NAME : Sumi

tRaj
Singh
t
h
CLASS : 12 B
SUBJECT : Bi
ology
TOPI
C : Detai
l
edSt
udyonI
nfer
ti
li
ty
i
tsCausesandTr
eat
ment
 CERTI
FICATE
Thi
sist
o cer
ti
fyt
hat
,thi
s Bi
ologyI
nvest
igat
oryPr
ojecton t
he t
opi
c

“
___
___
___
___
___
___
___
___
___
___
___
___
___
___
___
___
___
___
___
___
___
__” has

beensuccessf
ull
ycompl
etedby_
___
___
___
___
___
___
___
___
___ofcl
assXI
I

_
___
_undert
hegui
danceofMr/Mr
s._
___
___
___
___
___
___(
P.GBi
ology
)at

Del
hiPubl
i
c SchoolRK Pur
am,f
ort
he par
ti
alf
ulf
il
lmentofBi
ology

Pr
act
icali
nthecur
ri
cul
um ofAI
SSCE-CBSE,New Del
hif
ort
heacademi
c

y
ear2019-2020.

Teacheri
n-char
ge

Signat
ureofExt
ernal
Exami
ner Si
gnat
ureI
nter
nal
Examiner

Si
gnat
ureoft
hePr
inci
pal
 ACKNOWLEDGEMENT

I owe a gr
eat many t hanks t
o gr
eat many
peopl
ewhohelped and support
ed medur
ing t
his
proj
ect
.

Iexpr
ess my t hanks toPri
nci
palMadam ,Mrs.
PadmaShr
ini
vasan f orext
endi
nghersuppor
t.

My deepest thanks t
o Mr s.Kusum Yadav,t he
gui
de oft heprojectf
orgui ding and correcting
my vari
ous documents wi
th at tent
ion and car e.
She has t
aken pai ntogo t hrough the project
andmakecor rect
ionasandwhenneeded.
WHY ICHOSETHI
STOPI
C?
Ihav e chosen the t
opic– I nf
ert
il
it
y
because iti s one of t
he occurri
ng
probl
emsf acedbyworki
ngwomeni nIITfi
eld.Soas
toknowact ual
lywhati
sinf
ert
il
it
yanditscausesI’
ve
chosenthi
st opi
c.
And t hereisal so a mi sconception t
hatinfert
il
it
y
problemsonl ydeal swi t
hwomensoast omakei t
clearthatmostoft heinfert
il
it
ypr obl
emsdeal swith
men.Ev enthoughitdeal swithmen,womenar ethe
one who ar e bl
amed and cr i
ti
cized forallthese
problemsbyt hesoci ety.It’
sadat at hatmostof
thesepr obl
emsar e95%deal twithmenandonl yr
est
ofthe5%deal swithwomen
Soast ocreateacl earmindsetf ortheupcoming
futuresoci
etyabouttheseproblems,I’
vechosenthi
s
topic.And I’m personall
yi nter
ested i
n study
ing
about thist opi
c as my ai m ist o become a
Gynecologi
st.
Theot
hermai
nreasonisthatt
heIVFindust
ryi
n
I
ndi
aisonagrowt
hpath.However
,thei
ndust
ryi
s
l
argelyunregulatedwhichcanprov
etobeperni
cious
i
n t he long r un. 
Right f
rom changi
ng our old
mindsetstomot iv
ati
ngtechnol
ogyhasmadethings
possibl
ewhi chwer en’
tsobefor
e.

ThewonderofI VFisone suchexamplewhi chhas

comeasaboont omi l
li
onsofcoupleswhof acet he
scour
ge ofi nfer
ti
li
tylike a thor
ni nt he flesh.
Inv
estors searchi
ng fora new wayt o make bi g
moneyinmedi cinehavehituponanage-ol
dpr oblem:
i
nfert
il
it
y.Solet’sl
ookov ert
hroughi
tindepth.
 I
NDEX
1.
ABSTRACT
2.
THEORY
 Pr
imar
yVsSecondar
yInf
ert
il
it
y

3.
EFFECTS
 Psy
chol
ogi
cal
Impact

Soci
alI
mpact

4.
CAUSES
 Sexual
l
ytr
ansmi
tt
eddi
sease
 Genet
icCauses

Gener
alFact
ors

5.
INFERTI
LTI
TY I
NFEMALES
6.
INFERTI
LITYI
N MALES
 Combi
nedI
nfer
ti
li
ty

Unexpl
ainedI
nfer
ti
li
ty

7. TREATMENT
8. EFFECT ON THEPOPULATI
ON
9. CONCLUSI
ON
10.BI
BLOGRAPHY
 ABSTRACT
I
nfertil
i
tyistheinabil
i
tyofaper son,animalorpl
ant
toreproducebynat uralmeans.Itisusual
lynotthe
naturalst
ateofaheal thyadul
tor gani
sm,except
notablyamongcer tai
neusocialspecies(mostly
haplodipl
oidinsects).

Inhumans,infert
il
it
ymaydescr i
beawomanwhoi s
unabletoconceiv
easwel lasbei
ngunabl
etocarr
ya
pregnancytof ul
lterm.Therearemanybiologi
cal
andot hercausesofinfert
il
it
y,i
ncl
udi
ngsomet hat
medicali
nterventioncant reat
.Infer
t i
l
ityrat
eshav e
i
ncreased by 4% si nce the 1980s,most lyf r
om
probl
emswi thf ecundityduetoani ncreaseinage.
About40%oft hei ssuesinvol
vedwi thinfer
til
it
yar e
duetotheman, another40%duet othewoman, and
20%resultf
rom compl i
cati
onswi t
hbot hpartners.
Womenwhoar ef er
til
eexperi
enceanat uralperi
od
off er
ti
lit
ybeforeanddur i
ngovulat
ion,andtheyare
natural
lyinfert
il
edur ingtherestoft hemenst rual
cycle.Fer t
il
it
y awar eness methods are used to
discern when t hese changes occurby t racki
ng
changes i n cer vi
cal mucus or basal body
temper at
ure
Inf
erti
l
ityis“ adi seaseoft her epr oduct
ivesy stem
defi
nedbyt hefai l
uret oachi ev
eacl ini
calpregnancy
aft
er12 mont hs ormor e ofr egularunpr otected
sexualintercourse( andt hereisno ot herr eason,
suchasbr eastfeedingorpost par t
um amenor r
hea) .
Pri
mar yinferti
li
tyi si nfert
il
ityi
nacoupl ewhohav e
neverhadachi ld.Secondar yinf ert
il
it
yisf ail
uret o
conceivefol l
owingapr evi
ouspr egnancy.Inferti
lit
y
maybecausedbyi nfecti
oni nt hemanorwoman,
butoftentherei snoobv i
ousunder l
yingcause.
Onedefi
niti
onofinfer
ti
li
tythatisfr
equent
lyusedin
t
he United St
ates by doctor
s who speciali
ze i
n
i
nfer
ti
li
ty,t
oconsideracoupleeligi
blef
ortreat
ment
i
s:
Awomanunder35hasnotconcei vedafter12
months of cont racepti
ve-
free int
ercourse.
Twelvemont hsisthel owerrefer
enceli
mi tfor
Ti
met oPr egnancy( TTP)byt heWorldHeal th
Organi
zat
ion.
A womanov er35hasnotconcei vedaf t
er6
monthsofcont
racept
ive-
fr
eesexual
int
ercourse.
 THEORY
Researcherscommonl ybasedemogr aphicstudies
on infert
il
it
y preval
ence on a f i
ve-year peri
od.
Pract
icalmeasurementprobl
ems,howev er,exi
stfor
anydef i
niti
on,because i
tis di
ff
icultto measur e
conti
nuousexposuretotheri
skofpr egnancyovera
peri
odofy ears.
Pr
imar
yvs.secondar
yinf
ert
il
it
y
Primar yinfert
il
it
yisdef i
nedast heabsenceofal i
ve
bi
rthf orwomenwhodesi reachi l
dandhav ebeenin
auni onforatl eastfi
veyears,duri
ngwhichtheyhave
notused any cont racepti
ves.The Wor l
d Health
Organizat i
on al so adds t hat 'women whose
pregnancy spont aneously miscarr
ies,or whose
pregnancyr esult
sinast i
l
lbor nchil
d,wit
houtever
havinghadal ivebir
thwoul dpresentwit
hpr i
maril
y
i
nfertil
ity
Secondaryinfer
ti
li
tyisdefinedastheabsenceofa
l
ivebirt
hf orwomenwhodesi reachi l
dandhav e
beeninauni onforatleastfi
veyear
ssincethei
rlast
l
ive bir
th,dur i
ng whi ch they di
d not use any
contr
acepti
ves.

Thusthedi
sti
ngui
shingf
eaturei
swhetherornott
he
coupl
ehaveeverhadapregnancywhi
chledtoali
ve
bi
rth.
 EFFECTS
Psy
chol
ogi
cali
mpact
Theconsequencesofi nferti
li
tyaremani foldandcan
i
ncl ude soci et
al r epercussions and per sonal
suffering. Adv ances i n assi sted r epr oductiv
e
technol ogi
es,suchasI VF,canof ferhopet omany
coupl es wher et reatment i s av ai
lable,al though
barriers existint erms ofmedi calcov erage and
affordabili
ty.The medi cal i
zati
on ofi nfertil
it
y has
unwi tti
nglyl ed t
o a di sregardf ort he emot i
onal
responsest hatcoupl esexper ience,whi chi ncl
ude
distress,l oss of cont rol
,st igmatization,and a
disruption i n the dev el
opment al trajectory of
adul t
hood.
Inferti
li
tymayhav eprof oundpsy chologicalef
fects.
Par tnersmaybecomemor eanxioust o conceive,
i
ncr easingsexualdy sfunctionMar it
aldiscordoften
dev elopsini nfert
il
ecoupl es,especiallywhent hey
are underpr essuret o make medi caldecisi
ons.
Women t ryi
ng t o concei ve often hav e cli
nical
depr essionratessimilartowomenwhohav ehear t
disease orcancer .Ev en couplesunder t
aki
ng IVF
faceconsi derablestr
ess.
Theemot ionallossescr eatedbyi nf
ert
il
ityinclude
thedenialofmot herhoodasar i
teofpassage;t he
l
ossofone’ santici
patedandi maginedli
fe;feel
inga
l
oss of cont r
olov er one’sl i
fe;doubti
ng one’ s
womanhood; changed and somet imes l ost
fri
endshi
ps;and,formany ,thelossofone’sreli
gious
envir
onmentasasuppor tsystem.
Emot
ionalst
ressandmarit
aldi
ffi
cul
ti
esar
egreat
er
i
ncoupleswheret
heinf
ert
il
it
yli
eswit
htheman.
 Soci
ali
mpact
Inmanycul t
ures,inabili
tytoconceivebearsast igma.
Inclosedsocialgr oups,adegr eeofr ejecti
on( ora
senseofbei ngr ejectedbyt hecoupl e)maycause
considerabl
e anxi ety and disappointment .Some
respondbyact i
vel yavoidingthei ssueal together
;
middle-cl
assmenar ethemostl ikelytor espondi n
thi
sway .

In an ef f
ortt o end t he shame and secr ecy of
i
nf er
ti
li
ty,Redbooki nOct ober2011l aunchedav i
deo
campai gn,TheTr uthAboutTr ying,tostar tanopen
conversationabouti nfertil
i
ty,whi chst r
ikesonei n
eightwomeni nt heUni tedSt ates.Inasur veyof
coupleshav i
ngdi ffi
cultyconcei v
ing,conduct edby
thephar maceuticalcompanyMer ck,61per centof
respondent s hi
dt heiri nfert
il
ityf r
om f amily and
fri
ends.Near l
yhalfdi dn'teventel lt
heirmot hers.The
messageoft hosespeaki ngout :It'
snotal way seasy
togetpr egnant,andt here'snoshamei nthat.
Therear elegalr ami f
icat
ionsaswel l.Inferti
l
ityhas
begunt ogai nmor eexposuret olegaldomai ns.An
esti
mat ed 4mi l
lionwor kersint heU. S.usedt he
FamilyandMedi calLeav eAct( FMLA)i n2004t o
careforachi l
d,par entorspouse,orbecauseoft heir
ownper sonali l
l
ness.Manyt reat
ment sf orinfert
il
it
y,
i
ncludingdi agnost ictest
s,surgeryandt herapyf or
depression,canqual i
fyonef orFMLAl eave.Ithas
been suggest ed t hatinf
erti
li
tybe cl assif
ied asa
for
m ofdi sabil
it
y.
 CAUSES
Sexual
lyt
ransmi
tt
eddi
sease
I
nf ectionswi t
ht he foll
owi
ng sexual l
yt ransmitted
pathogens hav e a negat i
ve ef fect on f ert
il
ity
:
Chl amy diatr
achomat i
s,Nei
sseriagonor rhoeae,and
Syphi li
s. Therei s a consistent associ at
ion of
My copl asma geni t
ali
um i nfection and f emal e
repr oducti
ve t r
act sy ndr
omes. M. geni tal
ium
i
nfect ion is associated wit
h i ncreased r i
sk of
i
nfer ti
lit
y.
 Genet
ic
ARober t
soniantr
ansl
ocati
onineit
herpar
tnermay
causerecur
rentspont
aneousabor
ti
onsorcomplet
e
i
nfert
il
it
y.

Ot
hercauses
Fact
orsthatcan cause mal
e as wel
las f
emal
e
i
nfer
ti
li
tyar
e:
•DNAdamage
•DNAdamager educesf er
ti
li
tyinf emaleov ocyt
es,
as caused by smoki ng,ot her xenobiot
ic DNA
damaging agent s ( such as r adiat
ion or
chemother
apy)
oraccumul ati
onoft heoxidati
v eDNA
damage8-hydr
oxy-deoxyguanosine
•DNA damager educesfert
il
it
yinmal esperm,as
causedbyoxi dati
veDNA damage,smoki ng,ot
her
xenobioti
cDNAdamagi ngagents(suchasdrugsor
chemot her
apy )
or other DNA damagi ng agents
i
ncluding reacti
ve oxygen speci
es,feverorhigh
test
iculart
emper at
ure.
 DNA DAMAGEI
N SPERM
Gener
alf
act
ors
•Diabet
esmell
it
us,thy
roi
ddisor
ders,undi
agnosed
anduntr
eat
edcoel
iacdi
seaseadr
enaldi
sease
•Hy
pot
hal
ami
c-pi
tui
tar
yfact
ors
•Hy
per
prol
act
inemi
a
•Hy
popi
tui
tar
ism
• The pr esence of ant i-
thyroid anti
bodi
es is
associ
ated with an i
ncreased riskofunexplai
ned
subfer
ti
li
ty with an odds r at
io of1. 5 and 95%
confi
denceinter
valof1.1–2.0

•Env
ironment
alf
act
ors

•Toxinssuchasgl ues,v
olat
il
eorgani
csolv
entsor
si
li
cones,phy si
calagents,chemicaldusts,and
pesti
cidesTobaccosmokersare60%morelikel
yto
beinfert
il
ethannon-
smokers.
Ger mansci enti
stshavereportedthatav i
ruscalled
Adeno- associat
edv i
rusmi ghthavear ol
einmal e
i
nf ert
il
it
y,thoughi ti
sotherwisenothar mful.Other
diseasessuchaschl amydiaandgonor rheacanal so
causei nferti
li
ty,duetointernalscarr
ing(fall
opian
tubeobst ruct
ion).
 I
NFERTI
LTI
YINFEMALES
Thef ol
lowi ngcausesofinfer
ti
li
tymayonl ybefound
i
nf emal es.Forawomant oconceive,cer
taint
hings
havet ohappen:i nt
ercour
semustt akeplacearound
thetimewhenaneggi srel
easedfrom herovar
y ;
the
system t hatproduceseggshast obewor ki
ngat
optimum l evel
s; and her hor mones must be
balanced.
Forwomen,pr obl emswi thf er
til
izati
onar i
semai nly
from ei t
herstructuralpr oblemsi nt heFall
opiantube
orut erusorpr oblemsr eleasingeggs.I nfert
il
it
ymay
becausedbybl ockageoft heFal l
opiantubeduet o
mal formations,infectionssuchasChl amy di
aand/ or
scart issue.Forexampl e,endomet ri
osiscancause
i
nf erti
l
itywiththegr owthofendomet ri
alti
ssueinthe
Fallopian t ubes and/ or ar ound t he ov ar
ies.
Endomet ri
osisisusual l
ymor ecommoni nwomeni n
their mi d-twenties and ol der, especiall
y when
post ponedchi l
dbi rt
hhast akenplace.
Anothermajorcauseofinfer
til
i
tyinwomenmaybe
theinabi
li
tytoov ul
ate.Malformati
onoftheeggs
themselv
es may compl i
cate concept
ion. For
example,pol
ycyst
icov ar
iansyndromeiswhent he
eggsonl yparti
allydevel
opedwi thi
ntheov aryand
ther
ei sanexcessofmal ehormones.Somewomen
areinfer
til
ebecauset hei
rovari
esdonotmat ureand
rel
easeeggs.Int hiscasesyntheti
cFSHbyi nj
ecti
on
orClomid( Cl
omi pheneci
trat
e)viaapil
lcanbegiven
tostimulatef
oll
iclestomatureintheovar
ies.

Otherfactor
sthatcanaffectawoman'schancesof
concei
v i
ngincl
udebeingov er
wei
ghtorunderwei
ght
,
orherageasf emal
eferti
l
itydecl
i
nesaft
ertheageof
30.
Somet
imesitcanbeacombi nati
onoffact
ors,and
somet
imesaclearcausei
sneverest
abl
i
shed.
Common causes ofi
nfer
ti
li
ty off
emal
es
i
ncl
ude:
• Ovul
ation pr
oblems ( e.g. pol
ycy
sti
c ovar
ian
sy
ndrome,PCOS,t heleading r
easonwhywomen
pr
esent to fer
ti
li
ty cl
ini
cs due t o anov
ulat
ory
i
nfer
ti
li
ty)
•t
ubal
blockage
•pel
vici
nfl
ammator
ydi
seasecausedbyi
nfect
ions
l
iket
uber
culosi
s
•age-
rel
atedf
act
ors
•ut
eri
nepr
obl
ems
•pr
evi
oust
ubal
li
gat
ion
•endomet
ri
osi
s
•adv
ancedmat
ernal
age
 I
NFERTI
LITYI
NMALES
Themai n causeofmal ei nferti
l
ityi sl ow semen
quali
ty.Inmenwhohav ethenecessar yr eproductive
organst opr ocreate,infer
til
it
ycanbecausedbyl ow
sperm countdue t o endocr ine problems,dr ugs,
radi
ati
on,ori nfect i
on.Ther e may be t esti
cular
malformat ions,hor monei mbal ance,orbl ockageof
theman' sductsy stem.Al thoughmanyoft hesecan
be t r eated t hrough sur gery or hor monal
substi
tutions,some may be i ndefini
te.I nf
erti
l
ity
associatedwi thv iable,butimmot il
esper m maybe
causedbypr imaryci l
iarydyskinesia.
 Combi
nedi
nfer
ti
li
ty
Insomecases,bot hthemanandwomanmaybe
i
nferti
le orsub-fer
ti
le,and the couple'
si nfer
ti
li
ty
ari
sesf r
om thecombi nati
onoft heseconditi
ons.In
other cases, the cause i s suspected t o be
i
mmunol ogi
calorgenet ic;itmay be t hateach
partneri
sindependentl
yfert
il
ebutt hecouplecannot
conceivetoget
herwithoutassi
stance.
 Unexpl
ainedi
nfer
ti
li
ty
Int he US,up t o 20% ofi nferti
le couples hav e
unexplai nedinferti
l
ity.
Inthesecasesabnor mal i
ti
es
arelikelyt obepr esentbutnotdet ectedbycur r
ent
methods.Possi bleproblemscoul dbet hattheeggi s
notr eleasedatt heopt imum timef orfertil
izat
ion,
whichi tmaynotent erthefall
opiant ube,sperm may
notbeabl et oreacht heegg,fert
ili
zationmayf ai
lto
occur,t ransportoft hezygotemaybedi sturbed,or
i
mpl ant ati
onf ai
ls.Itisincr
easinglyr ecognizedthat
eggqual i
tyisofcriti
calimportanceandwomenof
advanced maternalage hav e eggs of r educed
capaci
tyfornormal andsuccessfulfer
ti
li
zat
ion.Also,
poly
mor phismsinf olat
epat hwaygenescoul dbe
one reason for ferti
li
ty complicati
ons i
n some
womenwi t
hunexplainedinf
erti
l
ity.
 TREATMENT

Tr eat
mentdependsont hecauseofi nferti
li
ty,but
mayi ncludecounsel ing,f erti
li
tyt r
eatments,whi ch
i
ncl ude inv i
trof erti
li
zation.Accor di
ng to ESHRE
recommendat i
ons,coupl eswi thanest i
mat edl i
ve
birthrateof40%orhi gherpery earareencour aged
to cont i
nueai mi ngf oraspont aneouspr egnancy.
Tr eat
mentmet hodsf orinfertil
itymaybegr oupedas
medi cal or compl ement ary and al ternati
ve
treatment s.Somemet hodsmaybeusedi nconcer t
wi thothermet hods.Dr ugsusedf orbothwomenand
meni ncludeclomi pheneci trate,humanmenopausal
gonadot ropin( hMG) ,f oll
icle-sti
mulati
ng hor mone
(FSH) , human chor i
onic gonadot ropin ( hCG) ,
gonadot ropin-r
el easing hor mone( GnRH)analogues,
aromat asei nhibitors,andmet f
or min.
Medi
calt
reat
ment
s

Medi caltreatmentofi nf
erti
li
tygener all
yinvolvest he
useoff ertil
it
ymedi cati
on,medi caldev i
ce,sur gery
,
oracombi nati
onoft hef oll
owi ng.I
fthesper m ar eof
good qual i
tyand t hemechani csoft hewoman' s
reproductiv estructuresar egood( patentfallopian
tubes, noadhesi onsorscar r
ing),acour seofov arian
stimulati
ngmedi cati
onmay beused.Thephy sician
orWHNPmayal sosuggestusi ngaconcept i
oncap
cervicalcap,whi ch thepat ientusesathomeby
placingt hesper mi nsidet hecapandput ti
ngt he
concept i
on dev i
ce on t he cer vi
x,ori nt
rauterine
i
nseminati
on (I
UI)
,in whi
ch the doct
ororWHNP
i
ntr
oducesspermi ntotheuterusduri
ngov ul
ati
on,
v
iaacat het
er.I
nthesemethods,fer
ti
li
zat
ionoccurs
i
nsi
dethebody .

Ifconser
vati
vemedi caltr
eatmentsf ailtoachievea
ful
lterm pregnancy ,thephy si
cianorWHNP may
suggestt
hepat i
entunder goinvit
rof ert
il
izat
ion( I
VF)
.
IVFandrelat
edt echniques(I
CSI,ZI FT,andGI FT)are
call
ed assisted r eproduct
ive t echnology ( ART)
t
echni
ques.
ARTt echniquesgener all
yst artwi thst i
mulati
ngthe
ov ar
iest oincr
easeeggpr oduction.Aftersti
mulati
on,
thephy sici
ansur gi
call
yext r
act soneormor eeggs
from t heov ary,anduni test hem wi thsper mi na
l
abor atorysetti
ng,wi tht hei ntentofpr oducingone
ormor eembr yos.Fertil
izati
ont akespl aceoutsi
de
thebody ,andthef er
til
izedeggi sr ei
nsertedint
othe
woman' sr epr
oduct i
vet ract,inapr ocedurecall
ed
embr yot ransf
er
Other medical t
echniques ar
e e.g. t
ubopl
ast
y,
assist
ed hatchi
ng, and Prei
mplant
ati
on genet
ic
diagnosi
s.
 EFFECTSONTHEPOPULATI
ON
Perhapsexceptf orinfert
ili
tyinsci
encefi
ct i
on,f i
l
ms
andot herf i
cti
ondepi cti
ngemot i
onalstrugglesof
assist
ed r eproducti
ve t echnol
ogy have had an
upswingfirstinthelatterpartofthe2000sdecade,
alt
hough the t echni
ques hav e been avail
ablef or
decades.Yet ,thenumberofpeopl ethatcanr el
ate
toitbypersonalexper i
encei nonewayoranot heris
evergrowing,andt hev ariet
yoft r
ial
sandst ruggles
i
shuge.
Pixar'
sUpcont ai
nsadepict
ionofinfer
ti
li
tyinan
extended l
i
f e mont
age t
hatlast
st he fi
rstfew
mi nut
esofthefi
lm.
Ther
e are sev
eralethi
calissues associ
ated wi
th
i
nfer
ti
li
tyandit
streat
ment.
•High-
costtr
eatment
sar
eoutoff
inanci
alr
eachf
or
somecouples.
•Debateoverwhet
herhealthi
nsur
ancecompanies
(
e.g.i
ntheUS)shoul
dber equi
redt
ocoveri
nfer
ti
li
ty
t
reatment
.
•Al
locat
ionofmedi
calr
esour
cest
hatcoul
dbeused
el
sewhere
•Thel egalst
atusofembry
osfert
il
izedi
nv i
tr
oand
nott ransf
err
ed inv i
vo.(
See al
so Beginni
ng of
pregnancycontr
over
sy).
•Pro-l
if
eopposit
iontothedest
ruct
ionofembr
yos
nottr
ansfer
redi
nv i
vo.
•IVFandot herfer
ti
lit
ytreatmentshav eresul
tedin
an increase in multi
ple bi
rths,provoki
ng ethical
analysi
s because of t he link between mul t
ipl
e
pregnancies,prematurebirt
h,andahostofheal t
h
problems.
•Rel i
giousleaders'opini
onsonf ert
il
it
ytreat
ment s;
forexampl e,t he Roman Cat holi
c Church vi
ews
i
nf er
tili
tyasa cal l
ing to adoptort o usenat ural
treatments ( medicat
ion, surgery, and/or cy cl
e
charting) and member s must r eject assi
sted
reproducti
vetechnologies.
•I nf
ert
il
it
y caused by DNA def ects on the Y
chromosomei spassedonf rom fathertoson.I f
natur
alselecti
on ist he primary errorcorrecti
on
mechanism thatprevent
sr andom mut at
ionsont he
Y chromosome,t hen fert
ili
tytreat
ment sformen
withabnormalsper m( i
npar t
icul
arICSI)onlydef er
theunderl
yi
ngpr obl
em tothenextmal egeneration.
Manycountri
eshavespeci
alf
ramewor
ksf ordeali
ng
wit
ht heethi
caland soci
ali
ssuesaround fert
il
it
y
t
reatment
.
•Oneoft hebestknowni stheHFEA – TheUK' s
regulat
orf
orfer
ti
li
tytr
eatmentandembry
or esear
ch.
This was setup on 1 August1991 fol
l
owi ng a
detail
ed commission of enqui
ry l
ed by Mar y
War nocki
nthe1980s
•Asi mil
armodeltotheHFEAhasbeenadopt edby
therestoft
hecountri
esint
heEuropeanUnion.Each
countryhasit
sownbodyorbodi esresponsiblef
or
the i
nspect
ion and l
i
censi
ng offert
il
it
ytreatment
undertheEUTissuesandCel
lsdi
rect
ive
•Regul
ator
ybodiesarealsofoundi
nCanadaandi
n
thest
ateofVi
ctori
ainAustr
ali
a.
 CONCLUSI
ON

Infertil
ityi sof tennotseen( byt he
West )asbei ngani ssueout side
i
ndust rializedcount ries.Thisi sbecauseof
assumpt i
onsaboutov erpopulat i
onpr obl emsand
hy perf er ti
lityi ndev elopi ngcount ries, anda
per ceivedneedf orthem t odecr easet hei r
popul at ionsandbi rthr ates.Thel ackofheal t
hcar e
andhi ghr atesofl ife-threateni ngi ll
ness( suchas
HI V/AI DS)i ndev elopi ngcount ri
es, suchast hosei n
Af ri
ca, ar esuppor ti
ngr easonsf ort hei nadequat e
suppl yoff ertili
tytreat mentopt i
ons. Fert i
lity
treatment s, ev ensimpl eonessuchast reat mentf or
STI sthatcausei nfertilit
y,aret her ef orenotusual ly
madeav ailabl et oindi vidualsint hesecount ries.
Despi tet his, inferti
li
tyhaspr ofoundef fect son
i
ndi vidual si ndev elopi ngcount r
ies, ast he
product ionofchi ldreni softenhi ghl ysoci all
yv alued
andi sv ital forsoci al secur i
tyandheal thnet works
aswel l asf orf ami l
yi ncomegener at i
on.I nf erti
li
tyin
thesesoci et iesof tenl eadst osoci al stigmat izati
on
andabandonmentbyspouses. I
nf ertili
tyi s,inf act,
commoni nsub-SaharanAfri
ca.Unli
keintheWest ,
secondaryi
nferti
l
ityi
smor ecommont hanpr i
mary
i
nfert
il
it
y,bei
ngmostof tentheresul
tofunt r
eated
STIsorcomplicati
onsfr
om pregnancy/bi
rth.
Duet ot heassumpt i
onssur r
oundi ngi ssuesofhy per
-fert
il
it
yi ndev elopingcount ries,et hicalcontroversy
surrounds t he idea ofwhet herornotaccess t o
assistedr epr oductivet echnol ogiesshoul dcompr i
se
acr it
icalaspectofr eproduct i
veheal thoratl east,
whet herornott hedi st r
ibutionandaccessofsuch
technologi esshoul d besubj ectt o gr eat
erequi ty.
Howev er,ashi ghlightedbyI nhor nt heov er
arching
concept ualizat i
on ofi nferti
lit
y,t o a gr eatext ent,
disguisesi mpor tantdi sti
nctionst hatcanbemade
wi t
hinal ocalcont ext,bot h demogr aphi
callyand
epidemi ologi calandmor eov er,thatt hesef actorsare
highlysigni f
icanti ntheet hicsofr eproduct i
on.
Ani mportantfactor,arguesI nhorn,ist hepositioning
ofmenwi t
hinthepar adigm ofr eproduct i
v eheal th,
wher ebybecauser atesofgener ali nfert
ili
tymask
diff
erencesbet weenmal eandf emal ei nferti
li
ty,men
remai n a l argely i nv i
sible f acet wi thi
n t he
theorisat
ionanddi scour sesur r
oundi ngi nfert
il
ity,as
wel last herelatedt r
eat ment sandbi otechnologies.
Thisi s par ti
cularl
y si gnificant gi ven that mal e
i
nf ertil
ityaccount sformor et hanhal fofallcasesof
i
nf ertil
ity and mor eov er ,i ti s ev ident that the
attitudes and behav i
our s ofmen hav e profound
i
mpl ications fort he r epr oduct i
ve health ofbot h
i
ndi v i
dual sandcoupl es.Forexampl e,Inhornnot es
thatwhencoupl esinEgy ptar ef acedwi thseemi ngly
i
nt ractabl einferti
li
typr oblems-duet oar angeof
fami lyandsoci etalpressur est hatcentrearoundt he
placeofchi ldreni nconst itutingt hegenderi dent i
ty
ofmenandwomen-i ti sof tent hewomenwhoi s
forcedt oseekcont i
nuedt reatment ;thiscont i
nues
tooccur ,eveni nknowni nst ancesofmal einferti
li
ty
and t hat t he const ant seeki ng of t reatment
frequent lybecomesi atrogeni cf orthewomen.
Inhornst at
est hatinferti
li
tyof tenleadst o“mar i
tal
demi se,physicalv i
olence,emot i
onalabuse,soci al
exclusion, communi t
y exi le, ineffecti
ve and
i
at r
ogenict herapies,pov ert
y,ol d age i nsecuri
ty,
i
ncr easedriskofHI V/ AIDS,anddeat h”Signif
icant
ly,
Inhorndemonst rat
est hatt hisphenomenoncannot
simplybeexpl ainedbyal ackofknowl edge,ratherit
occur s in a compl ex i nteract
ion bet ween t he
centrali
tyofchil
dreninthemalegenderi dent
ityasa
symbolofmat uri
tyandt herel
ati
velackofpowerof
womeni nEgyptiansociety
,wherebyt heyef f
ecti
vel
y
become scapegoat s f or a cult
urally accepted
narrati
ve as a si te of blame for t he lack of
chil
dlessness.Itshouldbeemphasi sedt hatthi
sis
notsi mplyanissueof“ womenoppr essedbymen”
butr ather
,thatmen and women bot h sharethe
burdenoft hi
snar r
ati
ve,butindif
fer
ent ,unequaland
highlycomplexway s.
Ther efore,whi l
et henot ionthatr eproduct i
veheal t
h
i
sa‘ women’ sissue’,may hav e power f
ulsoci al
currency ,especi all
ywi thin populardi scourse and
i
ndigenous sy stems of meani ng,t he reali
ty of
i
nfert i
lit
y suggest s t hat medi cal and heal t
h
paradi gms hav e a si gnif
icant par tt o play in
challengingt hev ali
dit
yoft hisent renchedbel i
ef.
Mor eov er,t he ef f
ectiveness of any t herapeuti
c
i
nterv ention,medi calorot herwisewi llbecont i
ngent
onsuchout comesandhasani mpor tantparttoplay
i
nt heal leviat i
onofgender edsuf f
er i
ng,especially
thebur deni mposed onwomen,who cont i
nuet o
suffer di spr oporti
onately f r
om t he ef fect
s of
i
nfert i
lit
y.
Highcost smayal sobeaf actorandr esearchbyt he
GenkI nsti
tut
ef orFer ti
li
tyTechnol ogy,i nBel gi
um,
claimedamuchl owercostmet hodol ogy( about90%
reduct i
on) wi t
h si milar effi
cacy ,whi ch may be
suitabl ef orsomef erti
li
tyt r
eat ment .Att he1994
United Nat ions I nternati
onal Conf erence on
Popul ati
on and Dev elopment( I
CPD)i n Cairo,the
prev ent i
onandt reatmentofi nf ert
il
itywasaccept ed
i
nt o t he pr ogram of act ion f or r eproducti
v e
healt hcare.Infertil
ityhasshownt ohav eagr eater
affectondev elopingnat ionst hanonbi rt
hr atesor
popul ati
oncont rol,butalsoonasoci all
ev elaswell.
Repr oduct i
on isal arge aspectofl ifeformany
cultureswi thindevel
opi ngnat ions,andi nf
erti
li
tycan
l
ead t o soci aland f ami l
ialpr oblems such as
rejection or abandonment as wel las per sonal
psy chologicalissues.Cur rently,ferti
l
itytreatment
opt i
ons and pr ograms ar e onl yav ai
labl
et hrough
pr i
vateheal thsect
orsi ndev elopingnat i
onsandl i
ttl
e
-to-not reatmentisav ail
ablet hr
oughpubl icheal th
sect ors.The f er
til
i
tyt reatment opt i
ons of fered
throught hepr i
vat
esect orsar eof tencost l
yornot
easi l
y accessi bl
e. Addi ti
onal l
y, counsel i
ng i s
consi deredanessent ialaspectoff erti
li
tytreat
ment ,
and duet ol ackofeducat i
on
and r esourcessuch f ormsof
therapyr emainscar ceaswell.
Thel ackoff ert
ili
tytr
eatmenti
s
problemat i
c,andhi ghbirt
hand
populat i
on r ates ar e ever
y
reasont oimpl ementt r
eatmentopt
ionsr
athert
han
rej
ectt hem.
 REFERENCES

Biol
ogi
calSci
ence:Thi
rdEdi
ti
onBy ,
N.P.O.Gr
een
(Aut
hor)
,G.W.Stout(Aut
hor
),D.J.Tay
lor(
Aut
hor
),
R.Soper(
Edit
or)

Expl
ori
ngBi
ologyBy
,El
l
aTheaSmi
th

NCERTTextBook

Tel
lMeWhy

Ency
clopedi
aBr
it
anni
ca