INTRODUCTION
Fertility is an existential necessity. Being unable to bring forth a progeny in a devastating experience to the couple. The label of infertility corrodes in to the physical, mental, and social aspects of the couple. Even in modern times a child less woman continues to be a subject of ridicule. Infertility is not a pathological condition ,but the absence of a desired condition as Griel put it. The perceived undesirability of childlessnessleads couple to seek help at any cost. So in recent times this social problem has become “medicalised”. In the last five decades perhaps most of the advances in medicine has taken place in the field of reproductive medicine.
The discovery of the working of the hormones related to human reproduction and their production for commercial use was an important milestone. The development of laparoscopic instruments and their refinement was another advancement in surgery. Ultra sonography and newer imaging technology made it possible to view internal organs in a non- invasive manner.
The pioneering work of Robert Edwards a biologist and Patric Steptoe a gynaecologist, lead to the birth of Louise Brown, the first officially recorded “ test tube “ baby on 25 th July 1978. But before thisDr.SubhashMukhopadhyay from Kolkata had helped a womanconcieve by the technique of In-vitro fertilisation as it is known Today. But his work was not accepted by the scientific community. He was punished for his unscientific work and finally this great scientist committed suicide.
In vitro fertilization technology did not take much time to reach India and Dr.IndiraHinduja’s work lead to the birth of Durga in Mumbai in 1986. The search for newer and safer methodology continues and molecular biology and genetics play a great role in reproductive medicine today.
DEFINITION
According to the World Health Organization (WHO), infertility can be described as the inability to become pregnant, maintain a pregnancy, or carry a pregnancy to live birth. A clinical definition of infertility by the WHO is “a disease of the reproductive system defined by the failure to achieve a clinical pregnancy after 12 months or more of regular unprotected sexual intercourse.” Infertility can further be broken down into primary and secondary infertility.
ROLE OF AYURVEDA
In India even in the 6th century BC gynaecological disorders and infertility were studied and documented by the great masters. Ayurveda embraces wonderful description about the process of reproduction. It emphasizes the importance of the care to be given in preconception time which offers a golden opportunity to provide the best of the individual.
PRE CONCEPTION CARE
Ayurvedic preconception care takes advantages of our body’s natural ability to cleanse and renew. In “Brihatrayis” We can see magnificent depictions regarding conception and Post conception care. Ayurveda offers a complete approach to fertility that embraces both the male and female roles as equally important.
Vagbhatacharya has quoted that the “darshana and sparshana of a child provides heavenly feeling which is incredible. Where as a person who is “nirapatya”( infertile), is compared with a tree which is not giving shade, not giving fruits , with foul-smelling flowers and with out any branches.
Since the problem of infertility is common it is important to find out solution which is having less complications and affordable.
Factors Affecting Female Fertility
Age
· With advanced maternal age causing an increased risk of female infertility.
· A woman’s fertility peak’s in the early and mid 20’s, after which it starts to decline slowly.
Occupational or environmental hazards.
· Prolonged exposure to mental stress,
· High temperatures
· Chemicals
· Radiation
· Heavy electromagnetic or microwave emissions may reduce woman’s Fertility.
Medication
· Anti depressants
· Antibiotics
· Painkillers
· Other drugs used to treat chronic disorders May cause temporary infertility.
Using tobacco or alcohol
· Smoking and even moderate alcohol consumption can impair conception.
Infertility may be due to male or female factors.
Conditions Affecting Female Fertility
Menstrual irregularities
· Polymenorrhoea
· Dysmenorrhoea
· Amenorrhea
Abnormal Uterine Bleeding
Ovarianfactors,
Ovulation problems– ovaries fail to release a mature egg.
· LUF( LuteinisedUnruptured Follicle)
· Follicular cyst
· Corpus luteum cyst
· PCOS(poly cystic ovary syndrome)
UTERINE FACTORS
· Endometriosis
· Adenomyosis
· Adenomyoma
· Uterine polyps
· Uterine fibroids
· Extra uterine fibroids
Tubal factors
· Hydrosalpinx
· Fallopian tube block
HORMONAL FACTORS
Hypogonadism
· Primary
· Secondary
Thyroid dysfunction
· Hypothyroidism
Other Diseases
· Diabetes
· Recurrent UTI ( urinary tract infections)etc
Male infertility is caused by problems that affect either sperm production or sperm transport which include varococele, infections, ejaculation problems, tumors,hormone imbalance, defects of tubules that transport sperm.
Factors Affecting Male Fertility
Age- with age the sex hormones decreases which in turn affects the spermatogenesis.
Tobacco-smoking hampers the process of spermatogenesis.
Alcohol- Excess usage affects testes directly.
Diet- Modern diet style have become a cause for different metabolic hormonal disorders in humans.
Occupation-
· Exposure to very hot climates or environment can affect the process of spermatogenesis badly.
· Long standing posture may cause varococele
· Electromagnetic radiation hampers sperm cells.
· Tight dress increase testicular temperatures and lowers blood circulation to that area.
Drugs-
· Anabolic steroids which are used in gym for increasing the muscle size can add to impotency.
· Psychotic drugs may also affect inversely.
Sleep-
According to Ayurveda, sleepless ness leads to “infertility” .
Other Factors
· Colouring, sweetening, preserving agents in food
· Atmospheric radiation
· Lead, toxins in food, water.
· Paint/ fabrics
· Radiation from mobile tower
· Continues hot watersitz bath
Conditions Affecting Male Fertility
Varococele
It is an abnormal enlargement of thepampiniform plexus inside the scrotum.
It is graded as:
· Sub clinical – not detected upon physical examination.
· Grade 1 –only palpable during or after Valsalva maneuver on physical examination.
· Grade 2- palpable on routine physical examination.
· Grade 3- visible to the eye.
After 3-4 months of treatment,
In grade 1 ,2- improvement in the quantity and quality of the sperms.
In grade 3- may see improvements.
Hydrocele
It is the accumulation of serous fluid around the testis. Due to the obstruction of the lymphatic drainage.
Hypogonadism
Diminished functional activity of the testes.
Types
o Primary
o Secondary
Causes of primary hypogonadism
· Kline filter’s syndrome
· Undescended testes
· Mumps orchitis
· Hemochromatosis
· Injury to the testis
· Post chemo/radiation treatment
Causes of secondary hypogonadism
· Kallmann syndrome
· Pituitary disorders
· Inflammatory diseases
· HIV/AIDS
· Medication s
· Obesity
Epididymal cyst and spermatocele
It is a painless fluid filled cyst, causing epididymal obstruction.
Ejaculatory duct obstruction.
May be congenital or acquired.
Infections ( male accessory gland infections)
May involve one or more sites in the male genital tract.
Immotile cilia syndrome.
Is a rare,ciliopathic, autosomal recessive genetic disorder.
Sertoli cell only syndrome
Characterised by male sterility without sexual abnormalities.
TREATMENT MODALITIES IN AYURVEDA
Chikitsatatwaof infertility include,
1. Agni Deepana- improving the digestive fire and metabolic rate.
2. Amapachana- Destroying the unwanted toxins in the body.
3. Vatanulomana- correcting the movement of vaatadosha
4. Shodhana- purificatoryprocedures.
Ø Dietary regulations are very important in infertility management .
Ø This involves strict compliance and adherence to foods that increase ojus and to avoid the substance which diminish the ojus. This is important to enhance fertilization.
The right combination of Ayurvedic formulation s and treatments help in achieving the following
· In regulating menstrual cycles,
· Enhancing general health and wellness,
· Revitalizing sperm ( enhancing a man’s sperm count, morphology,and motility),
· Reducing stress,
· Enhancing sleep,
· Controlling anxiety and increasing energy levels,
· Balancing the endocrine system
· And improving the blood flow in pelvic cavity, there by promoting fertility.
