Infertility concerns can be both emotionally and physically challenging, often compounded by the complexities of the reproductive process and although technology has advanced significantly, the intricacies of implantation remain a bit elusive. Understanding and addressing the four critical pillars of fertility—egg quality, sperm health, uterine environment and luck—can significantly impact reproductive outcomes.

In an interview with HT Lifestyle, Dr Bhavna Banga, Clinical Director – Fertility at Cloudnine Group of Hospitals in New Delhi's East of Kailash and Noida, shared a detailed explanation of each pillar and how modern technology can offer support -

The Four Pillars of Fertility

1. Egg Quality

Women are born with a finite number of eggs, which begins to decline in both quantity and quality from puberty onward. By the time a woman reaches her early 30s, she has already lost about 17-18 years of her reproductive potential. This natural decline accelerates with age, significantly impacting egg quality.

As a woman ages, the remaining eggs are more likely to have chromosomal abnormalities. By age 35, approximately 70% of eggs may be abnormal, increasing the risk of miscarriage or congenital abnormalities. Therefore, the age at which a woman attempts to conceive is crucial.

Strategies to Optimise Egg Quality:

• Early Marriage and Childbearing: Planning pregnancy earlier can increase the chances of healthy eggs.
• Preimplantation Genetic Testing (PGT-A): For women over 37, PGT-A can identify chromosomal abnormalities in embryos before implantation, reducing the risk of miscarriage and enhancing the likelihood of a healthy live birth.
• Lifestyle Modifications: Eliminating smoking and reducing alcohol consumption can improve egg quality.

2. Sperm Health

Unlike eggs, sperm are continuously produced throughout a man’s life, with new sperm generated approximately every three months. While age does not drastically impact sperm production, factors such as sperm count and quality can affect fertility.

Enhancing Sperm Quality:

• Procedures Like IUI and ICSI: Intrauterine insemination (IUI) and intracytoplasmic sperm injection (ICSI) are recommended for men with suboptimal sperm counts or quality.
• Sperm Processing Technologies: Techniques such as Zymote and Microfluidics help minimize oxidative stress, which can damage sperm.
• Lifestyle Adjustments: Reducing or eliminating smoking, alcohol consumption, and processed foods can improve sperm health. Regular exercise can also help, as obesity—especially abdominal fat—can negatively impact testosterone levels, leading to reduced libido and erectile dysfunction.

3. Uterine Environment

The implantation process is highly complex, involving the activation of around 250 genes during the implantation window. Structural abnormalities in the uterus, such as a septum, unicornuate uterus, fibroids, or adhesions, can interfere with successful implantation.

Evaluating and Improving Uterine Health:

• Hysteroscopic Correction: This surgical procedure can correct structural abnormalities in the uterus.
• Endometrial Receptivity Analysis (ERA) Test: This test determines the optimal timing for implantation by taking a small tissue sample from the uterus after hormone replacement therapy (HRT). It helps in personalizing the timing for embryo transfer to increase success rates.

4. Luck

While the first three pillars can be managed and optimised to some extent, luck still plays a role in fertility. Random factors and individual variations can influence the success of conception and pregnancy.

Advanced Technologies and Treatments

1. Microsurgical Varicocele Repair: Varicocele, an enlargement of veins within the scrotum, can negatively impact sperm quality due to increased heat. Microsurgical repair can improve sperm quality by reducing this heat-induced damage.
2. Vasovasostomy: For men who have undergone a vasectomy but wish to reverse it, vasovasostomy can restore sperm flow, potentially aiding in conception.
3. Tubal Clipping and Removal: In cases of hydrosalpinx (fluid-filled fallopian tubes), procedures such as tubal clipping or removal can prevent toxic fluid from entering the uterus, thereby improving the chances of successful implantation.

Dr Bhavna Banga asserted, “Navigating infertility involves addressing multiple aspects of reproductive health. By understanding and optimising the four pillars—egg quality, sperm health, uterine environment and recognising the role of luck—individuals and couples can enhance their chances of conception and a successful pregnancy. Advanced technologies and medical interventions provide valuable tools in managing and overcoming fertility challenges. Consulting with a fertility specialist and exploring these options can pave the way toward a healthier reproductive journey and, ultimately, the joy of parenthood.”

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