Infertility is defined as the inability to achieve a pregnancy after 12 months or more of regular unprotected sexual intercourse.¹

Infertility is a commonly occurring problem in both genders of the reproductive age group. It is a medical condition that can cause psychological, physical, mental and medical disability in the patient.²

According to the World Health Organization, infertility is a serious health condition affecting approximately 8% to 10% of couples worldwide.¹

The signs and symptoms of infertility in women are:³

• Pain during sex
• Menstrual changes like: heavy, long or painful periods, dark or pale menstrual blood, irregular menstrual cycle, premature menopause, polycystic ovarian syndrome, endometriosis (growth of uterine tissue outside the uterus), etc.
• Hormonal changes
• Anxiety

The signs and symptoms of infertility in men are:

• Hormonal imbalance³
• Erectile dysfunction^3,4
• Problems with ejaculation³
• Decreased size of testicles³

Female infertility may be caused due to:¹

• Damaged or blocked fallopian tube, which generally occurs due to untreated sexually transmitted infections or complications of unsafe abortion
• Uterine disorders such as endometriosis
• Imbalance of reproductive hormones. Pituitary cancers and decreased size of the gland, examples of common disorders affecting the reproductive system.
• Ovarian disorders like polycystic ovary disease or ovarian cancer.

Male infertility may be caused due to:¹

• Reduced sperm production or sperm motility.
• Obstruction of the reproductive tract causing dysfunctionalities in the ejection of semen.
• Hormonal disorders leading to abnormalities in hormones produced by the pituitary gland and testicles.
• History of genital surgery, sexually transmitted infections, chemotherapy and radiotherapy. ³
• In a few advanced varicocele (an enlargement of veins in the scrotum).⁵

In both male and female reproductive systems, there are many risk factors for infertility, including: ⁶

• Age: Women's fertility gradually declines with age, especially in the age of 30–39 years compared to women who are younger than 30 years. Men over the age of 40 years may be less fertile.
• Smoking
• Excessive alcohol use.
• People with obesity or underweight.
• Excessive physical or emotional stress that results in amenorrhoea (absence of menstruation).

There are five diagnostic evaluation categories for infertility:²

• Semen analysis
• Assessment of ovarian function and reserve
• Hormonal testing
• Radiological evaluation of the uterus
• Fallopian tubes by hysterosalpingogram⁷

According to the gold standard, laparoscopy is indicated as a first-line diagnostic test for suspected pelvic adhesions, endometriosis or other pelvic pathologies, and hysteroscopy is used with saline infusion sonogram to access the uterine cavity abnormalities.

Treatment options are as follows:⁸

• Medical treatment for lack of regular ovulation
• Surgical procedures such as treatment for endometriosis, repair of the fallopian tubes or removal of scarring (adhesions) within the womb or abdominal cavity
• Assisted conception such as intrauterine insemination or in vitro fertilisation

These treatment options aim to eliminate the causes of infertility.

Role of nutritional supplementation in the treatment of infertility⁹

• Folate (vitamin B9) is an important nutrient that is involved in oocyte (immature egg) quality and maturation, implantation (a stage at which the embryo adheres to the uterine wall), fetal growth and organ development.
• Effects of zinc:
  • In males:
    • It accelerates the onset of sexual function
    • Improves sperm count
    • Improves sperm motility and morphology
    • Improves testosterone concentration
    • Improves sexual potency
  • In females:
    • It helps in sexual development, ovulation and the menstrual cycle
• Antioxidants such as vitamin B, C and A are responsible for improving cellular damage in semen and improving egg quality.
• Natural astaxanthin increases sperm concentration and linear velocity, thus exerting a positive effect on male infertility.

• Overview
• Risk factors for osteoarthritis
• Clinical features: Signs and symptoms
• Diagnosis
• Treatment

• Osteoarthritis is one of the most common types of arthritis, which causes inflammation and injury to the joints leading to bony changes, deterioration of tendons and ligaments and a breakdown of cartilage
• It is more likely to develop in older age individuals
• Approximately 80% of older persons, aged more than 55 years, have evidence of osteoarthritis on X-ray
• After menopause, women are at an increased risk of knee osteoarthritis
• Osteoarthritis most commonly affects the joints of the knee, hip, lower back, neck, hands and feet

• Obesity
• Older age
• Women are at increased risk of osteoarthritis
• Diabetes and hyperlipidemia (elevated levels of lipids or cholesterol)
• Low oestrogen levels as experienced by post-menopausal women
• Heredity

• Joints affected by pain might hurt during or after movement
• Joint stiffness may be most noticeable upon awakening in the morning or after being inactive
• Swelling may be triggered by soft tissue inflammation around the joints
• Tenderness: Feeling of pain while applying mild pressure
• Loss of flexibility: Reduced ability to move the joints through its full range of motion
• Grating sensation: Feeling of a grating sensation whenever there is a movement in the joints, and there may be a cracking sensation in the joints

• X-ray of the joints reveals cartilage loss with narrowing of the space between the bones in the joint
• X-ray also shows bone spurs around the joint
• Magnetic resonance imaging (MRI) can help provide more information in complex cases

1. Non-steroidal anti-inflammatory drugs (NSAIDs) such as paracetamol and ibuprofen can be used
2. Physiotherapy: Exercises to strengthen the muscles around the joint can help increase flexibility and reduce pain
3. Transcutaneous electrical nerve stimulation: This uses a low-voltage electrical current to relieve pain
4. Cortisone injections
5. Lubrication injections: Hyaluronic acid injections
6. Joint replacement
7. Exercise and Nutrition for Osteoarthritis

Complementary and alternative medicine treatments, which have shown promising results in the management of osteoarthritis, include the following:

• Acupuncture
• Glucosamine and chondroitin as nutritional supplements
• Omega-3 fatty acids
• Bioactive collagen peptides (BCPs)
  • Recent studies have shown that collagen peptide was absorbed and distributed to joint tissues, thus reducing pain and inflammation
  • In several clinical trials, BCP supplementation has demonstrated a positive effect on pain and mobility in patients with osteoarthritis

Nutrition is an important component for overall wellness and health.¹

Nutrition is a process by which substances in the food are transformed into body tissues and provide energy for the physical and mental activities that make up human life.²

The food that we eat undergoes many processes such as, digestion, absorption into blood and transportation to various parts of the body, and utilises the materials necessary for growth, renewal and maintenance of the body components. The waste products and undigested food are excreted from the body.²

Based on an individual’s needs, nutrients are divided into two types:

1. Macronutrients, which are needed in large amounts by the body. They essentially provide energy (or calories) to fuel up the bodily functions.³

Macronutrients are proteins, fats and carbohydrates.

These macronutrients contribute to the total energy intake as follows:⁴

1 gram fat = 9 kcal/g (Cal/g)

1 gram carbohydrate = 4 kcal/g (Cal/g)

1 gram protein = 4 kcal/g (Cal/g)

2. Micronutrients, are needed in small amounts by the body mostly responsible for building immunity and overall growth and development of the body. Micronutrients are vitamins and minerals.

Biological factors

• Age
• Height/weight
• Gender
• A host disease
• Genetic factors

Non-biological factors

• Poverty
• Low socio-economic status

Malnutrition occurs due to deficiencies, excesses or imbalances in a person’s intake of energy and/or nutrients.

Based on conditions, malnutrition can be:

• Undernutrition: Wasted growth (low weight-for-height), stunted growth (low height for age and underweight (low weight-for-age).
• Micronutrient-related malnutrition. This occurs due to the lack of important vitamin and minerals or micronutrient excess.
• Overweight, obesity and diet-related noncommunicable diseases (such as heart disease, stroke, diabetes and some cancers).

Nutrition is a basic element of health. Adequate nutrition plays a major role in maintaining health and wellness and many disease states.

Growth and development:

• Infant life and child: good nutrition helps in the growth and development during fetal life and childhood. Physical growth, intellectual development, learning and behaviour are essential while growing.
• Adult life: elderly people need special nutrition due to their physiological and chronological changes.
• Women: and lactating mothers require more proteins and nutrients to prevent abortion, growth retardation and low birth weight in infants and provide adequate breast-feeding for their babies. Good nutrition prevents miscarriage and helps in healthy breast-feeding habits for babies.

Specific deficiency disease: A good nutrition is essential to prevent nutritional deficiency diseases such as protein energy malnutrition, blindness, goitre (enlargement of thyroid gland), low haemoglobin, beriberi (vitamin B1/thiamine deficiency), rickets (vitamin D deficiency), etc. are common in India. It also helps to prevent increased incidence of abortion, prematurity, stillbirth and low birth weight babies in malnourished mothers and helps in the treatment of deficiency diseases.

Resistance to infection: Balanced nutrition helps prevent infections like tuberculosis, enhances wound healing and improves the resistance to an individual's infection.

Mortality and morbidity: Malnutrition increases the risk of death, neonatal mortality, stillbirths, and early births. The leading cause of death is prematurity, and poor nutrition leads to obesity, diabetes, hypertension, cardiovascular and renal disorders and causes death.

Functions of each nutrient in development of the bodily functions⁷