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. Many techniques are developed to resolve this problem but
not always . you know When I started, I did not even know what an egg looked like," recalls
Indira Hinduja, the gynaecologist responsible for the birth of Harsha Chawda, India's first
IVF baby in 1986. ... The Indian Council of Medical Research (ICMR) estimates at least 10
per cent of couples in India face infertility. New studies suggest that new varies of sexually
transmitted diseases have also been found which is responsible for infertility. A normative
survey was taken in my area among 500 individuals , among them everyone had different
knowledge or ideas about this infertility . the sample data collected was analysed on
percentage basis . The main aim of this survey was to understand the awareness among
people about infertility . Upon understanding most of the people about 55 per had the exact
knowledge . In comparison among males and females , females had more knowledge though
most of the problems are associated with males. majority of people are aware about
infertility that too the age group of 20-30 have more awareness.

INTRODUCTION

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.

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]. Researchers commonly base
demographic studies on infertility prevalence on a five-year period. Practical measurement

Page 1
problems, however, exist for any definition, because it is difficult to measure continuous
exposure to the risk of pregnancy over a period of years. A WHO study, published at the end
of 2012, has shown that the overall burden of infertility in women from 190 countries has
remained similar in estimated levels and trends from 1990 to 2010. A discussion on
reproductive health is incomplete without a mention of infertility. A large number of
couples all over the world including India are infertile, i.e., they are unable to produce
children inspite of unprotected sexual co-habitation. The reasons for this could be
many–physical, congenital, diseases, drugs, immunological or even psychological. In
India, often the female is blamed for the couple being childless, but more often than not,
the problem lies in the male partner. Specialised health care units (infertility clinics,
etc.) could help in diagnosis and corrective treatment of some of these disorders and
enable these couples to have children. However, where such corrections are not possible,
the couples could be assisted to have children through certain special techniques
commonly known as assisted reproductive technologies (ART).[NCERT], There are also
several types of art which are given in fig 1.

Page 2
Fig.1; Types of ASSISTED REPRODUCTIVE TECHNOLOGY.

 “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].

The global health community has had great success in improving maternal and child health in
the past decade, partly through a focus on reproductive health . Infertility is a critical
component of reproductive health, and has often been neglected in these efforts . The
inability to have children affects men and women across the globe. Infertility can lead to
distress and depression, as well as discrimination and ostracism . An accurate profile of the
prevalence, distribution, and trends of infertility is an important first step towards shaping
evidence-based interventions and policies to reduce the burden of this neglected disability
globally.The WHO's epidemiologic definition is more closely aligned with clinical practice
than demographic definitions are, and may be measured using survey data. However, few
household surveys determine whether a couple is trying to become pregnant, and the majority
do not collect information on past pregnancies, only on previous live births.

 There are two types of infertility ; primary and secondary infertility. 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.

Page 3
Fig.2 : Percentage of secondary infertility among couples

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 secondary infertility among couples is
given in fig.2.

Fig.3 ; Percentage of Families suffering with infertility.

Infertility also causes some psychological problems ;The consequences of infertility are
manifold and can include societal repercussions and personal suffering. Advances in
assisted reproductive technologies, such as IVF, can offer hope to many couples
where treatment is available, although barriers exist in terms of medical coverage and
affordability. The medicalization of infertility has unwittingly led to a disregard for
the emotional responses that couples experience, which include distress, loss of
control, stigmatization, and a disruption in the developmental trajectory of adulthood.
Many families have also been facing many problems with infertility such as financial
problem etc. The percentage of infertility among different families is given in fig.3

PYSCHOLOGICAL EFFECTS

Page 4
Infertility may have profound psychological effects. Research has shown that infertility
affects millions of couples worldwide. Infertility is considered one of the most difficult life
experiences and can result in psychological consequences for couples, [Ernestina S. Donkor]
Partners may become more anxious to conceive, increasing sexual dysfunction Marital
discord often develops in infertile couples, especially when they are under pressure to make
medical decisions. Women trying to conceive often have clinical depression rates similar to
women who have heart disease or cancer. Even couples undertaking IVF face considerable
stress. The emotional losses created by infertility include the denial of motherhood as a rite of
passage; the loss of one’s anticipated and imagined life; feeling a loss of control over one’s
life; doubting one’s womanhood; changed and sometimes lost friendships; and, for many, the
loss of one’s religious environment as a support system. Emotional stress and marital
difficulties are greater in couples where the infertility lies with the man.

SOCIAL PROBLEMS

Infertility can also cause many social problems ; In many cultures, inability to conceive bears
a stigma. In closed social groups, a degree of rejection (or a sense of being rejected by the
couple) may cause considerable anxiety and disappointment. Some respond by actively
avoiding the issue altogether; middle-class men are the most likely to respond in this way. In
an effort to end the shame and secrecy of infertility, Redbook in October 2011 launched a
video campaign, The Truth About Trying, to start an open conversation about infertility,
which strikes one in eight women in the United States. In a survey of couples having
difficulty conceiving, conducted by the pharmaceutical company Merck, 61 percent of
respondents hid their infertility from family and friends. Nearly half didn't even tell their
mothers. The message of those speaking out: It's not always easy to get pregnant, and there's
no shame in that. There are legal ramifications as well. Infertility has begun to gain more
exposure to legal domains. An estimated 4 million workers in the U.S. used the Family and
Medical Leave Act (FMLA) in 2004 to care for a child, parent or spouse, or because of their
own personal illness. Many treatments for infertility, including diagnostic tests, surgery and
therapy for depression, can qualify one for FMLA leave. It has been suggested that infertility
be classified as a form of disability.

CAUSES

Page 5
There are in general so many causes for infertility;

 Ovulatory dysfunction is quite common, especially with the difficulties we face as a

society with increasing weight; carrying excess weight often affects ovulating
function,” says [Jessica Scotchie , MD, the co-founder of Tennessee Reproductive
Medicine who’s double board-certified in reproductive endocrinology and infertility
(REI)].but mostly the main cause is “Sexually transmitted disease”.

Infections with the following sexually transmitted pathogens have a negative effect on
fertility: [also std test samples given in fig.4]

 Chlamydia trachomatis,
 Neisseria gonorrhoeae, and Syphilis. There is a consistent association of Mycoplasma
genitalium infection and female reproductive tract syndromes. M. genitalium
infection is associated with increased risk of infertility.

Fig4 ; STD test done by the couples for the check of STD a cause for infertility.

There are many factors that can impact the fertility of women as well as men. It can be
unhealthy life choices, such as diet, choosing a sedentary lifestyle, being lethargic, etc. One
major factor that women and men alike are blindsided to is sexually transmitted diseases
(STDs). Sexually transmitted diseases play a role in many infertility issues and have become
a problem for numerous people. Other causes can be due to some genetic problems, 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

Page 6
(such as radiation or 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.

SOME OTHER GENERAL FACTOR

 There may be other causes for infertility due to general factors like ;
 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).

For females the cause is different; 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 , endometriosis ,
advanced maternal age

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

Page 7
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. In fig5 it can be seen clearly different regions of
infertility.

Fig.5; Infertility in females in different regions.

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.

Factors responsible;

Page 8
There several factors which are responsible for infertility in females, but in general some
internal factors becomes the cause for infertility. fig 6 represents the different factors
responsible for infertility .

Fig.6; Different internal factors responsible for infertility

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

• endometriosis

• advanced maternal age

Page 9
Fig.7 ; Represents the blocked fallopian tubes.

INFERTILITY IN 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, or infection. There may be testicular malformations,
hormone imbalance, or 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.The
abnormality of sperms due to genetic problems are given in fig 8.

Fig.8 ; Difference between normal and abnormal sperm.

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

Page
10
but the couple cannot conceive together without assistance. Fig 9 represents the percentage of
infertility due to combined infertility.

Fig.9; 10% of infertility contributes combined.

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, which 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.[fig.10 shows that 70% of total reported cases are unexplained or its
cause is unknown.

Page
11
Fig.10; 70% of infertility cases are unexplained

Diagnosis of male infertility

Many infertile couples have more than one cause of infertility, so it's likely you will both
need to see a doctor. It might take a number of tests to determine the cause of infertility. In
some cases, a cause is never identified.Infertility tests can be expensive and might not be
covered by insurance — find out what your medical plan covers ahead of time.

Diagnosing male infertility problems usually involves:

 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
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. Fig.11 represents the semen analysis in which they
differentiate the normal and abnormal sperms.

Fig.11; SEMEN ANALYSIS

Page
12
Your semen is then sent to a laboratory to measure the number of sperm present and look for
any abnormalities in the shape (morphology) and movement (motility) of the sperm. The lab
will also check your semen for signs of problems such as infections.

Often sperm counts fluctuate significantly from one specimen to the next. In most cases,
several semen analysis tests are done over a period of time to ensure accurate results. If your
sperm analysis is normal, your doctor will likely recommend thorough testing of your female
partner before conducting any more male infertility tests.

Your doctor might recommend additional tests to help identify the cause of your infertility.
These can include:

 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 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.

Page
13
  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.

Diagnosis for female infertility

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.

Depending on your situation, rarely your testing might include:

 Laparoscopy. This minimally invasive surgery involves making a small incision

beneath your navel and inserting a thin viewing device to examine your fallopian tubes,

Page
14
 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.[Fig.12;depicts the diagnosis done for infertility in
females

Fig.12 ; Diagnosis of infertility in females.

TREATMENT .

Technology also developed equally as the cases of infertility, there are a lot of ways through
which a couple can have children; The one of the most important way is ART- assisted
reproductive technologies. In vitro fertilisation (IVF–fertilisation outside the body in
almost similar conditions as that in the body) followed by embryo transfer (ET) is one of
such methods. In this method, popularly known as test tube baby programme, ova from
the wife/donor (female) and sperms from the husband/donor (male) are collected and
are induced to form zygote under simulated conditions in the laboratory. The zygote or
early embryos (with upto 8 blastomeres) could then be transferred into the fallopian
tube (ZIFT–zygote intra fallopian transfer) and embryos with more than 8 blastomeres,
into the uterus (IUT – intra uterine transfer), to complete its further development.
Embryos formed by in-vivo fertilisation (fusion of gametes within the female) also could
be used for such transfer to assist those females who cannot conceive. Transfer of an
ovum collected from a donor into the fallopian tube (GIFT – gamete intra fallopian

Page
15
transfer) of another female who cannot produce one, but can provide suitable
environment for fertilisation and further development is another method attempted.
Intra cytoplasmic sperm injection (ICSI) is another specialised procedure to form an
embryo in the laboratory in which a sperm is directly injected into the ovum.it can be
clearly depicted in Fig.13. Infertility cases either due to inability of the male partner to
inseminate the female or due to very low sperm counts in the ejaculates, could be
corrected by artificial insemination (AI) technique. In this technique, the semen
collected either from the husband or a healthy donor is artificially introduced either
into the vagina or into the uterus (IUI – intra-uterine insemination) of the female.
Though options are many, all these techniques require extremely high precision
handling by specialised professionals and expensive instrumentation. Therefore, these
facilities are presently available only in very few centres in the country. Obviously their
benefits is affordable to only a limited number of people. Emotional, religious and social
factors are also deterrents in the adoption of these methods. Since the ultimate aim of
all these procedures is to have children, in India we have so many orphaned and
destitute children, who would probably not survive till maturity, unless taken care of.
Our laws permit legal adoption and it is as yet, one of the best methods for couples
looking for parenthood.[NCERT].

Fig.13; ICSI[intra cytoplasmic sperm injection]

Treatment depends on the cause of infertility, but may include counseling, fertility
treatments, which include in vitro fertilization. According to ESHRE recommendations,
couples with an estimated live birth rate of 40% or higher per year are encouraged to continue
aiming for a spontaneous pregnancy. Treatment methods for infertility may be grouped as
medical or complementary and alternative treatments. Some methods may be used in concert
with other methods. Drugs used for both women and men includeclomiphene citrate, human
menopausal gonadotropin (hMG), follicle-stimulating hormone (FSH), human chorionic

Page
16
gonadotropin (hCG), gonadotropin-releasing hormone (GnRH)analogues, aromatase
inhibitors, and metformin.

Often, an exact cause of infertility can't be found. Even if an exact cause isn't clear, your
doctor might be able to recommend treatments or procedures that will lead to conception.

In cases of infertility, it's recommended that the female partner also be checked. There may
be specific treatments recommended for your partner. Or, you may learn that proceeding with
assisted reproductive techniques is appropriate in your situation.

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.

 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

Page
17
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.

 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.

Page
18
Risks of fertility drugs

Using fertility drugs carries some risks, such as:

 Pregnancy with multiples. Oral medications carry a fairly low risk of multiples (less
than 10%) and mostly a risk of twins. Your chances increase up to 30% with injectable
medications. Injectable fertility medications also carry the major risk of triplets or more.

Generally, the more fetuses you're carrying, the greater the risk of premature labor, low
birth weight and later developmental problems. Sometimes, if too many follicles
develop, adjusting medications can lower the risk of multiples.

 Ovarian hyperstimulation syndrome (OHSS). Injecting fertility drugs to induce

ovulation can cause OHSS, which is rare. Signs and symptoms, which include swollen
and painful ovaries, usually go away without treatment, and include mild abdominal
pain, bloating, nausea, vomiting and diarrhea.

It's possible to develop a more severe form of OHSS that can also cause rapid weight
gain, enlarged painful ovaries, fluid in the abdomen and shortness of breath.

 Long-term risks of ovarian tumors . Most studies of women using fertility drugs
suggest that there are few if any long-term risks. However, a few studies suggest that
women taking fertility drugs for 12 or more months without a successful pregnancy
might be at increased risk of borderline ovarian tumors later in life.

Women who never have pregnancies have an increased risk of ovarian tumors, so it
might be related to the underlying problem rather than the treatment. Since success rates
are typically higher in the first few treatment cycles, reevaluating medication use every
few months and concentrating on the treatments that have the most success appear to be
appropriate.

Surgery to restore fertility

Several surgical procedures can correct problems or otherwise improve female fertility.
However, surgical treatments for fertility are rare these days due to the success of other
treatments. They include:

Page
19
  Laparoscopic or hysteroscopic surgery. Surgery might involve correcting problems
with the uterine anatomy, removing endometrial polyps and some types of fibroids that
misshape the uterine cavity, or removing pelvic or uterine adhesions.

 Tubal surgeries. If your fallopian tubes are blocked or filled with fluid, your doctor
might recommend laparoscopic surgery to remove adhesions, dilate a tube or create a
new tubal opening. This surgery is rare, as pregnancy rates are usually better with in
vitro fertilization (IVF). For this surgery, removal of your tubes or blocking the tubes
close to the uterus can improve your chances of pregnancy with IVF.

Reproductive assistance; The most commonly used methods of reproductive assistance

include:

 Intrauterine insemination (IUI). During IUI, millions of healthy sperm are placed

inside the uterus around the time of ovulation.

 Assisted reproductive technology. This involves retrieving mature eggs, fertilizing

them with sperm in a dish in a lab, then transferring the embryos into the uterus after
fertilization. IVF is the most effective assisted reproductive technology. An IVF cycle
takes several weeks and requires frequent blood tests and daily hormone injections.

Medical treatments

Medical treatment of infertility generally involves the use of fertility medication, medical
device, surgery, or a combination of the following. If the sperm are of good quality and the
mechanics of the woman's reproductive structures are good (patent fallopian tubes, no
adhesions or scarring), a course of ovarian stimulating medication maybe used. The physician
or WHNP may also suggest using a conception cap cervical cap, which the patient uses at
home by placing the sperm inside the cap and putting the conception device on the cervix, or
intrauterine insemination (IUI), in which the doctor or WHNP introduces sperm into the
uterus during ovulation, via a catheter. In these methods, fertilization occurs inside the
body.About this different medical methods can be illustrated in Fig.14.

Page
20
Fig.14 ; Different medical treatment methods.

AIM AND 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

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 convey the
exact reason and best treatment methods and what everyone else have understood about it.

METHODOLOGY .

METHOD

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

SAMPLE

Page
21
The primary data required for the study were collected from different people in my area. A
total number of 20 samples were collected from my area . the sample were by simple random
sampling technique. the sample is represented in pi chart form in percentage . 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 the
situation and causes and treatments for infertility in current situation.

DESCRIPTION OF AWARENESS SCALE AMONG DIFFERENT SEX

One of the important objective of this investigation id to find awareness among people. for
this purpose a scale was constructed with readings concluded by a survey among people in
my area, the scale consist of 7 categories along with two comparison namely male and
female, the concluded readings are given as such high , average and low. There were also
several surveys taken in other alternative manner also.

So the scoring to the response is given by the people is as follows

CATEGORY MALES FEMALE

Awareness about low high

infertility

Infertility among high average

different sex

Awareness about low average

causes of infertility

Awareness about low high

treatments for
infertility

Awareness about average high

STDs

Infertility cases high low

produced by

Page
22
 different sex

Awareness about low high

effects of infertility

CONCLUSION

We can conclude that though males are more prone to infertility than females in many ways ,
the knowledge or awareness level of infertility and it’s description is low among males as
compared to that of females. So males should guided properly about this infertility.

DESCRIPTION OF AWARENESS SCALE AMONG DIFFERENT AGE GROUPS

AGE GROUPS AWARENESS LEVEL

Below 20 average

20-30 high

30-40 high

40-50 average

50-60 average

60-70 low

70-80 low

80-90 low

Page
23
100% INFERTILITY CASE
90% GRAPH
80%
70%
60%
50%
40%
30%
20%
10%
STATISTICAL
0%
1950-1970 1970-1990 1990-2010 2010-2021 TECHNIQUES USED

For the analysis of data ,

percentage analysis was used as the statistical technique

DATA COLLECTION PROCEDURE

The data required for the present study was collected during the time period 2 days . a total
number of 20 people were surveyed through Gforms in my area. The results were analysed
properly and concluded

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

Page
24
 .
HIGH LOW AVERAGE

8%

39%

54%

.
HIGH LOW AVERAGE

8%

39%

54%

Among that 20 people who have been surveyed , 38% of the people have high knowledge
towards infertility and 54% low knowledge and 8% average knowledge. This suggest that
people must be educated properly about infertility and proper measures should be taken.

AWARENESS AMONG DIFFERENT SEX

Page
25
 .
FEMALE MALE BOTH

15%

38%

46%

Among the graph we can easily identify that males are more prone to infertility than females
but however the just blame women for no reason. Males must be given proper treatments like
AI(artificial insemination) etc.. male contribution towards infertility is about 46% and female
contribution is 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%

31%
8%

46%

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

Page
26
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%

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 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%

Page
27
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

Sales

IMMUNOLOGICAL FACTORS
18%
OVULATORY FAILURE
27%
PCOS
9%
ENDOMETRIOSIS
45%

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.

SYMPTOMS OF INFERTILITY

SYMPTOMS
STRESS ANXIETY BACK PAIN OTHER

8%

15%

46%

31%

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

Page
28
symptoms need not be necessary to compulsory infertile . it may also be caused by other
factors.

DIAGNOSIS OF MALE INFERTILITY

DIAGNOSIS
SEMEN ANALYSIS HORMONE TESTING SCROTAL ULTRASOUND
TRANSRECTAL ULTRASOUND TESTICULAR BIOPSY GENETIC TEST
POST-EJACULATION URINALYSIS

5% 3%
9%
33%

17%

15% 18%

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

TREATMENT
SURGERY
TREATING INFECTION
ASSISTED REPRODUCTIVE TECHNOLOGY[ART]
HORMONE TREATMENTS AND MEDICATIONS
TREATMENTS FOR SEXUAL INTERCOURSE PROBLEMS

7%3% 4%

36%

50%

Page
29
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%

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.

TREATMENTS FOR FEMALE INFERTILITY

TREATMENTS
CLOMIPHENE CITRATE GONADOTROPHINS METFORMIN
LETROZOLE ART

29%
36%

7%

7%
21%

Page
30
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%

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.

There were also several techniques performed by NaProTECHNOLOGY for female

infertility. Those techniques were suggested in different percentages.

Page
31
 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. Which 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.

Page
32
 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

Page
33
 NCERT textbook .

Page
34
APPENDIX .

Page
35
Page
36
Page
37
Page
38
Survey questions

1 Do you have in depth knowledge regarding infertility?

2 which sex do you think more prone to infertility?

3 which age group do you think more prone to infertility ?

4 what do think the more appropriate cause for infertility?

5 what may be the cause for infertility in males?

6 what may be the cause for infertility in females?

7 which symptom is most seen among people having infertility?

8 which method is followed for diagnosis of infertility in males?

9 which infertility treatment do you think most appropriate for males?

10 which method is followed for diagnosis of infertility in females?

11 which infertility treatment do you think most appropriate for females?

12 which side effects are caused in most of the cases of treatments using drugs in females

Page
39