Infertility is inability of a person to reproduce naturally. As per available scientific data is has been proved that the infertility in men and women are equally proportioned.

The World Population Prospects: The 2017 Revision report says that the fertility rate of Indians has come down by more than 50% as compared from the details available from the year 1975. Fertility rate is measured as the number of children born to a woman. Male factor infertility has been linked as a contributing factor causing infertility in 40-50% percent of cases, and as the sole cause for infertility in 15-20% percent of cases.

Causes / conditions affecting fertility among women are:

1Advancement in marital age: These days due to certain factors like education, career, family responsibility etc. there is delay in marital age and/or planning of the family. The ability to conceive a normal pregnancy for women starts decreasing from early 30s and biologically women are rarely fertile beyond the age of 45.

Tubal occlusion (Fallopian tube damage or blockage): Sexually transmitted infections like chlamydia, gonorrhea, or pelvic inflammatory disease prompt blockage in fallopian tubes. If a tube is blocked and filled with fluid, due to situation known as Hydrosalpinx and Tubal occlusion an ovulated egg is unable to be fertilized or to reach the endometrial cavity.

Uterine fibroids: Fibroids are very common, not all types of fibroids but few can reduce the pregnancy rate.

Endometrial polyps: are finger-like growths in the uterine cavity.

Endometriosis: is a condition when endometrial tissue grows outside the uterus and affects the function of the ovaries, uterus and fallopian tubes. It is found to affect approximately 50% of women in fertility age group.

Ovulation disorders affect the release of eggs from the ovaries. These include hormonal disorders such as polycystic ovary syndrome, Hyperprolactinemia, Hyperthyroidism and hypothyroidism.

 

Uterine or cervical abnormalities

Primary ovarian insufficiency (early menopause)

Pelvic adhesions: bands of scar tissue that bind organs after pelvic infection, appendicitis, abdominal or pelvic surgery.

Cancer and its treatment: Certain female reproductive cancers, radiations and chemotherapy.

Other conditions: like amenorrhea – absence of menstruation, delayed puberty, celiac disease, autoimmune diseases as lupus and diabetes.

Genetic abnormalities can make conception and pregnancy less likely.

Causes / conditions affecting fertility among men are:

male-infertility-treatment

Abnormal sperm production: due to various reasons genetic defects, diabetes, infectious conditions such as HIV, mumps, Chlamydia or gonorrhea. Dislocation of testes or varicocele (enlarged veins in the testes).

Delivery of sperm: due to sexual problems, blockage in the testicle, few genetic diseases, damage or injury to the reproductive organs or cystic fibrosis.

Environmental factors: over exposure to pesticides, chemicals, radiation, cigarette smoking, alcohol, marijuana, certain medications, few antibiotics, antihypertensives, anabolic steroids, heat (saunas or hot tubs).

Cancer and its treatment: Certain reproductive cancers, radiations and chemotherapy.

 

 

Risk factors common for both men and women include following:

Age: Fertility in men and women gradually declines with age.
Use of Tobacco: Smoking tobacco or marijuana reduces the likelihood of pregnancy and the possible benefit of fertility treatment. It affects both the partners.
Use of Alcohol: increases the risk of birth defects, decrease sperm count and motility.
Being Overweight or Underweight. 

Regenerative power of BM-MNCs and Infertility conditions

Infertility may be treated with medicine, surgery, artificial insemination, assisted reproductive technology and more recently cell based application. The regenerative power of BM-MNCs bring significant improvement in health conditions as given below:

Cell based application for Infertility in Women

Atrophic Endometrium

Lining of the uterus is known as Endometrium and if this is an abnormal thin lining the condition is known as Atrophic Endometrium. This results in irregular bleeding affecting fertility. In patients with Atrophic Endometrium the use of autologous bone marrow cells may improve the outcome of the endometrium with repeated IVF failure.

The transplantation of purified specific populations of autologous bone marrow derived cells are done into patients with atrophic endometrium without in vitro expansion or culture, with minimal manipulation.

Asherman’s syndrome (AS)

It is the partial or complete obliteration of the uterine cavity and or cervical canal with synechiae, resulting in menstrual abnormalities like hypomenorrhea, amenorrhea, infertility and recurrent pregnancy loss, depending on the severity.

It is known as per the scientific evidence that adult stem cell population exist in human endometrium and bone marrow derived cells can be transplanted in the uterine cavity for endometrial regeneration and endogenous Endometrial stem / progenitor cells can also be activated.

Cell based application for Infertility in Men

Azoospermia

This condition is commonly known as “no sperm count” as the sperm production is nil. Till now it was assumed that men with non-obstructive azoospermia were untreatable but now the bone marrow derived mono nuclear cells can bring improvement in the condition as per available clinical and research data.

Erectile dysfunction

This condition is due to damage of penile vascular system. It is a frequent adverse result after major prostatectomy for prostate cancer.

Publications

Autologous stem cell transplantation in refractory Asherman’s syndrome: A novel cell based therapy pdf


Autologous cell therapy with CD1331 bone marrow-derived stem cells for refractory Asherman’s syndrome and endometrial atrophy: a pilot cohort studypdf


Endometrial reconstruction from stem cellspdf


Endometrial regeneration using autologous adul stem cells followed by conception by in vitro fertilization in a patient of severe asherman’s syndromepdf


Stem-cell therapy for erectile dysfunctionpdf


The Current Status of Stem-Cell Therapy in Erectile Dysfunction: A Reviewpdf


Putative human male germ cells from bone marrow stem cellspdf

Clinical Trials Worldwide Under Investigation