Etiology of infertility varies from region to region and from one population to another, and even from one locality to another within the same population. Childlessness has serious demographic, social, and health implications. In India by using National Family Health Survey-2 (1998-1999) and National Family Health Survey-3 (2005-2006) data. The study population consists of women aged 20-49 years married for ≥ 5 years. Age of women, age at first marriage, place of residence, standard of living, working status of women, and region are some of the variables related with the rate of infertility and childlessness. The infertility rate is high among women in urban areas. This may be due to lifestyle or a later age at first marriage. Considering religion, Muslims show the lowest infertility rate. Scheduled tribes have a high infertility rate, according to one study. There is much variability in different groups in different places regarding infertility rates. Therefore, we must consider the latest statistics by cross-examining different studies. With increasing levels of educational attainment among women, the infertility rate increases. This can be related to the fact that with aspirations for attaining a higher educational level, marriage is delayed as a result of which by aforementioned causation factors (higher age at marriage, urban living style, etc.), the infertility rate is high among this subgroup of the population.
Female infertility can stem from various factors, including ovulation disorders, issues with the fallopian tubes or uterus, hormonal imbalances, and underlying medical conditions. Age, lifestyle choices, and certain environmental factors also play a role.
Male infertility can stem from a variety of causes, including sperm disorders, hormonal imbalances, anatomical issues, infections, and lifestyle factors. These factors can impact sperm production, quality, or transport, making it difficult to achieve natural conception.
Treatment of infertility in the male
Although important advances have been made in the evaluation of spermatogenic function, treatment of infertility caused by primary testicular disease is unsatisfactory. The results of therapy of hormonally normal men with oligospermia by the use of large doses of androgenic steroids, gonadotropins, pregnenolone (pregnenolone is converted to progesterone, the first biologically important steroid hormone in the sex steroid pathway), thyroid hormone, clomiphene, and vitamin preparations have been generally unsuccessful. The intermittent use of large doses of spermatogenesis has not been established as efficacious, although occasional men seem to benefit. The use of enterolactone, which inhibits aromatization, has been shown to increase the sperm count in some men with oligospermia. This suggests a role for intratubular oestrogen in the etiology of some types of oligospermia.
Treatment of Infertility in the Female
Treatment for female infertility can involve medications to regulate ovulation, surgery to address structural issues like blocked tubes or endometriosis, and assisted reproductive technologies like intrauterine insemination (IUI) or in vitro fertilization (IVF).
In Vitro Fertilization
In Vitro Fertilization (IVF) is a fertility treatment where fertilization of an egg occurs outside the body, typically in a laboratory setting. It involves retrieving eggs from the ovaries, fertilizing them with sperm in a dish, and then transferring the resulting embryos into the uterus. IVF is commonly used to help individuals or couples conceive when natural fertilization is not possible. In Vitro Fertilization (IVF) success rates in India generally range from 40% to 70% per cycle, with success rates varying based on factors like age and the clinic’s expertise. The cost of an IVF cycle in India typically ranges from Rs. 70,000 to Rs. 2,50,000, but can be higher depending on the specific treatment and clinic.
Decline of infertility in India
The decline of infertility in India in some known established populations, like in the Parsi population, is complex and multifaceted, with the low fertility rates being a significant factor. While some may attribute this to a lack of desire for children, the reality is more nuanced. To explain broadly, “nuanced” is an adjective that means complex, subtle, or delicate. It is often used to describe something that has multiple layers of meaning or that requires careful consideration or analysis to fully understand. Further, people who are encompassing economic considerations, career ambitions, late marriages, and a smaller pool of potential partners within the community have lower infertility.
The socioeconomic factors, financial stability some couples prioritize securing a good education for their children, which can lead them to delay having children until they are financially stable. For instance, parse women are increasingly pursuing high-achieving careers, which may lead them to postpone having children until they are ready to balance work and family. Also, family planning has been practiced for decades by Parsi couples to ensure they can afford a good education for their children. In observational studies, it is revealed that the Parsi community is relatively small, which can make it difficult to find suitable partners within the community. Added to that social and cultural factor,s for example, a young Parsi couple may have a large number of dependents, making it challenging to plan for a family. It is also found that the exclusion of children born to women married outside the Parsi community can also contribute to the decline.
Infertility
Infertility is a concern for some Parsi couples, and initiatives like Jiyo Parsi aim to address this issue through funding for IVF treatments. The Jiyo Parsi scheme is unique, where the Central Sector Scheme is working under the Ministry of minority affairs for arresting the population decline of the Parsi community. The scheme was launched in 2013-14. “Muslims still have the highest fertility rate among India’s major religious groups, followed by Hindus at Jains have the lowest fertility rate. The general pattern is largely the same as it was in 1992, when Muslims had the highest fertility rate at 4.4, followed by Hindus at 3.3. In the last 20 years, fertility among Hindus has dropped by 30%, while the decline among Muslims has been 35%. With a higher rate of progress in the decline of Muslim fertility, the Hindu and Muslim fertility rates are on track to converge, plausibly by 2030.
Intermarriage
While intermarriage is not inherently detrimental, it can contribute to the decline if the children are not considered part of the Parsi community. Increasing divorce in many couples can also impact the infertility among the Parsi community. Some Parsis migrate to other countries, contributing to the decline in the Indian Parsi population.
In different countries all over the world, different patterns of infertility is emerging. It needs comprehensive research to make the global population uniformly disseminate which may be a hope only.
