STUDY ON
INFERTILITY
( ITS CAUSES AND
TREATMENT )
INDEX
S. No. CONTENTS
1. ABSTRACT
2. THEORY
3. EFFECT OF INFERTILITY
4. CAUSE OF INFERTILITY
5. FEMALE INFERTILITY
6. MALE INFERTILITY
7. TREATMENT
8. ETHICAL ISSUES
9. CONCLUSION
10. BIBLIOGRAPHY
ABSTRACT
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
haplodiploid 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 Infertility is a disease of the
reproductive system defined by the failure to achieve a clinical
pregnancy after 12 months or more of regular unprotected sexual
intercourse (and there is no other reason, such as breastfeeding or
postpartum amenorrhea). Primary infertility is infertility in a couple
who have never had a child. Secondary infertility is failure to
conceive following a previous pregnancy. Infertility may be caused by
infection in the man or woman, but often there is no obvious
underlying cause.
THEORY
Researchers commonly base demographic studies on infertility prevalence on a
five-year period. Practical measurement problems, however, exist for any
definition, because it is difficult to measure continuous exposure to the risk of
pregnancy over a period of years.
Primary Vs. Secondary Infertility
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.
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.
Thus, the distinguishing feature is whether or not the couple have ever had a
pregnancy which led to a live birth. Effect of Infertility
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EFFECT OF INFERTILITY
Psychological impact:
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.
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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.
Social impact:
In many cultures, inability to conceive bears a stigma. In closed social groups, a
degree of rejection (or a sense of being rejected by the couple) may cause
considerable anxiety and disappointment. Some respond by actively avoiding
the issue altogether; middle-class men arc the most likely to respond in this
way
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In an effort to end the shame and secrecy of infertility, Redbook in October
2011 launched a video campaign, The Truth About Trying, to start an open
conversation about infertility, which strikes one in eight women in the United
States.
In a survey of couples having difficulty conceiving, conducted by the
pharmaceutical company Merck, 61 percent of respondents hid their infertility
from family and friends. Nearly half didn’t even tell their mothers. The
message of those speaking out: It's not always easy to get pregnant, and
there's no shame in that.
There are legal ramifications as well. Infertility has begun to gain more
exposure to legal domains. An estimated 4 million workers in the U.S. used the
Family and Medical Leave Act (FMLA) in 2004 to care for a child, parent or
spouse, or because of their own personal illness. Many treatments for
infertility, including diagnostic tests, surgery and therapy for depression, can
qualify one for FMLA leave. It has been suggested that infertility be classified
as a form of disability
CAUSES OF INFERTILITY:
Infertility can have various causes, affecting both men and women. Here are
some common factors:
1. Age:
As women age, their fertility decreases due to a decline in the quantity
and quality of eggs. Similarly, aging can affect sperm quality and quantity
in men.
2. Reproductive System Disorders:
Conditions such as polycystic ovary syndrome (PCOS), Endometriosis,
fibroids, and pelvic inflammatory disease (PID)
can interfere with fertility in women. In men, conditions like varicocele
(enlarged veins in the testes), sperm duct defects, and erectile
dysfunction can affect fertility.
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3. Hormonal Imbalances:
Hormonal disorders, such as thyroid problems or abnormal levels of
reproductive hormones like estrogen, progesterone, testosterone, and
follicle-stimulating hormone (FSH), can impact fertility in both men and
women.
4. Lifestyle Factors:
Unhealthy lifestyle habits like smoking, excessive alcohol consumption,
drug abuse, poor diet, obesity, and lack of exercise can negatively affect
fertility.
5. Sexual Issues:
Problems with sexual function or intercourse, such as erectile
dysfunction or painful intercourse, can contribute to infertility.
6. Environmental Factors:
Exposure to certain environmental toxins, chemicals, pesticides, and
pollutants can impair fertility.
7. Genetic factors:
Inherited genetic conditions or chromosomal abnormalities can affect
fertility in both men and women.
8. Medical Treatments:
Certain medical treatments such as chemotherapy, radiation therapy, and
surgeries may affect reproductive organs and impair fertility.
9. Psychological Factors:
Stress, anxiety, and depression can affect hormone levels and
interfere with ovulation and sperm production.
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FEMALE INFERTILITY
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 fertilisation arise mainly from either structural
problem 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
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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.
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 if can he a combination of factors and sometimes a clear
cause is never established.
Common causes of infertility of females include:
1. Ovulation Problems
2. Tubal Blockage
3. Pelvic Inflammatory disease caused by Infection like Tuberculosis
4. Age-Related Factors
5. Uterine Problems
6. Previous Tubal Ligation
7. Endometriosis
8. Advanced Maternal Age
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MALE INFERTILITY:
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.
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Combined infertility:
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.
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TREATMENT
Treatment depends on the cause of infertility, but may include counselling
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 include
clomiphene citrate, Human Menopausal Gonadotropin (hMG), Follicle
Stimulating Hormone (FSH), Human Chorionic Gonadotropin (hCG),
Gonadotropin-Releasing Hormone (GnRH) analogues, aromatase inhibitors,
and metformin
Medical treatments:
Medical 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, no adhesions or scarring), a course
of ovarian stimulating medication maybe used. The physician or WHNP may
also suggest using conception cap cervical cap, which the patient uses at home
by placing the sperm inside the cap and putting the conception device on the
cervix, or lntrauterine Insemination (IUI), in which the doctor or WHNP
introduces 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 (1VF). IVF and related techniques (ICSI,
ZIFT, and GIFT) are called Assisted Reproductive Technology (ART) techniques.
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ART techniques generally start with stimulating the ovaries to increase egg
production. After stimulation, the physician surgically extracts 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.
Other medical techniques are e.g. tuboplasty, assisted hatching, and Pre-
implantation genetic diagnosis.
ETHICAL ISSUES:
There are several ethical issues associated with infertility and its treatment.
1. High-cost treatments are out of financial reach for some couples. Debate
over whether health insurance companies (e.g. in the Us) should be
required to cover infertility treatment.
2. Allocation of medical resources that could be used elsewhere.
3. The legal status of embryos fertilized in vitro and not transferred in vivo.
(See also Beginning of pregnancy controversy)
4. 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.
5. Religious leaders' opinions on fertility treatments, for example, the
Roman Catholic Church views infertility as a calling to adopt or to use
natural treatments (medication, surgery, and/or cycle charting) and
members must reject assisted reproductive technologies
6. Infertility caused by DNA defects on the Y chromosome is passed on
from father to son. If natural selection is the primary error correction
mechanism that prevents random mutations on the Y chromosome,
then fertility treatments for men with abnormal sperm (in particular
1CSI) only defer the underlying problem to the next male generation
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Many countries have special frameworks for dealing with the
ethical and social issues around fertility treatment.
1. One of the best known is the HFEA - The UK's regulator for fertility
treatment and embryo research. This was set up on1 August 1991
following detailed commission of enquiry led by Mary Warnock in the
1980s.
2. A similar model to the HFEA has been adopted by the rest of the
countries in the European Union. Each country has its own body or
bodies responsible for the inspection and licencing of fertility treatment
under the EU Tissues and Cells directive.
3. Regulatory bodies are also found in Canada and in the state of Victoria in
Australia.
4. In India, The Assisted Reproductive Technology (Regulation) Act, 2021,
was passed on December 20, 2021 by an act of Parliament to regulate
the functioning of assisted reproductive technology (ART) clinics and ART
banks in the country.
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CONCLUSION
In conclusion, infertility presents a complex and multifaceted challenge
affecting individuals, couples, and society at large. With increasing rates
observed globally, understanding the causes, impacts, and treatment options
for infertility crucial for addressing this issue effectively.
The investigation into infertility has revealed a myriad of factors contributing
to its occurrence, ranging from biological and genetic to environmental and
lifestyle-related influences Both men and women can experience infertility due
to various reproductive system disorders, hormonal imbalances, genetic
predispositions, and medical treatments. Psychological factors such as stress
and anxiety further exacerbate the challenges faced by individuals and couples
struggling with infertility.
The social and emotional impact of infertility cannot be overstated, as it often
leads to feelings of distress, loss, and stigma within communities. Despite
advancements in assisted reproductive technologies offering hope to many
couples, barriers related to accessibility and affordability persist, underscoring
the need for comprehensive support systems and awareness campaigns.
Ethical considerations surrounding infertility treatment, including the
allocation of resources, legal status of embryos, and religious perspectives.
Further complicate the landscape of reproductive healthcare, However,
regulatory frameworks and guidelines implemented in various countries aim to
address these ethical dilemmas and ensure responsible practices within the
field of assisted reproductive technology.
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In light of these findings, efforts to destigmatize infertility, improve access to
fertility treatments, and provide holistic support to affected individuals and
couples are essential. By fostering open dialogue, raising awareness, and
advocating tor inclusive healthcare policies, we can work towards mitigating
the social, emotional, and financial burdens associated with infertility,
ultimately empowering individuals to pursue their reproductive aspirations
with dignity and Support.
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BIBLIOGRAPHY:
* https://www.wikipedia.com
*https://www.britannica.com/science/infertility
*https://www.vedantu.com/biology/in fertility
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