Infertility

The fertility rate in India is currently 2.159 births per woman. The number may seem big but there are a huge number of women who are unable to conceive. In medical terms they are infertile. But how exactly is infertility defined in medicine? And how do you know if you are infertile? Let’s now visit the medical definition of infertility.

A woman is infertile if she is unable to get pregnant after 1 or more years of unprotected sex. A woman undergoes many processes in her body to get pregnant. Impairment in any one of the following processes may result in a woman being unable to conceive:

  1. A woman’s body must release an egg from one of her ovaries.
  2. A man’s sperm must join with the egg along the way (fertilize).
  3. The fertilized egg must go through a fallopian toward the uterus (womb).
  4. The embryo must attach to the inside of the uterus (implantation).


One of the major reasons for infertility is delayed family planning. After a woman has reached the age of 35 years, fertility declines steadily.

Now let’s talk about infertility in men. If a male’s sperms are fewer in concentration in the semen, they don’t move as they should in the semen or their shapes are not as they should have been then a man’s semen is less likely to fertilise an egg in a woman’s body. 

There are many factors where a man’s body is unable to deliver quality sperm in large a quantity.

  1. If veins within a man’s testicles are enlarged then the number of sperms gets affected and so does the shape. The condition is called Varicocele.
  2. If at some point in a man’s life, he has had trauma to the testes then sperm production may get affected
  3. Smoking, heavy alcohol use and other narcotic drugs may reduce the number of sperms in the semen
  4. Cancer treatment that involved the use of certain types of chemotherapy or radiation may decrease sperm quality.
  5. Medical conditions like diabetes, cystic fibrosis and some other autoimmune disorders and infections may cause testicular failure causing infertility.
  6. If the hypothalamus or the pituitary gland doesn’t function in a normal way then the hormones that result in normal testicular function may not be released in an adequate quantity leaving immature testicles and so poor quality sperms.

A man’s risk of infertility increases as they reach 40 years of age. 

There are many treatments to treat infertility in men. A few of them are mentioned below:

Sperm retrieval procedures involve the retrieval of sperms directly from the male testicles. There are 5 types of this surgery. Namely, TESA, PESA, TESE, MESA and finally micro TESE. Now let’s explore each one of these options.

TESA (Testicular sperm aspiration): In this surgery, a needle is inserted into the testicles to aspire sperms. Yes, local anaesthesia is required to perform this surgery. The operation is timed with the female partner’s egg retrieval. If the operation fails to obtain enough sperm a biopsy of testicles is needed.

PESA (Percutaneous Epididymal Sperm Aspiration): This procedure is done on patients who had the former operation and have obstructive azoospermia from either a vasectomy or an infection. 

TESE (Testicular sperm extraction): A small incision is done in the testis and small tubes in them are studied for the presence of sperms. The sperms thus retrieved are often cryogenically frozen for future conception. The operation is performed in OTs with local anaesthesia.

MESA (Microepididymal Sperm Aspiration): As compared with other types of sperm retrieval procedures, this procedure can harvest the most mature sperm cells. It may be considered the best procedure of all. The sperm obtained are stored for future conception.

Microdissection TESE (microTESE): MicroTESE is a procedure performed for men who have a sperm production problem and are azoospermic. MicroTESE has significantly improved sperm retrieval rates in azoospermic men and is a safer procedure since less testicular tissue is removed.

If the male patient has enlarged veins in the scrotum causing a condition called varicoceles, then the textbook procedure calls for a incision to be made above the scrotum to find and remove swollen veins and preserve the healthy vains.