Infertility is the inability of a person, animal or plant to reproduce in a natural way. It is usually not a natural state of healthy adults, except especially among certain eusocial species (mostly haplodiploid insects).
In humans, infertility is the inability to conceive or carry a pregnancy for the full term. There are many causes of infertility, including some that can be handled by medical intervention. Estimates from 1997 show that worldwide around five percent of all heterosexual couples have unresolved problems with infertility. More couples, however, experience childless disability for at least a year: estimates range from 12% to 28%. "20-30% of cases of infertility caused by male infertility, 20-35% caused by female infertility, and 25 -40% are due to joint problems in both parts. In 10-20% of cases, no cause is found. common causes of female infertility are ovulation problems that generally manifest themselves with rare or non-existent menstrual periods. Male infertility most commonly due to deficiency in semen, and semen quality are used as a measure of male fecundity.
Fertile women experience a natural period of fertility before and during ovulation, and they are naturally infertile during the rest of the menstrual cycle. The fertility awareness method is used to see when this change occurs by tracking changes in cervical mucus or basal body temperature.
Video Infertility
Definitions
"Demographers tend to define infertility as having no children in a reproductive age female population," whereas "epidemiological definitions refer to" trying to "or" time for "pregnancy, generally in a female population exposed to" the possibility of conception. Currently, female fertility usually peaks at age 24 and decreases after 30, with pregnancy rarely after the age of 50. A woman is most fertile in 24 hours ovulation. Peak male fertility is usually at the age of 25 and decreases after age 40. The time it takes to pass (where couples try to conceive) for the couple to be diagnosed with different infertility between different jurisdictions. The existing definition of infertility lacks uniformity, rendering comparisons in prevalence among countries or over time troubled. Therefore, the data estimate the prevalence of infertility quoted by various sources differ significantly. Couples who try unsuccessfully have children after a period of time (often short periods, but definitions vary) are sometimes said to be subfertil, which means less fertile than regular couples. Both infertility and subfertility are defined as the inability to conceive after a period of time (which varies in length), so often the two terms overlap.
World Health Organization
The World Health Organization defines infertility as follows:
United States
One of the definitions of infertility that is often used in the United States by reproductive endocrinologists, doctors who specialize in infertility, to consider eligible couples for treatment are:
- a woman under 35 is not pregnant after 12 months of contraceptive-free sex. Twelve months is the lower reference limit for Time to Pregnancy (TTP) by the World Health Organization.
- a woman over 35 is not pregnant after 6 months of unprotected contraception.
This time interval seems to be reversed; this is an area where public policy defeats science. The idea is that for women beyond the age of 35, every month is calculated and if it is made to wait another 6 months to prove the need for medical intervention, the problem may get worse. The natural consequence of this is that, by definition, failure to conceive in women under 35 is not considered to be the same urgency as those over 35 years of age.
United Kingdom
In the UK, previous NICE guidelines define infertility as a failure to conceive after unprotected intercourse for 2 years without any known reproductive pathology. The NICE Guide update does not include a specific definition, but recommends that "A woman of reproductive age who is not pregnant after 1 year unprotected vaginal sex, in the absence of known infertility causes, should be offered clinical judgment and further investigation, together with her partner, with a prior referral to a specialist if the woman is over 36 years of age.
Other definitions
Researchers generally base their demographic studies on the prevalence of infertility over a five-year period. Practical measurement problems, however, exist for any definition, as it is difficult to measure the ongoing exposure to the risk of pregnancy for several years.
Primary vs. primary infertility. secondary
Primary infertility is defined as the absence of live births for women who want children and have been allied for at least 12 months, where they have not used contraception. The World Health Organization also adds that 'women whose pregnancies spontaneously miscarry, or whose pregnancy results in children born, without ever having a live birth will come with mainly infertility'.
Secondary infertility is defined as the absence of live births for women who want children and have been allied for at least 12 months since their last live birth, where they do not use contraception.
Thus the distinguishing feature is whether the couple has a pregnancy that causes live birth.
Maps Infertility
Effects
Psychological
The consequences of infertility are manifold and may include social impacts and personal suffering. Advances in assisted reproductive technology, such as IVF, can offer hope for many couples where treatment is available, although barriers exist in terms of medical coverage and affordability. Unconscious medicalization of infertility has led to a neglect of the emotional response experienced by a partner, which includes distress, loss of control, stigmatization, and disruption in the trajectory of adult development.
Infertility may have psychological effects. Partners can become more eager to conceive, increasing sexual dysfunction. Marital disputes often develop, especially when they are under pressure to make medical decisions. Women who try to get pregnant often have levels of depression that are similar to women who have heart disease or cancer. Emotional stress and marital difficulties are greater in couples where infertility lies in the man.
Older people with older children seem to live longer. Why this case is unclear and may be partially dependent on those who have children who adopt a healthier lifestyle, support from children, or circumstances that cause no children.
Social
In many cultures, the inability to conceive contains stigma. In a closed social group, the level of rejection (or feeling rejected by a spouse) can cause considerable anxiety and disappointment. Some respond by actively avoiding problems altogether; middle-class men are the most likely to respond in this way.
In the United States some treatments for infertility, including diagnostic tests, surgery and therapy for depression, can qualify one for Family leave and Medical Leave. It has been argued that infertility is classified as a form of disability.
Cause
Immune Infertility
Antisperm antibodies (ASA) have been considered to cause infertility in about 10-30% of infertile couples. In men and women, the production of ASA is directed against the surface antigen in the sperm, which can disrupt sperm motility and transport through the female reproductive tract, inhibit capacitance and acrosome reactions, fertilization disorders, influence on implantation process, and growth and developmental disorders. of the embryo. Factors that contribute to the formation of antisperm antibodies in women are impaired normal immunoregulation mechanisms, infections, integrity of mucous membranes, rape and oral or anal sex without condoms. Risk factors for the formation of antisperm antibodies in men include blood-testicular barrier disorders, trauma and surgery, orchitis, varicocele, infection, prostatitis, testicular cancer, immunosuppression failure and anal or oral sex without receptive condoms with men.
Sexually transmitted infections
Infections with the following sexually transmitted pathogens have a negative effect on fertility: Chlamydia trachomatis and Neisseria gonorrhoeae . There is a consistent relationship of mycoplasma genitalium infection and female reproductive tract syndrome. M. genitalium infection is associated with an increased risk of infertility.
Genetic
Robertsonian translocation in one partner may cause recurrent spontaneous abortion or complete infertility.
Mutations in the NR5A1 gene encoding Steroidogenic Factor-1 (SF-1) have been found in a small proportion of men with non-obstructive male factor infertility in which the cause is unknown. Results from one study investigating a 315 male cohort revealed changes in the SF-1 hinge region and no rare allele variants in fertile control men. Affected individuals showed more severe forms of infertility such as azoospermia and severe oligozoospermia.
Other causes
Factors that can cause men as well as female infertility are:
- DNA damage
- DNA damage reduces fertility in female ovaries, caused by smoking, other xenobiotic DNA destroyers (such as radiation or chemotherapy) or the accumulation of oxidative DNA damage 8-hydroxy-deoxyguanosin DNA damage reduces fertility in male sperm, such as those caused by oxidative DNA damage, smoking, other xenobiotic DNA destroyers (such as drugs or chemotherapy) or other DNA-damaging agents including reactive oxygen species, fever or high testicular temperatures. The damaged DNA associated with infertility manifests itself by increased susceptibility to heat or acid induced denaturation and/or in the presence of double-stranded breaks that can be detected by the TUNEL test.
- Diabetes mellitus, thyroid disorder, undiagnosed and untreated celiac disease, adrenal disease
- Hyperprolactinemia
- Hypopituitarism
- The presence of anti-thyroid antibodies is associated with an unexplained increase in subfertility risk with an odds ratio of 1.5 and 95% confidence interval from 1.1 to 2.0.
- Toxins such as glue, volatile organic solvents or silicones, physical substances, chemical dusts, and pesticides. Tobacco smokers are 60% more likely to be infertile than non-smokers.
German scientists have reported that a virus called a virus associated with Adeno may have a role in male infertility, although it is harmless. Other diseases such as chlamydia, and gonorrhea can also cause infertility, due to internal scarring (obstruction of the fallopian tube).
Female
The following infertility causes can only be found in women. For a woman to get pregnant, certain things must happen: sex should be done around the time when the egg is removed from its ovaries; the egg-producing system must work at an optimal level; and hormones must be balanced.
For women, problems with fertilization arise mainly from structural problems in Fallopian tubes or uterus or egg-release problems. Infertility can be caused by fallopian tube blockage due to malformations, infections such as chlamydia and/or scarring. For example, endometriosis can cause infertility with endometrial tissue growth in Fallopian tubes and/or around the ovaries. Endometriosis is usually more common in women in their mid-twenties and older, especially when delayed labor has occurred.
Another cause of infertility in women is the inability to ovulate. Malformations of the egg itself can complicate conception. For example, polycystic ovary syndrome is when the eggs are only partially developed in the ovaries and there is an excess of male hormones. Some women are sterile because their ovaries do not mature and release eggs. In this case synthetic FSH by injection or Clomid (Clomiphene citrate) through a pill can be given to stimulate the follicle to mature in the ovary.
Other factors that may affect a woman's chances of becoming pregnant include being overweight or underweight, or her age when female fertility declines after the age of 30 years.
Sometimes it can be a combination of factors, and sometimes the obvious cause is never fixed.
Common causes of female infertility include:
- ovulation problems (eg polycystic ovary syndrome, PCOS, the main reason why women come to a fertility clinic because of anovulatory infertility.)
- tubal blockage
- pelvic inflammatory disease caused by infection such as tuberculosis
- age related factors
- uterine problem
- previous tubal ligation
- endometriosis
- advanced mother age
- immune infertility
Men
The main cause of male infertility is low semen quality. In men who have reproductive organs needed to reproduce, infertility can be caused by low sperm counts due to endocrine problems, drugs, radiation, or infection. There may be testicular malformations, hormonal imbalance, or blockage of the human canal system. Although many of these can be treated through surgery or hormone replacement, some may be unlimited. Infertility is associated with live sperm, but imotyl may be caused by primary ciliary dyskinesia. Sperm should provide a zygote with DNA, centrioles, and activation factors for the embryo to develop. Damage to one of these sperm structures can cause infertility that will not be detected by semen analysis. Antibody antibodies cause immune infertility. Cystic fibrosis can cause infertility in men.
Combined infertility
In some cases, both male and female may be infertile or sub-fertile, and partner infertility arises from a combination of these conditions. In other cases, the cause is suspected to be immunological or genetic; maybe every couple is independently fertile but the couple can not get pregnant together without help.
Unexplained infertility
In the US, up to 20% of infertile couples have unexplained infertility. In these cases the abnormality tends to be present but is not detected by the current method. A possible problem is the egg is not released at optimal time for fertilization, which may not enter the fallopian tube, the sperm may not reach the egg, the fertilization may fail, the transport of the zygote may be impaired, or implantation fails. It is increasingly recognized that egg quality is very important and older women have eggs with reduced capacity for normal and successful conception. Also, polymorphism in the folate pathway can be one of the reasons for fertility complications in some women with unexplained infertility. However, more and more evidence suggests that epigenetic modification in sperm may be partly responsible.
Diagnosis
If both young and healthy couples have tried to conceive for a year with no results, a visit to a health care practitioner's doctor or nurse (WHNP) may help highlight potential medical problems sooner rather than later. The doctor or WHNP may also be able to suggest lifestyle changes to increase the likelihood of getting pregnant.
Women over 35 should see their physician or WHNP after six months because fertility tests take time to complete, and age may influence open treatment options in such cases.
A doctor or WHNP takes a medical history and provides a physical examination. They can also perform some basic tests on both partners to see if there are any identifiable reasons for not reaching a pregnancy. If necessary, they refer patients to a fertility clinic or local hospital for more specific tests. The results of these tests help determine the best fertility treatment.
Treatment
Treatment depends on the cause of infertility, but may include counseling, fertility treatments, 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 targeting spontaneous pregnancies. Treatment methods for infertility can be classified as medical or complementary and alternative medicine. Some methods can be used in conjunction with other methods. Drugs used for both women and men include clomiphene citrate, human menopausal gonadotropin (hMG), follicle-stimulating hormone (FSH), human chorionic gonadotropin (hCG), analogous gonadotropin-releasing hormone (GnRH), aromatase inhibitor, and metformin.
Medical care
Infertility medical treatment generally involves the use of fertility drugs, medical devices, surgery, or a combination of the following. If the sperm is of good quality and the mechanism of the female reproductive structure is good (patent fallopii tube, no adhesion or scarring), of course ovarian stimulant drugs may be used. The doctor or WHNP may also suggest using a conception cap cervical cap, which is used by the patient at home by placing sperm inside the cap and putting a conception device on the cervix, or intrauterine insemination (IUI), in which the doctor or WHNP introduces sperm to the uterus during ovulation, through catheter. In this method, fertilization takes place inside the body.
If conservative medical care fails to achieve full-term pregnancy, the doctor or WHNP may advise the patient to undergo in vitro fertilization (IVF). IVF and related techniques (ICSI, ZIFT, GIFT) are called reproductive technology assistance techniques (ART).
ART techniques generally begin by stimulating the ovaries to increase egg production. After stimulation, the doctor surgically extracts one or more eggs from the ovary, and incorporates them with sperm in a laboratory setting, with the intention of producing one or more embryos. Fertilization occurs outside the body, and the fertilized egg is put back into the female reproductive tract, in a procedure called embryo transfer.
Other medical techniques such as tuboplasty, assisted hatching, and genetic diagnosis Preimplantation.
In-vitro fertilization
IVF is the most commonly used ART. It has proven useful in treating infertility conditions, such as blocked or damaged tubes, endometriosis, recurrent IUI failure, unexplained infertility, poor ovarian reserve, poor sperm count or even nil.
Injection of intrasitoplasmic sperm
ICSI techniques are used in cases of poor semen quality, low sperm count or fertilization attempts failed during previous IVF cycles. This technique involves injection of a healthy sperm that is directly injected into a cooked egg. The fertilized embryo is then transferred to the uterus.
Tourism
fertility tourism is the practice of traveling to other countries for fertility treatments. This can be considered a form of medical tourism. The main reason for fertility tourism is the legal regulation of the procedures sought in the country of origin, or lower prices. In-vitro fertilization and donor insemination are the main procedures involved.
Epidemiology
The prevalence of infertility varies depending on the definition, ie on the time span involved in failure to conceive.
- The infertility rate has increased by 4% since the 1980s, mostly from problems with fecundity due to increasing age.
- The fertility problem affects one in seven couples in the UK. Most couples (about 84%) have regular intercourse (ie, every two to three days) and who do not take birth control in a year. About 92 out of 100 couples who try to get pregnant do so within two years.
- Women become less fertile with age. For 35-year-old women, about 94% who have unprotected sexual intercourse regularly get pregnant after three years of trying. For women aged 38 years, only about 77%. The effect of age on male fertility is less clear.
- In the person who will undergo IVF in the UK, about half the fertility problems with the diagnosed cause are due to problems with the man, and about half of them due to problems with the woman. However, about one in five cases of infertility do not have a clear cause of diagnosis.
- In the UK, male factor infertility accounts for 25% of infertile couples, while 25% remains unexplained. 50% is the cause of women with 25% caused by anovulation and 25% of tubal/other problems.
- In Sweden, about 10% of couples who want infertile children. In about one-third of these cases, men are the factor, in one-third the woman is the factor, and in the third the infertility is the product of the factors in both parts.
Society and culture
Perhaps except for infertility in science fiction, movies and other fiction that illustrate the emotional struggle of assisted reproductive technology has made its first progress in the latter part of the 2000s, though this technique has been available for decades. However, the number of people who can relate it to personal experience in one way or another continues to grow, and the trials and struggles are enormous.
Pixar's Up contains an overview of infertility in a long life montage that lasts the first few minutes of the movie.
Other individual examples are referred to individual sub-particles of assisted reproductive technologies
Ethics
There are several ethical issues related to infertility and treatment.
- High cost treatments are not affordable for some couples.
- The debate over whether health insurance companies (eg in the US) should be required to cover infertility treatments.
- Allocation of medical resources that can be used elsewhere
- The legal status of the embryo is fertilized in vitro and not transferred in vivo. (See also Beginning of pregnancy controversy).
- Pro-life opposition to the destruction of embryos that are not transferred in vivo. IVF and other fertility treatments have resulted in increased twin births, provoking ethical analysis because of the relationship between multiple pregnancies, preterm delivery, and a number of health problems.
- The opinions of religious leaders on fertility treatments; for example, the Roman Catholic Church views infertility as a call to adopt or use natural treatments (medication, surgery, and/or cycle-making) and members should reject assisted reproduction technologies.
- The infertility caused by a DNA defect on the Y chromosome is passed from father to son. If natural selection is a major error correction mechanism that prevents random mutations on the Y chromosome, then fertility treatments for men with abnormal sperm (especially ICSI) only delay the underlying problem in the next generation of men.
Many countries have a specific framework for dealing with ethical and social issues surrounding fertility treatments.
- One of the best known is HFEA - the British Regulator for fertility treatment and embryo research. It was founded on 1 August 1991 after a detailed inquiry commission led by Mary Warnock in the 1980s
- Models similar to HFEA have been adopted by other countries in the European Union. Each country has its own body or body responsible for the inspection and licensing of fertility treatments under the EU Network and cell directive.
- The regulatory body is also found in Canada and in the Australian state of Victoria
Developing country
Infertility is often not seen (by the West) as a problem outside industrialized countries. This is because of assumptions about overpopulation and hyper fertility problems in developing countries, and their perceived need to lower their population and birth rate. Lack of health care and high rates of life-threatening diseases (such as HIV/AIDS) in developing countries, such as in Africa, are the supporting reasons for inadequate fertility treatment options. Fertility treatments, even simple ones like treatments for STIs that cause infertility, are therefore not usually available to individuals in these countries.
Nevertheless, infertility has a profound effect on individuals in developing countries, as children's production is often highly regarded socially and vital for social security and health networks and for family income generation. Infertility in this society often leads to social stigmatization and abandonment by spouses. Infertility is, in fact, common in sub-Saharan Africa. Unlike in the West, secondary infertility is more common than primary infertility, which is most often the result of untreated STIs or complications of pregnancy/birth.
Because of the assumptions surrounding hyper-fertility problems in developing countries, the ethical controversy surrounding the idea of ​​whether access to aid-assisted reproductive technology should comprise an important aspect of reproductive health or, at least, whether the distribution and access of such technologies or not should be subject to greater equity. However, as Inhorn highlighted, the overall conceptualization of infertility, to a large extent, disguises important differences that can be made in the local context, both demographically and epidemiologically and moreover, that these factors are highly significant in reproductive ethics. An important factor, Inhorn believes, is the position of men in the paradigm of reproductive health, which due to the general rate of infertility difference between male and female infertility, men remain an aspect largely unseen in theories and discourses around infertility, as well as related treatments and biotechnology. This is especially important given that male infertility accounts for more than half of all infertility cases and moreover, it is clear that male attitudes and behavior have profound implications for both individual and spouse reproductive health. For example, Inhorn notes that when couples in Egypt are confronted with infertility problems that seem unbreakable - due to family and social pressures centered around where children form gender identity of men and women - often women forced to seek follow-up care; this continues to occur, even in cases of known male infertility and that the constant search for treatment often becomes iatrogenic for women. Inhorn states that infertility often leads to "marital death, physical violence, emotional abuse, social exclusion, community seclusion, ineffective and iatrogenic therapy, poverty, elderly insecurity, increased risk of HIV/AIDS, and death." Significantly, Inhorn showed that this phenomenon can not simply be explained by the lack of knowledge, but rather occurs in the complex interaction between the centrality of children in the male gender identity as a symbol of maturity and the lack of women's power in Egyptian society, where they effectively become the scapegoat for narratives culture is accepted as a site blamed for the lack of children without children. It should be emphasized that this is not just a matter of "women oppressed by men" but that men and women share the burden of this narrative, but in different ways, unequal and very complicated. Therefore, while the idea that reproductive health is a 'women's issue' may have a strong social currency, especially in popular discourse and customary meaning systems, the reality of infertility shows that the medical and health paradigm has an important part to play in challenging the validity of the beliefs embedded in this. In addition, the effectiveness of therapeutic, medical or other interventions will depend on such outcomes and have an important part to play in the alleviation of gender suffering, especially the burden imposed on women, who continue to suffer disproportionately from the effects of infertility.
- RCOG clinical guidelines for infertility (quick guide)
- Fertility: Assessment and Care for People with Fertility Issues, 2004 (extensive guidelines)
- GeneReviews/NCBI/NIH/UW entry on CATSPER-Related Male Infertility
- Infertility is not just a Women's Problem
- Assisted Reproduction in Judaism
- Facing Life Without Children When It's Not Available Options
- Voice of Patient - Infertility
Source of the article : Wikipedia
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