“Mrs. Mamta, aged 35 years old, obese with a BMI of 27 kg/m² has been struggling with infertility for the last five years. One diagnosis was found that she has a history of anovulatory cycles and hysterosalpingography (HSG) revealed tubal blockage. The anovulatory cycle is when the egg is not released from the ovaries during menstruation. In the case of tubal blockage, fallopian tubes don’t allow egg and sperm to meet. Both lead to infertility,” shared Dr. Jasneet Kaur, Consultant and Clinical Director – Reproductive Medicine, Milann Fertility Center, Chandigarh.

She added, “Along with this, she also had borderline hypertension and a family history of diabetes, so in general she had impaired glucose tolerance or prediabetic. She was also diagnosed with bilateral fimbrial blockages and a positive test for tuberculosis (Koch’s disease) in her endometrial tissue causing atypical complex hyperplasia, which is the abnormal growth of endometrial cells (uterine lining), and well-differentiated endometrioid adenocarcinoma (Grade 1) means cancer cells are almost exactly replicating the endometrial cells, and slowly progressing towards cancer.

Based on the analysis, she was prescribed to undergo definitive surgery which could have possibly eliminated her natural conceiving, but she opted for fertility preservation.”

What is Fertility Preservation?

It is a process to preserve your eggs, embryo, sperm, and reproductive tissues for future use. It is usually recommended for those with cancer, and other health issues – autoimmune diseases, age, or transgender.

Fertility preservation can be categorized under two types – minimizing the impacts of drugs or diseases on reproductive tissues while getting treated for cancer and removing or freezing reproductive organs.

Procedure for Fertility Preservation

The procedure is mostly personalized based on body conditions and functioning. The process starts with ovary stimulation. And then hormones are injected. Eggs are drawn using needles under proper sedatives. This process is done under ultrasound guidance. Then eggs are directly frozen or after fertilization, it is done.

“But in her case, the team decided to treat her hormonal therapy beginning megestrol acetate 80 mg three times a day and placing a levonorgestrel intrauterine contraceptive device (LNG-IUCD) for treating cancer with the preservation of her reproductive organs. In addition, she resumed metformin for glucose control and was advised to lose weight for overall improved health,” she explained.

“The process was done under regular observation. After three – and – six months when the cancer was negative, hormonal therapy followed by assisted reproductive technology was done. Given her condition, controlled ovarian stimulation (COS) was started with a progestin-primed ovarian stimulation (PPOS) protocol. Ovarian stimulation was successful, giving rise to four mature oocytes: all were fertilized, making two blastocysts of high quality that have been frozen, “she added. 

The embryos or fertilized eggs are then placed in the womb of the mother or someone else’s womb who’ll conceive your child. Ultimately, Mrs. Mamta had to choose surrogacy due to the return of cancer, although it didn’t spread it made unable her to carry the child.

People should opt for conceiving naturally instead of going through many artificial procedures until it is needed for artificial methods. And also, this case suggests that woman should at least do a fertility test in their 20s to 30s.

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In a country where traditions, family values, and societal norms play a prime role in shaping lives, infertile women often face severe social stigma. Many women believe that they bear a higher responsibility for infertility than men, which puts them under greater psychological stress and more prone to suffering severe social consequences. The stigma of not giving birth to children affects approximately 53% to 64% of female infertility patients worldwide. This stigma not only causes harm to the mental health of these women, but also affects their quality of life, making them bear the adverse social consequences such as domestic violence, marriage breakdown, or even delay in receiving the treatment.

According to a WHO report, the prevalence of primary infertility in India was 3.9% (age-standardized to 25–49 years) and 16.8% (age-standardized to 15–49 years) using the “age but no birth” definition. Therefore, it is crucial to have a deep understanding of the patients’ stigma and effective intervention in alleviating it.

In India, the discussion of infertility as a circumstance in both men and women—has just recently gained recognition. A double-digit increase in infertility has made it a personal and societal health concern in India. Infertility negatively affects couples socially and financially, in addition to emotionally. India has a population of as many as 27.5 million infertile people, including men and women, according to the Indian Society of Assisted Reproduction.

Several lifestyle factors contribute to infertility, with low sperm count, lifestyle choices, alcohol consumption, insufficient sleep, delayed marriage, and the dilemma between pursuing a career or getting married being among the key influencers. These elements collectively play a significant role in affecting reproductive health and fertility. It’s essential to recognize the complex nature of infertility, as addressing these factors can enhance the chances of achieving successful conception.

When a couple has regular, unprotected sexual encounters yet is unable to conceive, the couple is said to be infertile. Around 30% of known cases of infertility contain defective sperm, while 40–50% are primarily caused by abnormalities of the female reproductive system. One of the biggest risk factors that can impact someone’s fertility is their age. A man’s fertility begins to fall after the age of 50, whereas a woman begins to decline after the age of 30 and continues to do so after that.

Low sperm count, influenced by various environmental and genetic factors, is a critical aspect of male infertility. Additionally, individuals’ lifestyles, characterized by stress, poor dietary habits, and lack of exercise, can contribute to reproductive challenges. Excessive alcohol consumption is known to impact fertility adversely, as it can disrupt hormonal balance and impair reproductive function. Inadequate sleep, often overlooked, can also be a contributing factor, as it affects the overall well-being of individuals, including reproductive health. Delayed marriage may pose challenges, as age can impact fertility in both men and women.

Furthermore, the modern dilemma of choosing between career aspirations and marriage can add another layer of complexity to the fertility equation, as individuals may face difficulties in finding the right balance. Addressing these factors through lifestyle modifications, timely medical interventions, and open communication about reproductive health can significantly contribute to improving fertility outcomes.

Infertility stigma can bring heavy mental pressure and psychological burden to female infertility patients and affect their quality of life. Therefore, effective and targeted psychological interventions should be developed to reduce the patients’ stigma and improve their quality of life.

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