Causes of the infertility
MODERN VIEW- the Causes of the Infertility
Primary vs. secondary
According to the American Society for Reproductive Medicine, infertility affects about 6.1 million people in the U.S., equivalent to ten percent of the reproductive age population. Female infertility accounts for one third of infertility cases, male infertility for another third, combined male and female infertility for another 15%, and the remainder of cases are "unexplained".
A Robertsonian translocation in either partner may cause recurrent abortions or complete infertility.
"Secondary infertility" is difficulty conceiving after already having conceived and carried a normal pregnancy. Apart from various medical conditions (e.g. hormonal), this may come as a result of age and stress felt to provide a sibling for their first child. Technically, secondary infertility is not present if there has been a change of partners.
Factors relating to female infertility are:
The International Council on Infertility Information Dissemination (INCIID) considers a couple to be infertile if:
- General factors
- Diabetes mellitus, thyroid disorders, adrenal disease
- Significant liver, kidney disease
- Psychological factors
- Hypothalamic-pituitary factors
- Kallmann syndrome
- Hypothalamic dysfunction
- Ovarian factors
- Polycystic ovary syndrome
- Diminished ovarian reserve
- Luteal dysfunction
- Premature menopause
- Gonadal dysgenesis (Turner syndrome)
- Ovarian tumor
- Tubal/peritoneal factors
- Pelvic adhesions
- Pelvic inflammatory disease (PID, usually due to chlamydia)
- Tubal occlusion
- Uterine factors
- Uterine malformations
- Uterine fibroids (leiomyoma)
- Asherman's Syndrome
- Cervical factors
- Cervical stenosis
- Antisperm antibodies
- Vaginal factors
- Vaginal obstruction
Factors relating to male infertility include:
- Pretesticular causes
- Endocrine problems, i.e. diabetes mellitus, thyroid disorders
- Hypothalamic disorders, i.e. Kallmann syndrome
- Hypogonadism due to various causes
- Psychological factors
- Drugs, alcohol
- Testicular factors
- Genetic causes, e.g. Klinefelter syndrome
- Neoplasm, e.g. seminoma
- Idiopathic failure
- Posttesticular causes
- Vas deferens obstruction
- Infection, e.g. prostatitis
- Retrograde ejaculation
Some causes of male infertility can be determined by analysis of the ejaculate, which contains the sperm. The analysis includes counting the number of sperm and measuring their motility under a microscope:
- Producing few sperm, oligospermia, or no sperm, azoospermia.
- A sample of sperm that is normal in number but shows poor motility, or asthenozoospermia.
In some cases, both the man and woman may be infertile or sub-fertile, and the couple's infertility arises from the combination of these conditions. In other cases, the cause is suspected to be immunological or genetic; it may be that each partner is independently fertile but the couple cannot conceive together without assistance.
AYURVEDIC VIEW -the Causes of the Infertility
The causes of infertility according to Acharya Sushruta is lacking in one or more four essential factors required for fertilization. (Su. Sha. 2/34)
Acharya Sushruta has described four essential factors essential for fertilization.
Four factors are :
- Ambu and
Among these, most important factor is Beeja (the ovum).
Beeja means both the gametes male as well as female. As this study is related with female so here female gamete (ovum) can be taken as beeja
Definition of Beeja
Beeja means both Shukra and Shonita. Here, Shonita can be taken as Dhatu Rupa Artava i.e. ovum (Streebeeja).(Ch. Sha. 2/23)
It is Artava in female and Shukra in male. Here again Artava is Dhatu Rupa Artava responsible for Garbhajanana. So by the definition it is indicated very clearly (Su. Sha. 2/33).
Beej is mentioned in Ayurveda by different terms as,Beeja,Artava,Shonit,Pushp,Rakt
There are various scattered reference available for the cause of Artava Dushti/Haani..
- Revati Jataharini (Pushpaghani) (Ka. S.Revati Kalpa - 33)
- Astartava Dusti( A.s.Sh2/5 and 1/25)
- Avarana ( A.s.Sh1/13)
- Use of Tikshna Virechana in Mridukostha (Ka. S. Si. – 3)
- Beeja Dusti Ch. Chi. - 30)Su. Su. - 38)
- Vandhya Yoni Vyapada Ch. Chi. 30,
- Chakrapani)Ch. Si. 1/34)Bh.Pr. Chi. 24/15-16)
- Asrik Dosha Dietetic Habit Ka. S. - 1)
- Artavaha Srotasa Viddhata Su. Sha.)
Summarizing all the references it can be stated that the nidana of yonivyapada given by Acharyas can be taken as Nidana of Vandhyatva and also for the anovulation causing vandhyatva.
Aharaja Nidana,Viharaja Nidana,Pradusta, ArtavaBeeja Dosha,Daiva are the different Nidana
- Aharaja Nidana : Mithyaahara (Ch. Chi. 30/7), Dushtabhojana (A.S.Ut. 38/32; A.s. Ut. 33/27)
- Viharahja Nidana : Mithavihara (Ch. Chi. 30/7) coitus with Ruksa, Durbala, Bala, excessive coitus (Su.Ut. -38/3) use of foreign bodies for sexual orgasm (A.S. Ut. 38/32).
- Pradusta Artava : (Ch. Chi. 30/17)
- Beeja Dosha : Abnormalities of Sperm or ovum
- Daiva idiopathic factor
Thus etiologies of Vandhyatva can be boldly categorized under these four headings as specified by classics. Though we find number of reasons for a-beejotsarga they are in compaas of these four broad nidana.