Reproductive health should be taken seriously, especially when the incidence of infertility is rising at an alarming levels. Preserving the human fertility potential also revolves around the personal and menstrual hygiene of the women. Globally various initiative were taken to increase the fertility awareness and identify the various risk factors associated with declining fertility potential.
According to a recent meta-analysis, apart from age, certain infections and cultural practices pose increased risk of infertility among women.
Bayoumi et al (2024) found out that among various factors, genital tuberculous (GTB) lead to 9 fold decline in fertility of the women. Genital infections like HIV and bacterial vaginosis can decrease the fertility potential by 3 fold. Female genital mutilation seen as a cultural ritual among women of Africa (Sudan, Ethiopia, Somalia, Egypt, etc.) and other parts of the World can affect the fertility potential by 2 fold.
Genital Tuberculosis is caused by mycobacterium tuberculosis which mainly affect the fallopian tubes of the woman. It can spread to ovaries, uterus and adjoining peritoneum from abdomen and chest area, leading to blocked fallopian tubes, hydrosalpinx, thin endometrial lining, ovarian abscess, recurrent implantation failures, abortions, etc. It is usually diagnosed by endometrial biopsy, tubal patency test like hystero-salpingeography (HSG), ovarian biopsy during laparoscopy. Treatment involves anti-tubercular therapy (ATT) for atleast 9 months and surgeries like tubal clipping, salpingectomy, and/or oophorectomy. In-vitro fertilization (IVF) may be an important fertility treatment in such patients.
HIV usually remains undiagnosed for a long period of time. Only symptom may be discharge per vaginum. Bacterial vaginosis is most common cause of abnormal vaginal discharge among women of reproductive age group. It usually presents with milky whitish foul smelling discharge per vaginum, without itching. It is mostly diagnosed during per speculum examination of the vaginum and by wet mount slide smear showing presence of clue cells. It is treated with azole compound mainly metronidazole, secnidazole, etc.
Female genital mutilation is female circumcision that involves chopping of citoris, labia minor and or labia majora, and fusing the remaining skin of vulva together in order to prevent ladies from indulging in sexual activities. This traditional activity increases the risk of urinary infections, pelvic inflammatory diseases, endometriosis and adenomyosis. According to Bayoumi et al, FGM type II and III which are severe degree of circumcision poses danger to the fertility potential of the women by causing genital infection and tubal factor infertility, thereby increasing the time to pregnancy interval by 2 folds. Many countries including United Kingdom have imposed ban on such cultural activities.
There are many other factors that can affect fertility.
- Age at marriage
- Use of any contraceptives
- Wrong timing, decreased frequency of intercourse
- Other medical conditions like PCOD/PCOS, Endometriosis, Adenomyosis, Poor ovarian reserve due to genetic reasons, Fibroid uterus, Other causes of PID/infections, Uterine malformations
- Husband poor semen quality
Also, marriages happening in close relationships lead to post delivery problems. It has been seen that consanguineous marriages increase the risk of stillbirths and neonatal deaths by two fold.
Biological and cultural diversity can bring genetic diversity and decrease the chances of building up abnormal genes within the community.
Read more: Poor Personal Hygiene And Biological Non-Diversity Can Decline Fertility
Dr Anadeep Chandi 
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