Study on causes of infertility

Background: Infertile women are severely stigmatized by Indian society. A new definition of reproductive health envisages the provision of a woman's health package which includes family planning and healthy motherhood, the treatment of reproductive infections, and the support of infertile couples for the delivery of children.

Prevalence of female infertility causes to be measured. To explore the various causes that affect women's infertility.

Detailed history of the patient, thorough general examination, height, weight, speculum, TFT, urine routine, and USG abdominal and pelvic.

Majority of the patients belonged to the age group of 21 to 25 yrs with 38%. Majority of the patients were married for around 5 to 10 yrs around 53% of them. Family history was seen in 28% of the cases. Around 43% were overweight and 10% were obese. In 44% of the cases menstrual cycle was irregular. Dysmenorrhea was seen in 33% of the cases. Vaginal discharg e was seen in 30% of the cases. During hysteroscopy tubal block was seen in 10% of the cases. In pelvic examination Foul smelling vaginal discharge was seen in 28% of the cases. Bulky uterus was seen in 10% of the cases. Fornixes tender restricted mobility was seen in 7% of the case. In USG examinat ion PCOD was seen in 50% of the cases. Fibroid and Chocolate cyst was seen in 7.5% of the cases each and adenomyosis was seen in 2.5% of the cases.

Female infertility causes should be systematically analyzed starting from history, analysis and research. The main cause of female infertility is polycystic ovarian disease (PCOD), which is rising because of lifestyle changes. PCOD is also easy to deal with and a good prediction of infertility relative to the other factors. Other medical conditions such as thyroid dysfunction and hyperprolactinemia will coexist with PCOD, which must be tested and treated accordingly for better outcomes.

PCOD, hysteroscopy, dysmenorrhea, tubal block

Parenthood is a human necessity. There is a virtual universal desire to replicate. All humans want to become parents and look after their children. Parental desire itself is a step in forming a family [1]. Infertility is generally characterized as unwanted failure after a year of unprotected interc ourse. If after sexual intercourse, a woman has never conceived after one year it is primary infertility. Whether a woman has conceived and then cannot reproduce for a span of one year despite sexual intercourse, it is secondary infertility [2]. One contra diction in Indian culture is that fertility and childbirth in marriage are extremely important on the one hand. If a woman does not conceive within one year of marriage, she is seen in Indian culture as a shame. Sadly, the finger is pointed at the woman fo r infertility, not the husband. Couples may be reluctant to pursue medical advice by being fearful of definitive diagnosis, psychological anguish, physical pain in testing and a lack of conceivability. Primary infertile couples typically have a greater priority in care than secondary infertile couples [3]. The WHO predicts a general infertility rate of 3.9 to 16.8 percent in India. Supportive and therapeutic advice is an integral aspect of a fertility unit's programmes. The anxiety of infertiles, the appreh ension and frustration involved with systems of therapy, the uncertainty of success and the probability of failure was there in the back of the mind. They should be helped with professional guidance [4]. According to the literature review, 80 million indiv iduals are infertile across the globe (10% - 15%) and two -thirds of cases of infertility are exclusively attributable to women. In this study the causes of female infertility are identified and assessed and the risk percentage determined for patients presenting at the outpatient department [5]. International Journal of Clinical Obstetrics and Gynaecology http://www.gynaecologyjournal.com ~ 428 ~

Study Design: Non-randomized cross-sectional study Study setting: Outpatient department of obstetri cs and gynecology. Research duration: One year People with a history of infertility visiting t he outpatient department of Obstetrics, taking into account inclusion and Criteria for exclusion. Inclusion Criteria The following criteria apply to women in the outpatient gynecology department:  20 to 40 years of age  married for >1 year and staying with a husband;  Do not use any contraceptives  couples that do not conceive after a pregnancy,  For two years, in the absence of abortion, lactation or postpartum amenorrhea. Exclusion Criteria  Those unwilling to participate.  Women on In vitro fertilization (IVF) treatment. A comprehensive history of patients including socio-economic status, menstrual history, coital history, obstetrical history, the previous medical history, family history, psychological history and the history of patients was noted after recei ving informed consent from patients. History of surgery. The thoroughness and breast examination, cardiovascular system, metabolic system, abdominal system, was followed by a thorough general physical assessment of height, weight, pulse, blood pressure, re spiratory rate and thyroid examination, speculum examination, pelvic examination and rectal exam, also performed and recorded. Ethical Clearance: Ethical clearance was obtained from the institutional committee prior to the commencement of the study. Observation and results Table 1: Distribution of patients according to age, socio economic, marital duration, Family history and BMI parameters Age (In yrs) No. of patients Percentage 21 – 25 15 37.5% 26 - 30 13 32.5% 31 - 35 10 25% 36 - 40 2 5% Total 40 100% Socio economic status Middle 2 5% Upper middle 38 95% Married for yrs 10 yrs 3 7.5% Family History Present 11 27.5% Absent 29 72.5% BMI 18.5-24.9 19 47.5% 25-29.9 17 42.5% >30 4 10% Majority o f the patients belonged to the age group of 21 to 25 yrs with 38% and the least belonged to the age group of 36 to 40 yrs with 5%. Majority of the patients around 95% belonged to the upper middle class. Majority of the patients were married for around 5 to 10 yrs around 53% of them. Family history was seen in 28% of the cases. Around 43% were overweight and 10% were obese. Table 2: Distribution based on menstrual cycle, Dysmenorrhea, Vaginal discharge and Hysteroscopy Menstrual cycle No. of patients Percentage Irregular 18 44.2% Regular 22 55.8% Dysmenorrhea Present 12 32.6% Absent 28 67.4% Vaginal discharge Present 11 30.2% Absent 29 69.8% Hysteroscopy Normal 36 90% Tubal block 4 10% In 44% of the cases menstrual cycle was irregular. Dysmenorrhea was seen in 33% of the cases. Vaginal discharge was seen in 30% of the cases. During hysteroscopy tubal block was seen in 10% of the cases. Table 3: Distribution based on Co-morbidities Co-morbidities No. of patients Percentage Diabetes Mellitus 6 15% Hypothyroid 2 5% Tuberculosis 2 5% None 30 75% Comorbidities found were, Diabetes mellitus was seen in 15% of the cases, hypothyroidism was seen in 5% of the cases. TB was seen in 5% of the cases. Table 4: Pelvic Examination Pelvic Examination No. of patients Percentage Normal 22 55% Foul smelling vaginal discharge 11 27.5% Bulky uterus 4 10% Fornixes tender restricted mobility 3 7.5% In pelvic examination Foul smelling vaginal discharge was seen in 28% of the cases. Bulky uterus was seen in 10% of the cases. Fornixes tender restricted mobility was seen in 7% of the case. Table 5: USG examination outcomes USG No. of patients Percentage PCOD 20 50% Normal 13 32.5% Fibroid 3 7.5% Chocolate cyst / Endometriosis 3 7.5% Adenomyosis 1 2.5% In USG examination PCOD was seen in 50% of the cases. Fibroid and Chocolate cyst was seen in 7.5% of the cases each and adenomyosis was seen in 2.5% of the cases. Table 6: Patients opting for Treatment for infertility Treatment for Infertility No. of patients Percentage Ovulation induction 15 37.5% Laparoscopy 3 7.5% None 22 55% International Journal of Clinical Obstetrics and Gynaecology http://www.gynaecologyjournal.com ~ 429 ~ Patients who are getting treated for infertility were 45%, of which Ovulation induction was done in 37.5% of the cases and laparoscopy was done in 7.5% of the cases.

This study investigated 40 women who came to OPD with infertility complaints. They were screened for infertility by routine blood tests, thyroid function tests, ultrasound of abdomen and pelvis and hysteroscopy. Women aged 21 -40 years are part of the research sample. In a study by Abha maheshwari et al . stated women aged 35+ are about twice as vulnerable to unexplained infertility [6]. 95% of women had the highest socioeconomic status, depending on the distribution of the study population, accor ding to the socioeconomic status of women. F Grodstein et al. reported that about 70% of unfertile women had a comparatively high socioeconomic status in his research [7]. Approximately 53 percent of the study population had been married and suffered infer tility for five to ten years. In a study by Karla Lucian and Bretherick et al. stated that the incidence of infertility increases as marital age increases [8]. In this research, 28 percent of women had symptoms of foul smelling vaginal discharge, which was suggestive of infection. WESTROM et al said that about 28.6 percent of women's infertility is primarily attributed to pelvic inflammatory disorder, a preventable cause if early diagno sis and treatment was performed [9]. George Schaefer et al . has suggeste d that genital tract tuberculosis can be present in 5 percent or more people with infertility without apparent clinical signs and symptoms [10]. B M Zaadstra et al . in their analysis concluded that body fat distribution appears to have more effect on ferti lity than age i n women of reproductive age [11]. In our study, 50% of women assessed for infertility had PCOD, followed by tubal blocks due to multiple causes, pelvic inflammatory disorder, diabetes, tuberculosis and fibroid uterine adenomyosis. Table 8: Percentage of causes of female infertility Causes of Infertility Percentage PCOD 50% PCOD with DM 12.5% Tubal Block 10%  PID 2.5%  DM 2.5%  Tuberculosis 5% Fibroid Uterus 7.5% Endometriosis 7.5% Unexplained 10% Adenomyosis 2.5% Infertility is the big concern that has risen at this era. Female infertility causes should be carefully evaluated, investigated and studied from history. PCOD is the primary cause of infertility in women, which rises because of changes in the lifestyle. PCOD can also be qu ickly handled and the forecast is strong relative to the other causes. The next big cause is tubal block due to PID, DM, and TB infertility for women. Any women who present with infertility also have endometriosis. In this group of people, the outcome is b ad and it is not entirely treatable. Very small infertile population with adenomyosis and fibroid uterus. There is an explicit definition of infertility, also known as idiopathic infertility, which involves the population whose cause is uncertain.

Infertility is the biggest concern that has risen at this era. Female infertility causes should be systematically analyzed starting from history, analysis and research. The main cause of female infertility is polycystic ovarian disease (PCOD), which is rising because of lifestyle changes. PCOD is also easy to deal with and a good prediction of infertility relative to the other factors. Other medical conditions such as thyroid dysfunction and hyperprolactinemia will coexist with PCOD, which must be tested and treated accordingly for better outcomes.

1. Fleur Heyliger. Realities in child bearing. Clinical Obstet and Gynaecol 2001;42(1):164-168. 2. Shireen Jeejeboy. Infertility in India. Journal of family welfare 1998;44(2):15-24. 3. Dutta DC. Text Book o f Obstetrics. Calcuta: New Central Book Agency Ltd 1998. 4. WHO. Infertility: a tabulation of available data on prevalence of primary and secondary infertility 1991, 716- 720. 5. Jumayev I, Harun -Or-Rashid M, Rustamov O, Zakirova N, Kasuya H, Sakamoto J. Social c orrelates of female infertility in Uzbekistan. Nagoya J Med Sci 2012;74(3- 4):273-83. 6. Abha Maheshwar , et al ., Effect of female age on the diagnostic categories of infertility; Human Reproduction 2008;23(3):538-542. 7. Grodstein F , Goldman MB, Cramer DW. Infert ility in women and moderate alcohol use. American Journal of Public Health September 1994;84(9):1429-1432. 8. Karla Bretherick L et al . Fertility and aging, Fertility and sterility 2010;93(7):2162-2168. 9. Westrom et al . Pelvic inflammatory disease and fertility ; Sexually Transmitted Diseases 1992;19(4):185-192. 10. George Schaefer et al . Female Genital Tuberculosis; Clinical Obstetrics & Gynecology 1976;19(1):223-239. 11. Zaadstra BM et al . Fat and female fecundit y; British Medical Journal 1993;306:484.