Introduction Infertility is the inability of a person, animal or plant to reproduce by natural means. It is usually not the natural state of a healthy adult organism, except notably among certain eusocial species (mostly haplo diploid insects). In humans, infertility may describe a woman who is unable to conceive as well as being unable to carry a pregnancy to full term. There are many biological andother causes of infertility, including some that medical intervention can treat. Infertility rates have increased by 4% since the 1980s, mostly from problems 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 complications 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 these changes occur by tracking changes in cervical mucus or basal body temperaturePri lary infertili Primary infertility is defined as the absence of a live birth for women who desire a child and have been in a union for at least five years, during which they have not used any contraceptives. The World Health Organization also adds that 'women whose pregnancy spontaneously miscarries, or whose pregnancy results in a still born child, without ever having had a live birth would present with primarily infertility Tjntbty aa Cound NOt NGF OS OHO a Did Aatity 1 Corcieve & GniG afer ORG OF ote CeonponeySecondary infertility is defined as the absence of a live birth for women who desire a child and have been in a union for at least five years since their last live birth, during which they did not use any contraceptives. 12% of couples who already have a child go on to experience econdary infertility. Hele Aee elie eased a] ie i Primacy tafertifity. Peco Case Prat ‘ ae Ck a Ladd eat Thus the distinguishing feature is whether or not the couple have ever had a pregnancy which led to a live birth.Causes of infertility Psychological i The consequences of infertility are manifold and can include societal repercussions 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.Infertility may have profound psychological effects. Partners may become more anxious to conceive, 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. Even couples undertaking IVF face considerable stress. The emotional losses created by infertility include the denial of motherhood as a rite of passage; the loss of one’s anticipated and imagined life; feeling a loss of control over one’s life; doubting one’s womanhood; changed and sometimes lost friendships; and, for many, the loss of one’s religious environment as a support system. Emotional stress and marital difficulties are greater in couples where the infertility lies with the man.Sexuall itted di Infections with the following sexually transmitted pathogens have a negative effect on fertility: Chlamydia trachomatis, Neisseria gonorrhoeae, and Syphilis. There is a consistent association of Mycoplasma genitalium infection and female reproductive tract syndromes. M. genitalium infection is associated with increased risk of infertility.A Robertsonian translocation in either partner may cause recurrent spontaneous abortions or complete infertility. Other causes Factors 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 or chemotherapy)or accumulation of the oxidative DNA damage 8-hydroxy- 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.INFERTILTIY IN FEMALES The following causes of infertility may only be found in females. For a woman to conceive, certain things have to happen: intercourse must take place around the time when an egg is released from her ovary; the system that produces eggs has to be working at optimum levels; and her hormones must be balanced. For women, problems with fertilization arise mainly from either structural problems in the Fallopian tube or uterus or problems releasing eggs. Infertility may be caused by blockage of the Fallopian tube due to malformations, infections such as Chlamydia and/or scar tissue. For example, endometriosis can cause infertility with the growth of endometrial tissue in the Fallopian tubes and/or around the ovaries. Endometriosis is usually more common in women in their mid-twenties and older, especially when postponed childbirth has taken place. Another major cause of infertility in women may be the inability to ovulate. Malformation of the eggs themselves may complicate conception. For example, polycystic ovarian syndrome is when the eggs only partially developed within the ovary and there is an excess of malehormones. Some women are infertile because their ovaries do not mature and release eggs. In this case synthetic FSH by injection or Clomid (Clomiphene citrate) via a pill can be given to stimulate follicles to mature in the ovaries. Female Infertility Other factors that can affect a woman's chances of conceiving include being overweight or underweight, or her age as female fertility declines after the age of 30. Sometimes it can be a combination of factors, and sometimes a clear cause is never established.Common causes of infertility of females include: * Ovulation problems (e.g. polycystic ovarian syndrome, PCOS, the leading reason why women present to fertility clinics due to anovulatory infertility) * tubal blockage * pelvic inflammatory disease caused by infections like tuberculosis * age-related factors * uterine problems * previous tubal ligation * endometriosis * advanced maternal ageINFERTILITY IN MALES The main cause of male infertility is low semen quality. In men who have the necessary reproductive organs to procreate, infertility can be caused by low sperm count due to endocrine problems, drugs, radiation, or infection. There may be testicular malformations, hormone imbalance, or blockage of the man's duct system. Although many of these can be treated through surgery or hormonal substitutions, some may be indefinite. Infertility associated with viable, but immotile sperm may be caused by primary ciliary dyskinesia. SEMEN ANALYSIS (ern oe rn ren Sk Diaawe a Sea ana at amas araMale Intertility In some cases, both the man and woman may be infertile or sub-fertile, and the couple's infertility arises from the combination of these conditions. In other cases, the cause is suspected to be immunological or genetic; it may be that each partner is independently fertile but the couple cannot conceive together without assistance.Unexplained infertility In the US, up to 20% of infertile couples have unexplained infertility.In these cases abnormalities are likely to be present but not detected by current methods. Possible problems could be that the egg is not released at the optimum time for fertilization, which it may not enter the fallopian tube, sperm may not be able to reach the egg, fertilization may fail to occur, transport of the zygote may be disturbed, or implantation fails. It is increasinglyrecognized 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. Genes ( of Unexplained cases ) mans" Factors (Male Sperms)Treatment for infertility 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 aiming for a spontaneous pregnancy. Treatment methods for infertility may be grouped as _ medical or complementary and alternative treatments. Some methods may be used in concert with other methods. Drugs used for both women and men includeclomiphene citrate, human menopausal gonadotropin (hMG), _ follicle- stimulating hormone (FSH), human — chorionic gonadotropin (hCG), gonadotropin-releasing hormone (GnRH)analogues, aromatase inhibitors, and metformin.IN-VITRO FERTILIZATION: Process refers to the fertilization outside the body. Most effective and successful ART, IVF is most often recommended when fallopian tubes of woman are blocked or ir case when men produce too few sperm. © IVF is a major treatment in infertility when other methods of assisted reproductive technology have failed. The process involves : — Ovulation induction through hormone treatment, — Monitoring of hormone levels and follicle scans with ultrasound, — Egg retrieval from the woman's ovaries — and fertilize eggs with sperms ina fluid medium. The fertilized egg (zygote) is then transferred to the patient's uterus with the intent to establish a successful pregnancy.ZIFT: (Zygote Intra-fallopian transfer) It is similar to IVF and fertilization occurs in the laboratory, then instead of the uterus, very young healthy embryo is transferred to the fallopian tubes. Zygote intrafallopian transfer (ZIFT) is an infertility treatment where a blockage in the fallopian tubes are the cause. Egg cells are removed from a woman's ovaries, and in vitro fertilized. The resulting zygote is placed into the fallopian tube by the use of laparoscopy.GIFT: (Gamete Intra-fallopian transfer) In this process fertilization take place in woman’s body by transferring eggs and sperm into the woman’s fallopian tubes. -In gamete intrafallopian transfer (GIFT), eggs are removed from the woman, and placed in one of the fallopian tubes, along with the man's sperm. This allows fertilization to take place inside the woman's body. Therefore, this variation is actually an in vivo fertilization, and not an in vitro fertilization.ARTIFICLAL INSEMINATION: Process is often used when there is serious problem with the sperm. Sometimes it is also used for those with failed IVF attempts or for older couples. In this process, a single healthy sperm is injected directly into a mature egg and then healthy embryo is transferred to the fallopian tube or woman’s uterus. © Sperm is collected and placed into a woman’s vagina, cervical canal or in the uterus. © Sperm can come from partner or an anonymous donor. © Insemination is when sperm is collected and processed. The sperm is then placed into a woman’s vagina, cervical canal or directly into the uterus. ¢ Insemination may be used if the mucus around cervix is not compatible with partner’s sperm, or may have problems with immune system. This can cause sperm to be killed before egg is fertilized. Artificial Insemination is when the sperm used comes from partner.CONCLUSION Infertility is often not seen (by the West) as being an issue outside industrialized countries. This is because of assumptions about overpopulation problems and hyper fertility in developing countries, and a perceived need for them to decrease their populations and birth rates. The lack of health care and high rates of life-threatening illness (such as HIV/AIDS) in developing countries, such as those in Africa, are supporting reasons for the inadequate supply of fertility treatment options.Fertility treatments, even simple ones such as treatment for STIs that cause infertility, are therefore not usually made available to individuals in these countries. Despite this, infertility has profound effects on individuals in developing countries, as the production of children is often highly socially valued and is vital for social security and health networks as well as for family income generation. Infertility in these societies 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, being most often the result of untreated STIs or complications from pregnancy/birth. Due to the assumptions surrounding issues of hyper- fertility in developing countries, ethical controversy surrounds the idea of whether or not access to assisted reproductive technologies should comprise a critical aspect of reproductive health or at least, whether or not the distribution and access of such technologies should be subject to greater equity. However, as highlighted by Inhorn the overarching conceptualization of infertility, to a great extent, disguises important distinctions that can be made within a local context, both demographically and epidemiological and moreover, that these factors are highly significant in the ethics of reproduction. An important factor, argues Inhorn, is the positioning of men within the paradigm of reproductive health, whereby because rates of general infertility mask differences between male and female infertility, men remain a largely invisible facet within the theorisation and discourse surrounding infertility, as well as the related treatments and biotechnologies. This is particularly significant given that male infertility accounts for more than half of allcases of infertility and moreover, it is evident that the attitudes and behaviours of men _ have profound implications for the reproductive health of both individuals and couples. For example, Inhorn notes that when couples in Egypt are faced with seemingly intractable infertility problems - due to a range of family and societal pressures that centre around the place of children in constituting the gender identity of men and women - it is often the women who is forced to seek continued treatment; this continues to occur, even in known instances of male infertility and that the constant seeking of treatment frequently becomes iatrogenic for the women.Bibliography > Biological Science: Third Edition By, N. P. O. Green (Author), G. W. Stout (Author), D. J. Taylor (Author), R. Soper (Editor) > Exploring Biology By, Ella Thea Smith >» NCERT Text Book > Tell Me Why > Encyclopedia Britannica