{"paper_id":"2c8be9a3-d1ce-4aa1-8fc4-99b9093caf3e","body_text":"~ 427 ~ \nInternational Journal of Clinical Obstetrics and Gynaecology 2021; 5(1): 427-429 \n \nISSN (P): 2522-6614 \nISSN (E): 2522-6622 \n© Gynaecology Journal \nwww.gynaecologyjournal.com \n2021; 5(1): 427-429 \nReceived: 21-11-2020 \nAccepted: 25-12-2020 \n \nDr. Nazima Alauddin \nAssociate Professor,  \nDepartment of Obstetrics and \nGynecology, Dr. Patnam Mahender \nReddy Institute of Medical \nSciences, Chevella, Ranga Reddy, \nTelangana, India \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \nCorresponding Author: \nDr. Nazima Alauddin \nAssociate Professor,  \nDepartment of Obstetrics and \nGynecology, Dr. Patnam Mahender \nReddy Institute of Medical \nSciences, Chevella, Ranga Reddy, \nTelangana, India \n \nStudy on causes of infertility \n \nDr. Nazima Alauddin \n \nDOI: https://doi.org/10.33545/gynae.2021.v5.i1g.850 \n \nAbstract \nBackground: Infertile women are severely stigmatized by Indian society. A new definition of reproductive \nhealth envisages the provision of a woman's health package which includes family planning and healthy \nmotherhood, the treatment of reproductive infections, and the support of infertile couples for the delivery of \nchildren. \nObjective: Prevalence of female infertility causes to be measured. To explore the various causes that affect \nwomen's infertility. \nMethods: Detailed history of the patient,  thorough general examination, height, weight, speculum, TFT, \nurine routine, and USG abdominal and pelvic. \nResults: Majority of the patients belonged to the age group of 21 to 25 yrs with 38%. Majority of the \npatients were married for around 5 to 10 yrs around 53%  of them. Family history was seen in 28% of the \ncases. Around 43% were overweight and 10% were obese. In 44% of the cases menstrual cycle was \nirregular. Dysmenorrhea was seen in 33% of the cases. Vaginal discharg e was seen in 30% of the cases.  \nDuring hysteroscopy tubal block was seen in 10% of the cases. In pelvic examination Foul smelling vaginal \ndischarge was seen in 28% of the cases. Bulky uterus was seen in 10% of the cases. Fornixes tender \nrestricted mobility was seen in 7% of the case. In USG examinat ion PCOD was seen in 50% of the cases. \nFibroid and Chocolate cyst was seen in 7.5% of the cases each and adenomyosis was seen in 2.5% of the \ncases.  \nConclusion: Female infertility causes should be systematically analyzed starting from history, analysis and  \nresearch. The main cause of female infertility is polycystic ovarian disease (PCOD), which is rising \nbecause of lifestyle changes. PCOD is also easy to deal with and a good prediction of infertility relative to \nthe other factors. Other medical conditions such as thyroid dysfunction and hyperprolactinemia will coexist \nwith PCOD, which must be tested and treated accordingly for better outcomes. \n \nKeywords: PCOD, hysteroscopy, dysmenorrhea, tubal block \n \nIntroduction  \nParenthood is a human necessity. There is a  virtual universal desire to replicate. All humans \nwant to become parents and look after their children. Parental desire itself is a step in forming a \nfamily [1]. \nInfertility is generally characterized as unwanted failure after a year of unprotected interc ourse. \nIf after sexual intercourse, a woman has never conceived after one year it is primary infertility. \nWhether a woman has conceived and then cannot  reproduce for a span of one year despite \nsexual intercourse, it is secondary infertility [2]. \nOne contra diction in Indian culture is that fertility and childbirth in marriage are extremely \nimportant on the one hand. If a woman does not conceive within one year of marriage, she is \nseen in Indian culture as a shame. Sadly, the finger is pointed at the woman fo r infertility, not \nthe husband. Couples may be reluctant to pursue medical advice by being fearful of definitive \ndiagnosis, psychological anguish, physical pain in testing and a lack of conceivability. Primary \ninfertile couples typically have a greater priority in care than secondary infertile couples [3]. \nThe WHO predicts a general infertility rate of 3.9 to 16.8 percent in India. Supportive and \ntherapeutic advice is an integral aspect of a fertility unit's programmes. The anxiety of infertiles, \nthe appreh ension and frustration involved with systems of therapy, the uncertainty of success \nand the probability of failure was there  in the back of the mind. They should be helped with \nprofessional guidance [4]. \nAccording to the literature review, 80 million indiv iduals are infertile  across the globe (10% -\n15%) and two -thirds of cases of infertility are exclusively attributable to women. In this study \nthe causes of female infertility are identified and assessed and the risk percentage determined for \npatients presenting at the outpatient department [5]. \n\n\nInternational Journal of Clinical Obstetrics and Gynaecology http://www.gynaecologyjournal.com \n~ 428 ~ \nMaterial and methods \nStudy Design: Non-randomized cross-sectional study \nStudy setting: Outpatient department of obstetri cs and \ngynecology. \n \nResearch duration: One year \n \nPeople with a history of infertility visiting t he outpatient \ndepartment of Obstetrics, taking into account inclusion and  \nCriteria for exclusion. \n \nInclusion Criteria \nThe following criteria apply to women in the outpatient \ngynecology department: \n 20 to 40 years of age \n married for >1 year and staying with a husband; \n Do not use any contraceptives \n couples that do not conceive after a pregnancy, \n For two years, in the absence of abortion, lactation or \npostpartum amenorrhea. \n \nExclusion Criteria \n Those unwilling to participate. \n Women on In vitro fertilization (IVF) treatment. \n \nA comprehensive history of patients including  socio-economic \nstatus, menstrual history, coital history, obstetrical history, the \nprevious medical history, family history, psychological history \nand the history of patients was noted after recei ving informed \nconsent from patients. History of surgery. The thoroughness and \nbreast examination, cardiovascular system, metabolic system, \nabdominal system, was followed by a thorough general physical \nassessment of height, weight, pulse, blood pressure, re spiratory \nrate and thyroid examination, speculum examination, pelvic \nexamination and rectal exam, also performed and recorded. \n \nEthical Clearance:  Ethical clearance was obtained from the \ninstitutional committee prior to the commencement of the study. \n \nObservation and results \n \nTable 1: Distribution of patients according to age, socio economic, \nmarital duration, Family history and BMI parameters \n \nAge (In yrs) No. of patients Percentage \n21 – 25 15 37.5% \n26 - 30 13 32.5% \n31 - 35 10 25% \n36 - 40 2 5% \nTotal 40 100% \nSocio economic status   \nMiddle 2 5% \nUpper middle 38 95% \nMarried for yrs   \n<5 yrs 16 40% \n5-10 yrs 21 52.5% \n>10 yrs 3 7.5% \nFamily History   \nPresent 11 27.5% \nAbsent 29 72.5% \nBMI   \n18.5-24.9 19 47.5% \n25-29.9 17 42.5% \n>30 4 10% \n \nMajority o f the patients belonged to the age group of 21 to 25 \nyrs with 38% and the least belonged to the age group of 36 to 40 \nyrs with 5%. Majority of the patients around 95% belonged to \nthe upper middle class. Majority of the patients were married for \naround 5 to 10 yrs around 53% of them. Family history was seen \nin 28% of the cases. Around 43% were overweight and 10% \nwere obese. \n \nTable 2: Distribution based on menstrual cycle, Dysmenorrhea, \nVaginal discharge and Hysteroscopy \n \nMenstrual cycle No. of patients Percentage \nIrregular 18 44.2% \nRegular 22 55.8% \nDysmenorrhea   \nPresent 12 32.6% \nAbsent 28 67.4% \nVaginal discharge   \nPresent 11 30.2% \nAbsent 29 69.8% \nHysteroscopy   \nNormal 36 90% \nTubal block 4 10% \n \nIn 44% of the cases menstrual cycle was irregular. \nDysmenorrhea was seen in 33% of the cases. Vaginal discharge \nwas seen in 30% of the cases. During hysteroscopy tubal block \nwas seen in 10% of the cases. \n \nTable 3: Distribution based on Co-morbidities \n \nCo-morbidities No. of patients Percentage \nDiabetes Mellitus 6 15% \nHypothyroid 2 5% \nTuberculosis 2 5% \nNone 30 75% \n \nComorbidities found were, Diabetes mellitus was seen in 15% of \nthe cases, hypothyroidism was seen in 5% of the cases. TB was \nseen in 5% of the cases. \n \nTable 4: Pelvic Examination \n \nPelvic Examination No. of patients Percentage \nNormal 22 55% \nFoul smelling vaginal discharge 11 27.5% \nBulky uterus 4 10% \nFornixes tender restricted mobility 3 7.5% \n \nIn pelvic examination Foul smelling vaginal discharge was seen \nin 28% of the cases. Bulky uterus was seen in 10% of the cases. \nFornixes tender restricted mobility was seen in 7% of the case. \n \nTable 5: USG examination outcomes \n \nUSG No. of patients Percentage \nPCOD 20 50% \nNormal 13 32.5% \nFibroid 3 7.5% \nChocolate cyst / Endometriosis 3 7.5% \nAdenomyosis 1 2.5% \n \nIn USG examination PCOD was seen in 50% of the cases. \nFibroid and Chocolate cyst was seen in 7.5% of the cases each \nand adenomyosis was seen in 2.5% of the cases.  \n \nTable 6: Patients opting for Treatment for infertility \n \nTreatment for Infertility No. of patients Percentage \nOvulation induction 15 37.5% \nLaparoscopy 3 7.5% \nNone 22 55% \n\nInternational Journal of Clinical Obstetrics and Gynaecology http://www.gynaecologyjournal.com \n~ 429 ~ \nPatients who are getting treated for infertility were 45%, of \nwhich Ovulation induction was done in 37.5% of the cases and \nlaparoscopy was done in 7.5% of the cases. \n \nDiscussion \nThis study  investigated 40 women who came to OPD with \ninfertility complaints. They were  screened for infertility \nby routine blood tests, thyroid function tests, ultrasound \nof abdomen and pelvis and hysteroscopy. \nWomen aged 21 -40 years are part of the research sample. In a \nstudy by Abha maheshwari et al . stated women aged 35+ are \nabout twice as vulnerable to unexplained infertility [6]. \n95% of women had the highest socioeconomic status, depending \non the distribution of the study population, accor ding to the \nsocioeconomic status of women. F Grodstein et al. reported that \nabout 70% of unfertile women had a comparatively high \nsocioeconomic status in his research [7]. \nApproximately 53 percent of the study population had been \nmarried and suffered infer tility for five to ten years. In a  study \nby Karla Lucian and Bretherick et al. stated that the incidence of \ninfertility increases as marital age increases [8]. \nIn this research, 28 percent of women had symptoms of foul \nsmelling vaginal discharge, which was  suggestive of infection. \nWESTROM et al  said that about 28.6 percent of women's \ninfertility is primarily attributed to pelvic inflammatory disorder, \na preventable cause if early diagno sis and treatment was \nperformed [9]. \nGeorge Schaefer et al . has suggeste d that genital tract \ntuberculosis can be present in 5 percent or more people with \ninfertility without apparent clinical signs and symptoms [10]. \nB M Zaadstra et al . in their analysis concluded that body fat \ndistribution appears to have more effect on ferti lity than age i n \nwomen of reproductive age [11]. \nIn our study, 50% of women assessed for infertility had PCOD, \nfollowed by tubal blocks due to multiple causes,  pelvic \ninflammatory disorder, diabetes, tuberculosis and fibroid uterine \nadenomyosis. \n \nTable 8: Percentage of causes of female infertility \n \nCauses of Infertility Percentage \nPCOD 50% \nPCOD with DM 12.5% \nTubal Block 10% \n PID 2.5% \n DM 2.5% \n Tuberculosis 5% \nFibroid Uterus 7.5% \nEndometriosis 7.5% \nUnexplained 10% \nAdenomyosis 2.5% \n \nInfertility is the  big concern that has risen at this era. Female \ninfertility causes should be carefully evaluated, investigated and \nstudied from history. PCOD is the primary cause of infertility in \nwomen, which rises because of changes in the lifestyle. PCOD \ncan also be qu ickly handled and the forecast is strong relative to \nthe other causes. The next big cause is tubal block due to PID, \nDM, and TB infertility for women. Any women who present \nwith infertility also have endometriosis. In this group of people, \nthe outcome is b ad and it is not entirely treatable. Very small \ninfertile population with adenomyosis and fibroid uterus. There \nis an explicit definition of infertility, also known as idiopathic \ninfertility, which involves the population whose cause is \nuncertain. \nConclusion \nInfertility is the biggest concern that has risen at this era. Female \ninfertility causes should be systematically analyzed starting from \nhistory, analysis and research. The main cause of female \ninfertility is polycystic ovarian disease (PCOD), which is rising \nbecause of lifestyle changes. PCOD is also easy to deal with and \na good prediction of infertility relative to the other factors. Other \nmedical conditions such as thyroid dysfunction and \nhyperprolactinemia will coexist with PCOD, which must be \ntested and treated accordingly for better outcomes. \n \nReferences \n1. Fleur Heyliger. Realities in child bearing. Clinical Obstet \nand Gynaecol 2001;42(1):164-168. \n2. Shireen Jeejeboy. Infertility in India. Journal of family \nwelfare 1998;44(2):15-24. \n3. Dutta DC. Text Book o f Obstetrics. Calcuta: New Central \nBook Agency Ltd 1998. \n4. WHO. Infertility: a tabulation of available data on \nprevalence of primary  and secondary infertility 1991, 716-\n720. \n5. Jumayev I, Harun -Or-Rashid M, Rustamov O, Zakirova N, \nKasuya H, Sakamoto J. Social c orrelates of female \ninfertility in Uzbekistan. Nagoya J Med Sci  2012;74(3-\n4):273-83. \n6. Abha Maheshwar , et al ., Effect of female age on the \ndiagnostic categories of infertility; Human Reproduction \n2008;23(3):538-542. \n7. Grodstein F , Goldman MB, Cramer DW. Infert ility in \nwomen and moderate alcohol use. American Journal of \nPublic Health September 1994;84(9):1429-1432. \n8. Karla Bretherick L et al . Fertility and aging, Fertility and \nsterility 2010;93(7):2162-2168. \n9. Westrom et al . Pelvic inflammatory disease and fertility ; \nSexually Transmitted Diseases 1992;19(4):185-192. \n10. George Schaefer et al . Female Genital Tuberculosis; \nClinical Obstetrics & Gynecology 1976;19(1):223-239. \n11. Zaadstra BM et al . Fat and female fecundit y; British \nMedical Journal 1993;306:484.","source_license":"CC0","license_restricted":false}