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 causes are
not same , but for all of these problems one of the major reason 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.

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
 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
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]

 “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.

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.
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.

PYSCHOLOGICAL EFFECTS

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.

OTHER CAUSES

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:

 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.

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
(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
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.
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.

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

 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.
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, 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.

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
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. 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].

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

If conservative medical treatments fail to achieve a full term pregnancy, the physician or
WHNP may suggest the patient undergo in vitro fertilization (IVF). IVF and related
techniques (ICSI, ZIFT, and GIFT) are called assisted reproductive technology (ART)
techniques.

METHODOLOGY

METHOD

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

SAMPLE
 The primary data required for the study were collected from different people in my area. A
total number of 500 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.

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 infertilitty

Awareness about low high

treatments for
infertility

Awareness about average high

STDs

Infertility cases high low

produced by
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 bmales as
compared to that of females. So males shou;ld 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

100% INFERTILITY CASE

90% GRAPH
80%
70%
60%
50%
40%
30%
STATISTICAL
20%
TECHNIQUES USED
10%
0%
1950-1970 1970-1990 1990-2010 2010-2021
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 500 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

 .

AVERAGE
24% HIGH
40%

LOW
36%

Among that 500 people who have been surveyed , 40% of the people have high knowledge
towards infertility and 36% low knowledge and 24 % average knowledge. This suggest that
people must be educated properly about infertility and proper measures should be taken.

AWARENESS AMONG DIFFERENT SEX

.
MALE FEMALE BOTH

20%

54%

26%

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..

AWARENESS AMONG DIFFERENT AGE GROUPS

 .
BELOW 20 20-40 40-60 ABOVE 60

10%

30%

20%

40%

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 .

CAUSES FOR INFERTILITY

.
POOR HEALTH STD'S OBESITY GENETIC

4%
10%

26%

60%

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.

INFERTILITY IN MALES
 .
SPERM DISORDER LOW SPERM COUNT HORMONAL IMBALANCE

20%
30%

50%

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.