERENT SEX

MALE FEMALE OTHER

15%

39%

46%

Figure 8 AWARENESS AMONG DIFFERENT SEX

In figure 8, Among the graph we can easily identify that males are more prone to infertility
than females... male contribution towards infertility is about 46% and female contribution is

Page2
1
about 39% but in actual practice males are more.. in some cases there may be combined
infertility. It is about 15% both of them.

AWARENESS AMONG DIFFERENT AGE GROUPS

.
BELOW 20 20-40 40-60 ABOVE 60

15%
8% 31%

46%

Figure 9 AWARENESS INFERTILITY AMONG DIFFERENT AGE GROUPS

In figure 9, Among different age groups infertility has been frequently repeated in the age
group 20-40 such that they are even more aware of it . sex education must be improved a lot
to improve the awareness among below 20 . awareness among people in my area is greater in
20-40 age groups who contributes about 46% where below 20 contributes 31% and those in
the age group of 40-60 contributes about 15% and above 60 age groups contributes 8%.

CAUSES FOR INFERTILITY

.
HORMONAL DISORDERS STDs
OBESITY GENETIC
8%
17%
33%
42%

Figure 10 CAUSES FOR INFERTILITY

In Figure 10, Among the various data collected from people we can infer that obesity is an
important cause for infertility. Proper health along with proper exercise can help to resolve
this problem. The majority of cause is due to STDs which contributes 42% where next is due

Page2
2
to obesity which contributes about 33% . genetic problem can also contribute but as a rare
case of about 8%.

INFERTILITY IN MALES

.
SPERM DISORDER LOW SPERM COUNT
HORMONAL IMBALANCE

18%
36%

45%

Figure 11 INFERTILITY IN MALES

In figure 11,Among the various data collected from the people we can infer that majority of
the problem of infertility in males are caused due to low sperm count . it can be cured by AI ,
ICSI etc. most of the issues are associated with low sperm count of about 45% and next due
to sperm disorder or deformities of about 37% and 18% hormonal.

INFERTILITY IN FEMALES

IMMUNOLOGICAL FACTORS
18%
OVULATORY FAILURE
27%

PCOS
9%
ENDOMETRIOSIS
45%

Figure 12 INFERTILITY IN FEMALES

In figure 12, Among the collected data from different people it can be identified that due to
lack of proper exercise females get obese and have infertility . the majority is given by
endometriosis which contributes about 46% followed by 27% ovulatory failure.

Page2
3
SYMPTOMS OF INFERTILITY

SYMPTOMS
STRESS ANXIETY BACK PAIN OTHER

8%

15%
46%

31%

Figure 13 SYMPTOMS OF INFERTILITY

In figure 13,The most seen symptom of infertility is stress which contributes about 46%
followed by anxiety about 31% and then back pain of about 8% . females who are all having
these symptoms need not be necessary to compulsory infertile . it may also be caused by
other factors.

DIAGNOSIS OF MALE INFERTILITY

DIAGNOSIS
SEMEN ANALYSIS
5%3% HORMONE TESTING
9%
33% SCROTAL ULTRASOUND
TRANSRECTAL ULTRASOUND
17%
TESTICULAR BIOPSY
GENETIC TEST
15% 18%
POST-EJACULATION URINALYSIS

Figure 14 DIAGNOSIS OF MALE INFERTILITY

In figure 14, Among the data obtained from the survey , we can conclude that most probable
diagnosis recommended by doctor is semen analysis . it is may be probably due to check for
sperm count and any other deforms in sperms. 33% semen analysis is done the followed by
18% hormone testing followed by transrectal ultrasound.

TREAMENTS FOR INFERTILITY IN MALES

Page2
4
 TREATMENT SURGERY
7%3%4% TREATING INFECTION
ASSISTED REPRODUCTIVE
TECHNOLOGY[ART]
36%
HORMONE TREATMENTS
AND MEDICATIONS
TREATMENTS FOR SEXUAL
50% INTERCOURSE PROBLEMS

Figure 15 TREATMENT FOR INFERTILITY IN MALES

In figure 15, It can be clearly seen that the most probable treatment suggested by doctors are
assisted reproductive technology [ART] , the most advised treatment of about 50% and then
followed by treating infection which contributes about 36% and then hormone treatments
contributes 7%.

DIAGNOSIS OF FEMALE INFERTILITY

DIAGNOSIS
OVULATION TESTING OVARIAN RESERVE TESTING
OTHER HORMONE TESTING IMAGING TESTING
LAPAROSCOPY GENETIC TESTING

2%
1%
11%

37%
19%

30%

Figure 16 DIAGNOSIS OF FEMALE INFERTILITY

In figure 16,The most probable testing done for females are ovulation testing , in which the
females from home itself they can detect the LH surge that occurs before ovulation . it also
includes blood test for progesterone. Majority of them of about 37% suggest ovulation testing
followed by 30% of ovarian reserve testing. Genetic testing however is rare because most of
the cases are associated with it.

Page2
5
TREATMENTS FOR FEMALE INFERTILITY

TREATMENTS
CLOMIPHENE CITRATE GONADOTROPHINS METFORMIN
LETROZOLE ART

29%
36%

7%
7%
21%

Figure 17 TREATMENTS FOR FEMALE INFERTILITY

In figure 17,It can be clearly from the obtained survey most of the suggested treatments are
based on drugs , that too “metformin” drug is highly represented one , esp. for PCOS. Mostly
there are people saying ART with no use of drugs has best treatment. most of the suggested
treatments are clomiphene citrate which contributes about 36% followed by metformin of
about 29%.

SIDE EFFECTS OF SUCH TREATMENTS FEMALE

In females we probably see that the most recommended medications are based on drugs , so
the probable side effects are greater

SIDE EFFECTS
LONG TERM RISKS OF OVARIAN TUMORS
PREGNANCY WITH MULTIPLES
OVARIAN HYPERSTIMULATION SYNDROME[OHSS]

25% 38%

38%

Figure 18 SIDE EFFECTS

Page2
6
In figure 18,The most often seen problems due to these drug treatments for infertility is
related with 38% of pregnancy with multiples and followed by 37% of long term risk of
ovarian tumors.

SUMMARY AND CONCLUSION .

 The present study among people on the basis of infertility shows that females have
greater knowledge though they are not prone much to Infertility , but males lacks the
awareness for infertility and contribute more towards infertility.
 However even if the male is infertile or not or female Infertile , our society used to
blame only females for infertility. Infertility have many psychological effects in both
male and female and however everyone misunderstand the exact cause for infertility,
from this survey obtained it can be clearly seen which method is more appropriate to
get treated and which is not advised .people of our society lacks the knowledge of
infertility and often get wrong treatments which may cause more harmful effect .it can
be clearly understood that life style modification causes such harmful effect such as
obesity , hormonal disorders etc. which in turn affects infertility in one way or other .
but the most suitable treatment for infertility would probably be ART.
 This is common for both males and females .there is also a great concern on
infertility in future also.
 The govt. of india have also taken necessary step to provide the availability of
maximum technology to every citizen of the country as of their duty to cure infertility.
People who have infertility should come out of all religious factors and make use of
them .If these treatment methods have failed then couples can adopt children with
certain laws permitted by government.
 It can also be seen most of them agreed ART as a treatment method for infertility
becoz more than 90% efficiency can be obtained with this method. Scientist and govt.
of different are still working on to bring more technology which are more effective for
the problem of infertility and also at low cost such that everyone can afford it which is
an very challenging one for them.

Page2
7
 REFERENCE .

 Dr Kumarasamy Thangaraj, Thomas Obinchemti Egbe, Brenda Biaani León-Gómez,

S. Donkor, Jessica Scotchie, MD, the co-founder of Tennessee Reproductive
Medicine who’s double board-certified in reproductive endocrinology and infertility
(REI).
 . Cousens S, Blencowe H, Stanton C, Chou D, Ahmed S, et al. (2011) National,
regional, and worldwide estimates of stillbirth rates in 2009 with trends since 1995: a
systematic analysis. Lancet 377: 1319–1330.
 2. World Health Organization, United Nations Children's Fund, United Nations
Population Fund, The World Bank (2012) Trends in maternal mortality: 1990 to 2010.
Geneva: World Health Organization.
 3. Cui W (2010) Mother or nothing: the agony of infertility. Bull World Health
Organ 88: 881–882 .
 4. Chachamovich JR, Chachamovich E, Ezer H, Fleck MP, Knauth D, et al.
(2010) Investigating quality of life and health-related quality of life in infertility: a
systematic review. J Psychosom Obstet Gynaecol 31: 101–110
 5. Boivin J, Bunting L, Collins JA, Nygren KG (2007) International estimates of
infertility prevalence and treatment-seeking: potential need and demand for infertility
medical care. Hum Reprod 22: 1506–1512 .
 6. Rutstein SO, Shah IH (2004) Infecundity, infertility, and childlessness in
developing countries. Calverton (Maryland): ORC Macro. 57 p.
 7. Ericksen K, Brunette T (1996) Patterns and predictors of infertility among African
women: a cross-national survey of twenty-seven nations. Soc Sci Med 42: 209–220
 8. Larsen U (2000) Primary and secondary infertility in sub-Saharan Africa. Int J
Epidemiol 29: 285–291 .
 9. Gurunath S, Pandian Z, Anderson RA, Bhattacharya S (2011) Defining infertility—
a systematic review of prevalence studies. Hum Reprod Update 17: 575–588 .
 10. Dyer SJ (2009) International estimates on infertility prevalence and treatment
seeking: potential need and demand for medical care. Hum Reprod 24: 2379–2380
 NCERT textbook .

Page2
8
APPENDIX .

Page2
9
Page3
0
Page3
1
Page3
2
Page3
3
Page3
4
LIST OF FIGURES

S.NO NAME OF FIGURE PAGE.NO

1 Percentage of couples having secondary inferility 3
2 Male infertility due to deformed male. 4
3 Female infertility due to problems in different region in female 5
reproductive organ.

4 Two major causes of female infertility. 8

5 Semen analysis 12
6 Diagnosis of female infertility to test genetic problem

7 AWARENESS ABOUT INFERTILITY

8 AWARENESS AMONG DIFFERENT SEX
9 AWARENESS INFERTILITY AMONG DIFFERENT AGE GROUPS
10 CAUSES FOR INFERTILITY
11 INFERTILITY IN MALES
12 INFERTILITY IN FEMALES
13 SYMPTOMS OF INFERTILITY
14 DIAGNOSIS OF MALE INFERTILITY
15 TREATMENT FOR INFERTILITY IN MALES
16 DIAGNOSIS OF FEMALE INFERTILITY
17 TREATMENTS FOR FEMALE INFERTILITY
18 SIDE EFFECTS OF SUCH TREATMENTS FEMALE

Page3
5