Introduction
Infertility
is fundamentally the inability to conceive a baby. Infertility also refers to
the state of a woman who is unable to carry a pregnancy to full term.
is fundamentally the inability to conceive a baby. Infertility also refers to
the state of a woman who is unable to carry a pregnancy to full term.
There
are many biological causes of infertility, including some that medical intervention
can treat. Infertility has increased by 4% since 1980s, mostly from problem
with fecundity due to an increase in age.
are many biological causes of infertility, including some that medical intervention
can treat. Infertility has increased by 4% since 1980s, mostly from problem
with fecundity due to an increase in age.
About
40% of the issues involved with infertility are due to the man, another 40% due
to the woman, and 20% result from complication with both partners.
40% of the issues involved with infertility are due to the man, another 40% due
to the woman, and 20% result from complication with both partners.
Women
who are fertile experience a natural period of fertility before and during
ovulation and they are naturally infertile during the rest of the menstrual
cycle. Fertility awareness methods are used to discern when there changes occur
by tracking changes in cervical mucus or basal body temperature.
who are fertile experience a natural period of fertility before and during
ovulation and they are naturally infertile during the rest of the menstrual
cycle. Fertility awareness methods are used to discern when there changes occur
by tracking changes in cervical mucus or basal body temperature.
Definition
Definition of infertility differs.
Demographers tend to define infertility as childlessness in a population of
women of reproductive age, whereas the epidemiological definition refers to
‘trying for’ or ‘time to’ a pregnancy, generally in a population of women
exposed to a probability of conception.
Demographers tend to define infertility as childlessness in a population of
women of reproductive age, whereas the epidemiological definition refers to
‘trying for’ or ‘time to’ a pregnancy, generally in a population of women
exposed to a probability of conception.
The
time needed to pass [during which the couple tried to conceive] for that couple
to be diagnosed with infertility differs between different jurisdictions. Existing
definitions of infertility lack uniformity rendering comparisons in prevalence
between countries or overtime problematic. Therefore, data estimating the
prevalence of infertility cited by various sources differs significantly. A
couple that tries unsuccessfully to have a child after a certain period of time
(often a short period, but definition vary ) is sometimes said to be sub
fertile, meaning less fertile than a typical couple. But infertility and sub
fertility are defined as the inability to conceive after a certain period of
time (the length of which vary), so often the two terms overlap.
time needed to pass [during which the couple tried to conceive] for that couple
to be diagnosed with infertility differs between different jurisdictions. Existing
definitions of infertility lack uniformity rendering comparisons in prevalence
between countries or overtime problematic. Therefore, data estimating the
prevalence of infertility cited by various sources differs significantly. A
couple that tries unsuccessfully to have a child after a certain period of time
(often a short period, but definition vary ) is sometimes said to be sub
fertile, meaning less fertile than a typical couple. But infertility and sub
fertility are defined as the inability to conceive after a certain period of
time (the length of which vary), so often the two terms overlap.
World Health
Organization defines infertility as follows:
Organization defines infertility as follows:
Infertility
as the inability to conceive a child. A couple may be considered infertile if
after two years of regular sexual intercourse without conception, that has not
become pregnant (and there is other reason, such as breast feeding or
postpartum amenorrhea).
as the inability to conceive a child. A couple may be considered infertile if
after two years of regular sexual intercourse without conception, that has not
become pregnant (and there is other reason, such as breast feeding or
postpartum amenorrhea).
Primary
infertility is infertility in a couple who have never had a child while
secondary infertility is failure to conceive following a previous pregnancy.
Infertility may be caused by infection in men or women, but often there no
obvious underlying cause.
infertility is infertility in a couple who have never had a child while
secondary infertility is failure to conceive following a previous pregnancy.
Infertility may be caused by infection in men or women, but often there no
obvious underlying cause.
United States
One
definition of infertility that is frequently used in the United States by
reproductive endocrinologists, doctors who specializes in infertility to
consider a couple eligible for treatment is:
definition of infertility that is frequently used in the United States by
reproductive endocrinologists, doctors who specializes in infertility to
consider a couple eligible for treatment is:
A
woman under 35 has not conceived after 12 months of contraceptive free
intercourse. Twelve months is the lower reference limit for time to pregnancy (TPP)
by the world health organization.
woman under 35 has not conceived after 12 months of contraceptive free
intercourse. Twelve months is the lower reference limit for time to pregnancy (TPP)
by the world health organization.
A
woman over 35 has not conceived after months of contraceptive free sexual
intercourse. The time interval would seem to be reversed; this is an area where
public policy triumphs science. The idea is that for women beyond age 35, every
month counts and if made to wait another months to prove the necessity of medical
intervention, the problem could become worse. The contrary to this is that, by
definition, failure to conceive in women under 35 isn’t regarded with the same
urgency as it is in those over 35.
woman over 35 has not conceived after months of contraceptive free sexual
intercourse. The time interval would seem to be reversed; this is an area where
public policy triumphs science. The idea is that for women beyond age 35, every
month counts and if made to wait another months to prove the necessity of medical
intervention, the problem could become worse. The contrary to this is that, by
definition, failure to conceive in women under 35 isn’t regarded with the same
urgency as it is in those over 35.
United Kingdom
In
the UK, the NICE guidelines define infertility as failure to conceive after
regular unprotected sexual intercourse for 2 years in the absence of known reproductive
pathology.
the UK, the NICE guidelines define infertility as failure to conceive after
regular unprotected sexual intercourse for 2 years in the absence of known reproductive
pathology.
Other Definitions
Researchers
commonly base demographic studies on infertility prevalence on a five year
period, practical measurement problems, however, exists for any definitions,
because it is difficult to measure continuous
exposure to the risk of pregnancy over a
period of years.
commonly base demographic studies on infertility prevalence on a five year
period, practical measurement problems, however, exists for any definitions,
because it is difficult to measure continuous
exposure to the risk of pregnancy over a
period of years.
Prevalence
Prevalence
of infertility varies depending on the definitions, i.e. on the time span
involved in the failure to conceive.
of infertility varies depending on the definitions, i.e. on the time span
involved in the failure to conceive.
Some
estimates suggest that worldwide ‘between three and seven percent of all couples
or women have an unresolved problem of infertility. Many more couples, however,
experience involuntary childlessness for at least one year’s estimates ranges
from 12% to 28%
estimates suggest that worldwide ‘between three and seven percent of all couples
or women have an unresolved problem of infertility. Many more couples, however,
experience involuntary childlessness for at least one year’s estimates ranges
from 12% to 28%
Fertility
problems affect one in seven couples in the UK. Most couples (about 84 out of
every 100) who have regular sexual intercourse (that is, every two to three
days) and who do not use contraception to get pregnant within a year. About 92 out of 100 couples who are trying to get
pregnant do so within two years. Women become less fertile as they get older.
For women aged 35, about 94 out of every 100 who have regular unprotected
sexual intercourse get pregnant after three years of trying. For women aged 38,
however only 77 out of every 100 do so. The effect of age upon men’s fertility
is less clear.
problems affect one in seven couples in the UK. Most couples (about 84 out of
every 100) who have regular sexual intercourse (that is, every two to three
days) and who do not use contraception to get pregnant within a year. About 92 out of 100 couples who are trying to get
pregnant do so within two years. Women become less fertile as they get older.
For women aged 35, about 94 out of every 100 who have regular unprotected
sexual intercourse get pregnant after three years of trying. For women aged 38,
however only 77 out of every 100 do so. The effect of age upon men’s fertility
is less clear.
In
people going forward for IVF in the UK, roughly half of fertility problems with
a diagnosed cause are due to problems with women. However, about one in five
cases of infertility has no clear diagnosed cause. In Britain, male factor infertility
accounts for 25% of infertile couples, while25% remained unexplained 50% are
female cause’s with25% being due to anovulation and 25% tubal problems/others.
people going forward for IVF in the UK, roughly half of fertility problems with
a diagnosed cause are due to problems with women. However, about one in five
cases of infertility has no clear diagnosed cause. In Britain, male factor infertility
accounts for 25% of infertile couples, while25% remained unexplained 50% are
female cause’s with25% being due to anovulation and 25% tubal problems/others.
In
Sweden, approximately 10% of couples wanting children are infertile. In
approximately one third of these cases the man is the factor, in one third the
woman is the factor, and in the remaining third the infertility is a product of factors on both parts.
Sweden, approximately 10% of couples wanting children are infertile. In
approximately one third of these cases the man is the factor, in one third the
woman is the factor, and in the remaining third the infertility is a product of factors on both parts.
Data from UK 2009.
This
section deals with unintentional causes of sterility. For more information
about surgical techniques for preventing procreation, see sterilization (surgical
procedure).
section deals with unintentional causes of sterility. For more information
about surgical techniques for preventing procreation, see sterilization (surgical
procedure).
Causes in Either
Sex:
Sex:
Factors
that can cause male as well as female infertility are:
that can cause male as well as female infertility are:
·
DNA
Damage: DNA damage reduces fertility in
female ovocytes, as caused by smoking, other xenobiotic DNA damaging agents
(such as radiation of chemotherapy) or accumulation of the oxidative DNA damage
8-hydrogen-deoxyguanosine. DNA damage reduces fertility in male sperm, as
caused by oxidative DNA damage, smoking, other xenobiotic DNA damaging agents
(such as drugs or chemotherapy) or other DNA damaging agents including reactive
oxygen species fever or high testicular temperature.
DNA
Damage: DNA damage reduces fertility in
female ovocytes, as caused by smoking, other xenobiotic DNA damaging agents
(such as radiation of chemotherapy) or accumulation of the oxidative DNA damage
8-hydrogen-deoxyguanosine. DNA damage reduces fertility in male sperm, as
caused by oxidative DNA damage, smoking, other xenobiotic DNA damaging agents
(such as drugs or chemotherapy) or other DNA damaging agents including reactive
oxygen species fever or high testicular temperature.
·
Genetic
Factors: A robertsonian translocation in
either partner may cause recurrent spontaneous abortion or complete
infertility.
Genetic
Factors: A robertsonian translocation in
either partner may cause recurrent spontaneous abortion or complete
infertility.
·
General
Factors: diabetes mellitus, thyroid
disorders, adrenal diseases, hypothalamic-pituitary factors, hyperprolactinema,
hypopituitarism, the presence of anti-thyroid antibodies is associated with an
increased risk of unexplained sub fertility with an odds ratio of 1.5 and 95%
of confidence interval of 1. 1 -2.0
General
Factors: diabetes mellitus, thyroid
disorders, adrenal diseases, hypothalamic-pituitary factors, hyperprolactinema,
hypopituitarism, the presence of anti-thyroid antibodies is associated with an
increased risk of unexplained sub fertility with an odds ratio of 1.5 and 95%
of confidence interval of 1. 1 -2.0
·
Environmental
Factor: Toxins such as glues, volatile
organic solvents or silicones, physical agents, chemical dust, and pesticides.
Tobacco smokers are 60% more likely to be infertile than non-smoker.
Environmental
Factor: Toxins such as glues, volatile
organic solvents or silicones, physical agents, chemical dust, and pesticides.
Tobacco smokers are 60% more likely to be infertile than non-smoker.
·
German scientists
have reported that virus called “Adeno-associated virus” might have a
role in male infertility, though it is otherwise not harmful.
German scientists
have reported that virus called “Adeno-associated virus” might have a
role in male infertility, though it is otherwise not harmful.
·
Mutations that alter human DNA adversely can
cause infertility the human body thus preventing the tainted DNA from being
passed on.
Mutations that alter human DNA adversely can
cause infertility the human body thus preventing the tainted DNA from being
passed on.
Unexplained
Infertility
Infertility
In
the US, up to 20% of infertile couple have unexplained infertility. In these
cases, abnormalities are likely to be present but not detected by current
methods. Possible problems could be that the eggs is not released at the
optimum time for fertilization, that it may not enter the fallopian tube, sperm
may not be able to reach the egg, fertilization may fail to occur, transport
for the zygote may be disturbed or implantation fails. It is increasingly
recognised that egg quality is of critical importance and women of advanced
maternal age have eggs of reduced capacity for normal and successful
fertilization. Also, polymorphisms in folate pathway genes could
be one reason for fertility complications in some women with unexplained
infertility.
the US, up to 20% of infertile couple have unexplained infertility. In these
cases, abnormalities are likely to be present but not detected by current
methods. Possible problems could be that the eggs is not released at the
optimum time for fertilization, that it may not enter the fallopian tube, sperm
may not be able to reach the egg, fertilization may fail to occur, transport
for the zygote may be disturbed or implantation fails. It is increasingly
recognised that egg quality is of critical importance and women of advanced
maternal age have eggs of reduced capacity for normal and successful
fertilization. Also, polymorphisms in folate pathway genes could
be one reason for fertility complications in some women with unexplained
infertility.
Assessment
If
both partners are young and healthy and have been trying to conceive for a year
without success, a visit to the family doctor could help to highlight potential
medical problems earlier rather than later. The doctor may also be able to
suggest lifestyle changes to increase the chances of conceiving.
both partners are young and healthy and have been trying to conceive for a year
without success, a visit to the family doctor could help to highlight potential
medical problems earlier rather than later. The doctor may also be able to
suggest lifestyle changes to increase the chances of conceiving.
Women
over the age of 35 should see their family doctor after six months as fertility
tests can take some time to complete, and age may affect the treatment options
that are open in that case.
over the age of 35 should see their family doctor after six months as fertility
tests can take some time to complete, and age may affect the treatment options
that are open in that case.
A
family doctor takes a medical history and gives a physical examination. They
can also carry out some basic test on both partners to see if there is an
identifiable reason for having achieved a pregnancy. If necessary the refer
patients to a fertility clinic or local hospital for more specialized tests.
The results of these tests help determine the best fertility treatment.
family doctor takes a medical history and gives a physical examination. They
can also carry out some basic test on both partners to see if there is an
identifiable reason for having achieved a pregnancy. If necessary the refer
patients to a fertility clinic or local hospital for more specialized tests.
The results of these tests help determine the best fertility treatment.
Treatment
Treatment
depends on the cause of infertility, but includes:
depends on the cause of infertility, but includes:
1.
Counselling
Counselling
2.
Fertility
treatment, which include in-vitro fertilization.
Fertility
treatment, which include in-vitro fertilization.
According
to ESHRE recommendations, couples with an estimated live birth rate of
40% or higher per year are encouraged to continue aiming for a spontaneous
pregnancy.
to ESHRE recommendations, couples with an estimated live birth rate of
40% or higher per year are encouraged to continue aiming for a spontaneous
pregnancy.
Treatment
methods for infertility may be grouped as medical/complementary and alternative
treatments. Some methods maybe used in concert with other methods. Drugs used
for women include Clomiphene Citrate, Human menopausal gonadotropin,
Follicle-stimulating hormone, Human chorionic gonadotropin, Gonadotropin-releasing
hormone analogs, Aromatase inhibitor, metformin.
methods for infertility may be grouped as medical/complementary and alternative
treatments. Some methods maybe used in concert with other methods. Drugs used
for women include Clomiphene Citrate, Human menopausal gonadotropin,
Follicle-stimulating hormone, Human chorionic gonadotropin, Gonadotropin-releasing
hormone analogs, Aromatase inhibitor, metformin.
At Home Conception
Kit
Kit
In
2007, the FDA cleared the first at home tier one medical conception device to
aid in conception. The key to the kit are cervical cap for conception. This at
home (cervical cap) insemination method allows all the semen to be place up
against the cervical os for 6 hours allowing all available sperm to be placed
directly on the cervical os. For low sperm count, low sperm motility, or a
tilted cervix using a cervical cap aids conception. This is a prescriptive
medical device, but not commonly prescribed by physicians.
2007, the FDA cleared the first at home tier one medical conception device to
aid in conception. The key to the kit are cervical cap for conception. This at
home (cervical cap) insemination method allows all the semen to be place up
against the cervical os for 6 hours allowing all available sperm to be placed
directly on the cervical os. For low sperm count, low sperm motility, or a
tilted cervix using a cervical cap aids conception. This is a prescriptive
medical device, but not commonly prescribed by physicians.
Assisted Natural
Conception
Conception
For
some causes of infertility, assisted natural conception can provide couples with
a pregnancy rate at least as high as the one provided by fertility treatment.
This is typically for couples with unexplained infertility, sperm count above
5M/ml one tube blocked, or other mild infertility causes.
some causes of infertility, assisted natural conception can provide couples with
a pregnancy rate at least as high as the one provided by fertility treatment.
This is typically for couples with unexplained infertility, sperm count above
5M/ml one tube blocked, or other mild infertility causes.
Medical Treatment
Medical
treatment of infertility generally involves the use of fertility medication,
medical device, surgery, or a combination of the following:
treatment of infertility generally involves the use of fertility medication,
medical device, surgery, or a combination of the following:
If
the sperm are of good quality and the mechanics of the woman’s reproductive
structures are good. (patent fallopian tubes, adhesions or scarring),
physicians may start by prescribing a course of ovarian stimulating medication.
The physician may also suggest using a conception cap. Cervical cap the patient
uses at home by placing the sperm inside the cap and putting the conception device
on the cervix or intrauterine insemination (IUI) in which the doctor introduce
sperm into the uterus during ovulation, via a catheter. In these methods,
fertilization occurs inside the body. If conservative medical treatments fail
to achieve a full term pregnancy, the physician may suggest the patient undergo
in-vitro fertilization (IVF).
the sperm are of good quality and the mechanics of the woman’s reproductive
structures are good. (patent fallopian tubes, adhesions or scarring),
physicians may start by prescribing a course of ovarian stimulating medication.
The physician may also suggest using a conception cap. Cervical cap the patient
uses at home by placing the sperm inside the cap and putting the conception device
on the cervix or intrauterine insemination (IUI) in which the doctor introduce
sperm into the uterus during ovulation, via a catheter. In these methods,
fertilization occurs inside the body. If conservative medical treatments fail
to achieve a full term pregnancy, the physician may suggest the patient undergo
in-vitro fertilization (IVF).
IVF
and related techniques (ICSI, ZIFT,GIFT) are called assisted reproductive
technology (ART) techniques.
and related techniques (ICSI, ZIFT,GIFT) are called assisted reproductive
technology (ART) techniques.
ART
techniques generally start with stimulating the ovaries to increase egg
production, after stimulation, the physician surgically extract one or more
eggs from the ovary, and unites them with sperm in a laboratory setting with
the intent of producing one or more embryos.
techniques generally start with stimulating the ovaries to increase egg
production, after stimulation, the physician surgically extract one or more
eggs from the ovary, and unites them with sperm in a laboratory setting with
the intent of producing one or more embryos.
Fertilization
takes place outside the body and the fertilized egg is reinserted into the
woman’s reproductive tract, in a procedure called Embryo transfer.
takes place outside the body and the fertilized egg is reinserted into the
woman’s reproductive tract, in a procedure called Embryo transfer.
Other
medical techniques are e.g tuboplasty, assisted hatching, and pre-implantation
genetic diagnosis.
medical techniques are e.g tuboplasty, assisted hatching, and pre-implantation
genetic diagnosis.
Tourism (Or
Fertility Tourism)
Fertility Tourism)
Fertility
tourism is the practice of travelling to another country for fertility
treatments. It may be regarded as a form of medical tourism. The main
reasons for fertility tourism are legal regulation of the sought procedure in
the home country or lower price. The major procedures involved are in-vitro
fertilization and donor insemination.
tourism is the practice of travelling to another country for fertility
treatments. It may be regarded as a form of medical tourism. The main
reasons for fertility tourism are legal regulation of the sought procedure in
the home country or lower price. The major procedures involved are in-vitro
fertilization and donor insemination.
Ethics
There
are several ethical issues associated with infertility and its treatment.
are several ethical issues associated with infertility and its treatment.
1.
High costs
treatments are out of financial reach for some couples.
High costs
treatments are out of financial reach for some couples.
2.
Debate over whether
health insurance companies (e.g in US) should be required to cover infertility
treatment.
Debate over whether
health insurance companies (e.g in US) should be required to cover infertility
treatment.
3.
Allocation of
medical resources that could be used elsewhere.
Allocation of
medical resources that could be used elsewhere.
4.
The legal status of
embryos fertilized in-vitro and not transferred in-vivo.
The legal status of
embryos fertilized in-vitro and not transferred in-vivo.
5.
Pro-life opposition
to the destruction of embryos not transferred in-vivo.
Pro-life opposition
to the destruction of embryos not transferred in-vivo.
6.
IVF and other
fertility treatments have resulted in an increase in multiple births provoking
ethical analysis because of the link between multiple pregnancies, premature
birth, and a host of health problems.
IVF and other
fertility treatments have resulted in an increase in multiple births provoking
ethical analysis because of the link between multiple pregnancies, premature
birth, and a host of health problems.
7.
Religious leaders’
opinions on fertility treatment.
Religious leaders’
opinions on fertility treatment.
Psychological
Impact
Impact
The
consequences of infertility are manifold and can include social repercussion
and personal suffering. Advances in assisted reproductive technologies, such as
IVF, can offer hope to many couples where treatment is available, although
barriers exist in terms of medical coverage and affordability. The
medicalization of infertility has unwittingly led to a disregard for the
emotional responses that couples experience, which include distress, loss of
control, stigmatization, and a disruption in the developmental trajectory of
adulthood, anxiety, increasing sexual dysfunction.
consequences of infertility are manifold and can include social repercussion
and personal suffering. Advances in assisted reproductive technologies, such as
IVF, can offer hope to many couples where treatment is available, although
barriers exist in terms of medical coverage and affordability. The
medicalization of infertility has unwittingly led to a disregard for the
emotional responses that couples experience, which include distress, loss of
control, stigmatization, and a disruption in the developmental trajectory of
adulthood, anxiety, increasing sexual dysfunction.
Marital
discord often develops in infertile couples, especially when they are under
pressure to make medical decisions. Women trying to conceive often have
clinical depression rates similar to women who have heart disease or cancer.
discord often develops in infertile couples, especially when they are under
pressure to make medical decisions. Women trying to conceive often have
clinical depression rates similar to women who have heart disease or cancer.
Even
couples undertaking IVF face under considerable stress. The emotional losses
created infertility include the denial of motherhood as a rite of passage; the
loss of one’s anticipated and imagined life; felling a loss of control changed
and sometimes lost friendships; and for many, the loss of one’s religious
environment as a support system.
couples undertaking IVF face under considerable stress. The emotional losses
created infertility include the denial of motherhood as a rite of passage; the
loss of one’s anticipated and imagined life; felling a loss of control changed
and sometimes lost friendships; and for many, the loss of one’s religious
environment as a support system.
MEN= emotional stress and marital
difficulties.
Social Impact
1.
Stigmatization in
cultures
Stigmatization in
cultures
2.
Degree of rejection
of close social groups.
Degree of rejection
of close social groups.
