The Infertility Epidemic: The End of the Human Race?
When I first started looking into infertility, I didn’t really think it was a major global problem.
Some people couldn’t have kids. So what?
My initial thoughts couldn’t have been further from the truth.
I never realized how big of a problem infertility truly is, and I can’t even imagine how hard it must be for the 186 million individuals — that’s approximately one in every eight couples that are affected by it.
But more concerningly, the rate of infertility is increasing. The use of assisted reproductive technology increases by 5–10% annually. In 1950, there was an average of 5 children per woman worldwide, and in 2020, this number has dropped to 2 children.
Over the last 40 years, there has been a 52.4% decline in sperm concentration, and a 59.3% decline in sperm count in men from North America, Europe, Australia and New Zealand.
If sperm counts in men continue to fall at current rates, the human race could become extinct in about 50 years.
Underlying Causes of Infertility
At one point, scientists believed that only half of all infertility cases were because of physical conditions, and the rest were unexplained, or were a result of stress or mental illnesses.
Now, research shows that nearly all cases of infertility are based on physiological cases in the man or woman.
Female Infertility
The female reproductive system is complicated.
There are so many parts that come together. The more puzzle pieces there are, the harder it is to put the puzzle together (or in this case, the more things that could go wrong).
40% of infertile women fail to ovulate. This can be a result of disorders such as such as polycystic ovary syndrome (Affects 1/10 women), primary ovarian insufficiency, other endocrine disorders, hyperprolactinemia, and eating disorders.
Another major factor that affects female infertility are structural problems — endometriosis (also affects 1/10 women), uterine fibroids and polyps, cervical abnormalities, fallopian tube damage/ blockage or scarring in the uterus.
The scary thing is that we don’t know enough about these causes and therefore, have not developed a cure for so many of these diseases.
See a full breakdown of female infertility.
Male Infertility
With men, infertility results from one of two causes — abnormal sperm product/ function or there’s an issue with the delivery of the sperm.
Conditions such as azoospermia (no sperm), oligospermia (few sperm), and teratospermia (abnormally shaped sperm) are the main causes. These conditions can be caused by chromosome defects, diabetes, hyperprolactinemia, testicular injuries, STDs, thyroid, Cryptorchidism, or varicocele.
Delivery problems are typically attributed to hormonal problems such as premature ejaculation and erectile dysfunction or structural problems like varicocele, semen hyperviscosity, cystic fibrosis, or testicular blockages.
See full breakdown of male infertility.
The Influence of Age in Fertility
A woman’s age also plays a significant role in her ability to get pregnant. According to ACOG, 1/4 healthy woman in their 20s and 30s will get pregnant in any single menstrual cycle, but this number drops to 1/10 after the age of 40.
A combination of advanced education and career opportunities for women, later marriage and improved access to contraception leads to women having children at a later time.
About 20% of women have their first child after the age of 35, and one in three of those couples face infertility.
But unlike women, a male partner’s age doesn’t play a major role in fertility, until after the age of 60.
Assisted Reproductive Technologies (ART)
In order to address the lingering issue of infertility, researchers and scientists have developed many assisted reproductive technologies. The two most commonly used ARTs are IVF (in-vitro fertilization) and IUI (intrauterine insemination).
According the CDC, 12% of women of childbearing age have used an infertility service. As time goes on, more and more people are relying on these technologies to help them procreate.
But the thing is, these technologies aren’t really solving the problem.
The IVF Process
- Ovulation Induction: Synthetic hormones are injected to release multiple eggs instead of the singular egg that is released monthly.
- Egg Retrieval: Using a transvaginal ultrasound, physicians retrieve the eggs that were retrieved. The goal is to retrieve 10–20 eggs, but depending on the woman’s reaction to the medications and injections, it can be as less as 3 eggs.
- Fertilization: Healthy eggs are mixed with sperm and left to incubate overnight. If there is severe male infertility (little to no sperm), the ICSI process (Intracytoplasmic Sperm Injection) process is used, wherein the sperm is directly injected into the egg. Only 70% of all eggs get fertilized, and only 50% of fertilized eggs grow to see day 5–6.
- Implantation: Of all the embryos, 2 are selected to for implantation. The physician inserts a catheter into the uterus, and a syringe with the embryos is suspended in a a small amount of fluid is attached to the end of the catheter. The doctor places the embryo using a syringe.
The success rate of an IVF cycle depends on many factors; the cause for infertility, age, and location. After 1 round of IVF, 27.3% of women were pregnant, and 22.2% of cycles resulted in live births (These numbers vary based on age.)
In Canada, IVF can range from $7,750 — $12,250, plus an additional $2,500-$7,000 for medication. This amounts to $10,250–$19,250 per cycle.
Due to the low success rates, women often go to 2–3 cycles of IVF, which accumulates to ~$10,250–$19,250.
The IUI Process
- Sperm is retrieved and washed to concentrate sperm cells from the seminal fluids to increase the chances of pregnancy.
- Sperm is injected into the lining of the uterus using a catheter and an ultrasound. The goal is to place as many sperm as possible within the reach of fallopian tubes so that the sperm has a higher than of fertilizing the egg.
In Canada, IUI costs about $1500 — $4000 plus an additional $500 for the sperm wash, amounting to $2000-$4500. IUI works about 10% of the time.
IVF, IUI, and other ARTs are:
- Very expensive
- Not very successful
It doesn’t take a brilliant economist to recognize that those two factors don’t really add up. But day by day, people are turning to ARTs because they simply don’t have other options to have children that are genetically related to them.
Even beyond financial implications and results, the process of going through a cycle causes a lot of mental and emotional pain. In order for IVF to work, you’re injecting hormones and other medications to synthetically induce your body into doing something it wasn’t made to do.
We tried to conceive naturally for a year, before we got referred to a fertility clinic, and the first appointment was methodical, like an orientation: This is where you line up, doors open at 7 a.m., swipe your card, line up here to get your blood work. Next you wait to be called in for your ultrasound, then you pee, then get your internal exam, wait for the doctor and the nurse, learn how to inject yourself with these drugs, pay the bill, go to work, go home, take these meds, come back tomorrow.
Welcome to your new life. Say goodbye to mornings of pressing the snooze button, going to the gym before work, coffee. Hormones are exhausting! Your wardrobe turns over to all things loose so your injection sites don’t get irritated. Fertility appointments happen on weekdays, weekends and stat holidays; there are no exceptions.
Being a young, healthy woman, I had plenty of follicles. Mine just didn’t grow large enough in size to turn into a plump 2 mm-sized egg to fertilize. I quickly adapted to my new routine, but I did not adapt well to the hormones. My body only responded in extremes: Either nothing happened at all or I was reacting to the drugs in such a way that I would have ended up like Octomom. This method was obviously not working for me. I became so good at the needles, I didn’t even feel them. It was how they reacted with my brain and emotions that was so uncontrollable and terrifying.
After months of cyclical patterns of extreme highs and lows (I’m talking glass shattered, hair falling out, screaming, uncontrollable lows), it took such a toll on my relationship with my husband, our relationship with one another and with friends and family. I forced myself into isolation. In a hormonal Ursula state, I stopped looking at my husband as that loving, supportive, caring person I married. He became that extra body in the house when I wanted to be alone. I wanted him to hurt so he knew how much this process was hurting me. Yet I was the one who wanted to keep going.
I lay awake all night worrying because of the financial and emotional stress I had put on us. I would verbally abuse him without a single logical thought of what I was doing. I was out of control and could not get a grip. I hated myself for not being able to naturally do what every women is “supposed” to do.
- Anonymous
41% of infertile women have depression, and 87% of infertile women have anxiety. Women with infertility feel equally as anxious or depressed as those diagnosed with cancer, hypertension, or recovering from a heart attack.
That’s crazy.
Why do so many men and women have to go through such lengths to produce a child? We’ve come so far in the history of humanity, but we still haven’t figured out a solution to this epidemic that is ruining the lives of so many people and could be the cause of our extinction.
The biggest issue with IVF and IUI is that they’re both very dependent on there being many, healthy eggs and sperm.
It’s almost counterintuitive- many of these people BECAUSE they can’t produce a large number of eggs or sperm.
That’s precisely where Janam Labs comes in. We’re looking to reinvent conventional assisted reproductive technologies by completely bypassing the dependency on good eggs and sperm.
Using somatic cells, specifically skin fibroblasts we are able to turn the cells into Induced Pluripotent Stem Cells, and then to healthy germ cells: eggs and sperm. Following this, using a tissue engineered environment the egg is matured, and in vitro fertilization occurs prior to implanting the embryo within the uterus.
We envision a world where every couple has the opportunity to reproduce, start their own family by bringing a baby into this world.
More details about the exact science can be found here. Check out my amazing team members who helped make this possible: Manroop Kalsi, Simran Mayra, and Alisha Arora.
