An insight into Infertility

February 14th, 2011

(Article published in SDHA’s Chronicle)

Introduction
Giving birth to a baby is the happiest moment in the life of a woman. As per the custom in most of the cultures, a woman will be accepted by the society when she becomes a mother, and by which she also gets a secure feeling. If she is unable to conceive, it can cause tremendous psychological trauma and she will have to face social discrimination even if she is not responsible for the infertility. It is very unfortunate that there are many women in the society who are entitled as “childless lady.” Usually these women are treated badly by the family members, especially the in-laws and elder women in the society. This can lead to depression and other psychological problems, which in turn makes the situation more worse. The victims, especially the emotionally sensitive ladies, usually avoid social contacts to get rid of conception-related-inquires and comments from others. Considering the various aspects of infertility, in the year 2008, the WHO has declared infertility as a disease.

Who needs treatment for infertility?
The moment we get a couple complaining of no child issue, the first and the foremost thing is to see that whether they can be considered as infertile couple or not. Infertility is the inability to achieve pregnancy after one year of unprotected and regular sexually active life. Among the sexually active couple, 70 % of women get pregnant within 6 months of their sexual life. And 90% of them get pregnant within 1 year. Out of them, only 10% will not have any issues even after one year. Such couple needs systematic investigation and treatment. This doesn’t mean that only these couple are eligible for investigation and treatment, because a late diagnosis can be more serious in certain cases. For example: A case of endometriosis when late may be resulting in extensive adhesions that may not be managed easily. If the age of female partner is between 26 and 27, treatment should be started after 6 months of sexually active life. The best time for pregnancy is 22-27, and pregnancy may not be easy after 40. Hence, in late marriages, there is nothing wrong in doing the investigation and treatment even before one year, especially in NRI husbands who come to native place occasionally. They may not come under the category of infertile couple because they stay only for a few days with their partner. Hence suspending the investigations till they get long leave may not be always practical.

Causes of infertility
Even though the female partner is usually blamed for infertility, the percentage of male infertility and female infertility is almost equal.

Male factors: 30%
Female factors: 30%
Male and female combined: 30%
Unknown cause: 10%

Infertility may be primary or secondary. However, in both cases, first investigate the male partner and then investigate the female partner. Follow the investigations step by step, which can rule-out specific conditions responsible. For example: In Azoospermia, absence of fructose in the semen may be due to the congenital absence of vas deferens and seminal vesicles.

Some causes in males: Oligospermia, oligo-astheno-teratospermia, asthenospermia, azoosepermia, atrophy of testes, undescended testes, VDRL reactive, bilateral varicocele, impotency, antisperm antibody, congenital absence of vas deferens, etc.

Some causes in females: Unexplained cause, PCOD, tubal block, anovulatory cycles, missed abortion, hypothyroidism, endometriosis, IUGR, dyspareunia, TORCH positive, PID, septate uterus, cervical polyps, fibroid, ovarian tumors, premature ovarian failure, hypogonadism, cervical incompetence, molar pregnancy, unicornuate/bicornuate uterus, secondary amenorrhea, cervicitis, bulky uterus, repeated abortions, hypoplastic uterus, adhesions from previous surgery, etc.

General measures to be taken before marriage
Girls with menstrual irregularities and amenorrhoea (primary or secondary) should be investigated properly as early as possible. Proper treatment should be given before the development of gross pathology. PCOD is very common nowadays due to suppression of diseases by repeated symptomatic treatment. Apart from that, genetic influence, changed lifestyles and food habits are also responsible. Those boys with hydrocele, varicocele and undescended testes should be treated as early as possible. Since overweight and underweight cases show direct link with the infertility, body weight should be maintained since childhood. Doing investigations like x-ray and CT scan repeatedly for unnecessary reasons can be hazardous. Those who work in X-ray units and radiology departments should always take necessary precautionary measures. Recent wars in several countries are causing infertility among the population due to the use of some chemical weapons. Exposure to toxic chemicals should be reduced by any means.

It is very essential to give proper sex education right from the school level. If we do not give proper knowledge, the young children may go in search of improper knowledge that can lead them to perversions and certain misconceptions. The knowledge they get from the pornographic sites or books may be misguiding. Our professor had a case of infertility - A well-educated couple from a good family background. Their investigation reports were showing all normal findings. They had taken treatment for several years from a number of doctors and specialists. Finally, on close interrogation, our professor was shocked to know the actual reason for their infertility - they did know nothing about the normal sexual act!

Management
When the incidence of a particular disease or condition is more among the population, naturally there will be establishment of new specializations and a corresponding increase in specialty centers that offer treatment to handle such conditions. Similarly, in the treatment of infertility also there are many centers that apply modern techniques. Assisted reproductive technology (ART) is a group of methods practiced by many specialty centers. Intra uterine insemination (IUI), Intra vitro fertilization (IVF), Intra cytoplasmic sperm injection (ICSI) are some of those methods. Unfortunately, most of the treatment modalities available are beyond the reach of a common man. There is also a corresponding rise of adds in the media on the treatment of infertility and impotency. It is quite embarrassing to notice that the “drugs” to treat impotency are nowadays marketed as a panacea to cure infertility. There are many couples who spend their valuable time and money by taking these products available over-the-counter, even without a medical consultation and proper diagnosis.

Treating infertility may not be easy compared to the treatment of other conditions, because at the same time we will have to handle two individuals and their family members.  Cooperation from both partners is mandatory and they should be handled logically and assurance should be given to them. Counseling is very essential. The most common obstacle to the continuation of the treatment is the pressure on the couple from their friends, neighbors and relatives, which will usually force them to move from one doctor to the other, even without giving sufficient time for one doctor (Doctor Shopping). Most of the people do the semen analysis immediately after starting the treatment and come to a false conclusion that the treatment is ineffective! Hence, once we start the treatment, ask the patients to do the repetition of tests only after 2 to3 months, because spermatogenesis itself takes approximately 64 to 72 days, hence the result of our treatment can be seen only after that period. Similarly, the ovulation and fertilization may not be taking place immediately due to various hurdles; hence a positive result may take several months to appear.

Measures to be taken during the treatment
Education and counseling is mandatory before giving the treatment. A well-prepared couple will not leave the treatment in between. Giving moral support and assurance is very essential, because a life without stress can act like a catalyst to support the medicinal action. At the same time, giving unnecessary hope to the couple can also land up in medico-legal issues. Before giving hope, it is very essential to know the exact pathology of the case and to assess the possibility of success. For example: Giving 100% hope to a person who has congenital absence of vas deferens is meaningless, because, he can’t be managed only with medicines!

The male partner should avoid exposure to heat. The spermatogenesis will not take place in our normal body temperature, that is the purpose behind the situation of testes outside the body cavity, within the scrotal sac. To reduce heat, they should avoid tight under wears, jeans, especially while driving bike. Oligospermia is very common among truck drivers, cabs and those who work in furnaces and industries. Always encourage them to do hip bathing in cold water for 30 minutes daily. Recent studies show that keeping mobile phones in the pant-pocket can hamper the rate of spermatogenesis. Usually the infertile couple get attracted towards adds of drugs that are available over-the-counter. They should avoid aphrodisiacs that can cause side effects. Avoid the use of lubricating gels that may contain spermicidal substances. The couple should stop smoking, drinking and other habit forming substances that can result in deterioration of mind and body seriously. These substances can also hamper sperm production and its motility. Also encourage the couple to take healthy nutritious diet and perform regular exercises. They should avoid junk foods and other food items that contain toxic chemicals, preservatives and coloring agents, hormone-injected-broiler-chicken, artificial sugars, and other food items that contain toxic chemicals, pesticides, preservatives and coloring agents.

Relaxation techniques like meditation and yoga can also help. There are several yogic asanas to enhance sexual health and fertility. Setu Bandhasana is a very useful asana that can increase the blood supply to the pelvic organs.

While treating a case of infertility, find out the time of ovulation by doing an USG and ask the couple to have contact during that time, because calculating the date of ovulation by counting the 14th day may not be accurate since ovulation can take place at any time between 10 to 20 days - especially in the infertile women. But, too frequent ejaculation during ovulation period may not help because the sperms should be mature and healthy enough to move towards the fallopian tubes and fertilize the ovum, hence the intercourse should be regularized. After the ejaculation, the female partner should lie down on the back in Knee-Hug position with low-back supported by a pillow. This position should be continued for 30 minutes so that complete liquefaction of semen takes place and the cervix come in direct contact with the seminal pool that can help the sperms to enter through the external os. Infertile couple usually may develop some sexual problems such as absence of orgasm, loss of libido, etc. When the doctor predicts the ovulation day by USG, some couples may have difficulty to perform sex on that day due to anticipation, which is called “That night syndrome”. It is found that during orgasm, the cervix, uterus and the fallopian tubes can make some contractions that can help to make a favorable situation for fertilization. Therefore, sexual life should be enjoyable to both. The research proves that good relationship between couples enhances pregnancy.

Homeopathic perspective
The main cause for infertility may be due to a defect in only one partner, however, the infertile couple has to be treated as a single unit. Both should be treated constitutionally, because one person may be normal in the lab reports, but there may be some hidden miasmatic block that can’t be diagnosed with some instruments. Once the couple is treated holistically along with proper advice, we can expect for a favorable result. Among the infertility cases coming for homeopathic treatment, a notable percentage consists of cases with unknown etiology. The aim of a homeopath should be treating the individuals as a whole rather than treating a pathological condition. Use of some specific drugs can be useful in giving symptomatic relief to the patient in other diseases, whereas, cases like infertility should be treated holistically. Dr E B Nash says in his Leaders of Homeopathic Therapeutics (Page no: 347),  “There is nothing to be condemned in homeopathic prescribing than routinism”. However, the use of some intercurrent drugs such as Syphilinum, Oophorinum, etc. is beneficial in many cases. Homeopathy gives more importance in the removal of all causes, which may be a dynamic cause, physical cause and mental or emotional cause. As a common misunderstanding, homeopathy does not encourage only medicines to handle all cases. If the cause is purely surgical (adhesions or obstructions), it has to be managed surgically. But surgery can’t remove the fundamental causes, which can be managed only with dynamic medicines. Our medicines can reach the interior of the organism, which is beyond the reach of a surgeon’s lancet. Homeopathic drugs like Calc fluor, Thiosinaminum, Scirrhinum has treated even adhesions in the internal organs.

The predisposing factors can influence the dormant miasms in an individual and make them active. Hence it is the knack of the physician to identify the predisposing causes, exciting causes and maintaining causes and managed the case tactfully. Nowadays cases like PCOD, endometriosis, etc are increasing due to continuous suppression of symptoms and repeated symptomatic treatments. The infertility may be Psoric infertility, sycotic infertility or syphilitic infertility, but majority of cases are tri-miasmatic with prominence of either sycosis or syphilis. Almost all cases need constitutional medicine followed by the antimiasmatic medicines. Prescription of specific drugs may not be beneficial in most of the cases. Apart from the cure in a physical and mental level, our medicines can improve the interpersonal relations between the couples, and thereby making a favorable situation for reproduction. While giving homeopathic medicine to a couple, it is mandatory to inform them to report whenever they suffer from an acute disease or an acute exacerbation of chronic disease, because taking a medicine (especially homeopathic medicine) from another doctor may negatively influence the action of medicine they have already received. If the acute disease is mild and self-limiting, the second best remedy is the best. But, it should be kept in mind that some acute diseases are life threatening, hence, instead of placebo, a drug similar to the acute totality should be given to save the patient.

Conclusion
As per the statistics from various authentic sources, homeopathy has cured thousands of infertility cases that could not be managed even by sophisticated modern techniques. But, every system has got its own limitations; we may also come across difficult cases that are not responding to our prescription. When there is no conception even after trying different modes of treatments for several years, we can suggest the couple to go for a legal adoption. There are a number of infertile couples expecting a baby even though there is no chance. On the other side, there are thousands of orphans having no one to look after. They are the victims of sins done by somebody. Hence, as a last option, it is our duty to mentally prepare the couple to go for a legal adoption and give a chance for the innocent orphans to survive. When Allopathy, Homeopathy, Naturopathy and all other pathies fail, the SYMPATHY works better!

About the author: Dr Muhammed Rafeeque is the alumnus of Bharathesh Homoeopathic medical college Belgaum. He is the author of Be a Master of Materia Medica, Rapid prescribing, Drug Addiction and Its Side effects- A Homoeopathic Approach, published by B Jain publishers New Delhi. Now he is practicing at family Homoeopathic clinic, Kerala. He blogs at www.FamilyHomoeopathy.com/blog.

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