INFERTILITY

AIM:
To study about infertility in females and male, their causes and
treatment & tests for infertility.
INTRODUCTION:
Most people will have the strong desire to conceive a child at
some point during their lifetime. Understanding what defines normal
fertility is crucial to helping a person, or couple, know when it is
time to seek help. Most couples (approximately 85%)will achieve
pregnancy within one year of trying, with the greatest likelihood of
conception
occurring during the earlier
months. Only an additional 7%
of couples will conceive in the
second year.
Infertility is the inabilityof
a person, animal or plant to
reproduce by natural means. Itis
usually not the natural state of
a healthy adult organism, except
not able among certain eusocial
species. 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.
Average incidence of infertility is about 15% globally, it
varies in different population. Some causes can be detected and
treated, whereas others cannot unexplained infertility constitutes
about 10% of all cases.
INFERTILITY:
The biological inability of an individual who cannot carry a
pregnancy to full term. 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.
Medical treatment of infertility
generally involves the use of fertility
medication, medical device, surgery,
or a combination of the following.
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). There are mainly two types of infertility:
1.Primary infertility
2.Secondary infertility
PRIMARY 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

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least 12 months, during which they have not used any
contraceptives.
The World Health Organisation 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:
Secondary infertility is defined as the absence of a live birth
for women who desire a child and have been in a union forat least
five years since their last live birth, during which they did not use
any contraceptives.
SYMPTOMS:
The main symptom of infertility is not getting pregnant.
There may be no other obvious symptoms. Sometimes, a woman
with infertility may have irregular or absent menstrual periods. In
some cases, a man with infertility may have some signs of
hormonal problems, such as changes in hair growth or sexual
function.
Women should talk with a doctor earlier, however, if
they:
 Are age 35 or older and have
been trying to conceive for
six months or longer.
 Have irregular or absent
periods.
 Have very painful periods.
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  Have fertility problems.
 Have been diagnosed with endometriosis or pelvic
inflammatory disease and have undergone treatment for
cancer.
Men should talk to a doctor if they have:
 A low sperm count or other problems with sperm
 A history of testicular,
prostate or sexual
problems
 Undergone treatment for
cancer
 Small testicles orswelling
in the scrotum
 Others in your family
with infertility problems.
WHAT CAUSES INFERTILITY IN FEMALES:
Some cases of female infertility are caused by problems
with ovulation. Without ovulation, there are no eggs to be fertilized.
Some signs that a woman is not ovulating normally include irregular
or absent menstrual periods.
Ovulation problems are often caused by polycystic ovary
syndrome (PCOS). PCOS is a hormone imbalance problem which
can interfere with normal ovulation. PCOS is the most common
cause of female infertility. Primary ovarian insufficiency (POI) is
another cause of ovulation problems. POI occurs when a woman's
ovaries stop working normally before she is 40. POI is not the same
as early menopause. Other causes of infertility problems includes:
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 Blocked fallopian tube due to pelvic inflammatory
disease(PID)

 Uterine fibroid.

 Endometrium.

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 Ectopic pregnancy.

 Polycystic ovarian syndrome.

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RISK FACTORS THAT INCREASES THE INFERTILITY
INCLUDE:
 Age: The ability to conceive starts to fall around the age of
32 years.
 Smoking: Smoking significantly increases the risk of
infertility in both men and women, and it may undermine the
effects of fertility treatment. Smoking during pregnancy
increases the chance of pregnancy loss. Passive smokinghas
also been linked to lower fertility.
 Alcohol: Any amount of alcohol consumption can affect
the chances of conceiving.
 Being obese or overweight: This can increase the risk of
infertility in women as well as men.
 Eating disorders: If an eating disorder leads to serious weight
loss, fertility problems may arise.
 Diet: A lack of folic acid, iron, zinc, and vitamin B-12 can
affect fertility. Women who are at risk, including those on a
vegan diet, should ask the doctor about supplements.
 Exercise: Both too much and too little exercise can lead to
fertility problems.
 Sexually transmitted infections (STIs): Chlamydia can
damage the fallopian tubes in a woman and cause
inflammation in a man’s scrotum. Some other STIs may also
cause infertility.
 Exposure to some chemicals: Some pesticides, herbicides,
metals, such as lead, and solvents have been linked to
fertility problems in both men and women.

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  A mouse study has suggested that ingredients in some
household detergents may reduce fertility
 Mental stress: This may affect female ovulation and male
sperm production and can lead to reduced sexual activity.
INFRTILITY IN BLACK WOMENS:
Many people are usually taken aback to hear that in the
U.S. Black women suffer a much higher rate of infertility than
white women. Research from 2006 indicates that incidence
of infertility is higher in black women than in Caucasian women,
and that infertility among Black women has steadily been
increasing, whereas it is decreasing among white women
(Chandra, and Stephen 2006).
WHAT CAUSES INFERTILITY IN MALES:
Semen is the milky fluid that a man’s penis releases during
orgasm. Semen consists of fluid and sperm. The fluid comes from
the prostate gland, the seminal vesicle, and other sex glands. The
sperm is produced in the testicles. When a man ejaculatesand
releases semen through the penis, the seminal fluid, or semen,
helps transport the sperm toward the egg. The following problems
are faced by men:

 Low sperm count: The man ejaculates a low number of

sperm. A sperm count of under 15million is considered low.
Around one third of couples have difficulty conceiving due to a
low sperm count.
 Low sperm mobility (motility): The sperm cannot
“swim” as well as they should to reach egg.

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  Abnormal sperm: The
sperm may have an unusual shape,
making it harder to move and
fertilize an egg.

OTHER CAUSES MAY INCLUDE:

 Genetic factors: A man should have an X and Y

chromosome. If he has two X chromosomes and one Y
chromosome, as in Klinefelter’s syndrome, the testicles will
develop abnormally and there will be low testosterone and a
low sperm count or no sperm.
 Mumps: If this occurs after puberty, inflammation of the
testicles may affect sperm production.
 Hypospadias: The urethral opening is under the penis,
instead of its tip. This abnormality is usually surgically
corrected in infancy. If the correction is not done, it may be
harder for the sperm to get to the female’s cervix.
Hypospadias affects about 1 in every 500 newborn boys.
 Cystic fibrosis: This is a chronic disease that results in the
creation of a sticky mucus. This mucus mainly affects the
lungs, but males may also have a missing or obstructed vas
deferens. The vas deferens carries sperm from the
epididymis to the ejaculatory duct and the urethra.
 Radiation therapy: This can impair sperm production. The
severity usually depends on how near to the testicles the
radiation was aimed.

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  Some diseases: Conditions that are sometimes linked to
lower fertility in males are anemia, Cushing’s syndrome,
diabetes, and thyroid disease.
RISK FACTORS THAT INCREASES INFERILITY IN MALES:

 Sulfasalazine: This anti-inflammatory drug can

significantly lower a man’s sperm count. It is often
prescribed for Crohn’s disease or rheumatoid arthritis.
Sperm count often returns to normal after stopping the
medication.
 Anabolic steroids: Popular with bodybuilders and athletes,
long-term use can seriously reduce sperm count and
mobility.
 Chemotherapy: Some types may significantly reduce sperm
count.
 Illegal drugs: Consumption of marijuana and cocaine can
lower the sperm count.
 Age: Male fertility starts to fall after 40 years.
 Exposure to chemicals: Pesticides, for example, may
increase the risk.
 Excess alcohol consumption: This may lower malefertility.
Moderate alcohol consumption has not been shown to
lower fertility in most men, but it may affect those who
already have a low sperm count.
 Overweight or obesity: This may reduce the chance of
conceiving.
 Mental stress: Stress can be a factor, especially if it leads
to reduced sexual activity.

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TREATMENTS:
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. Some methods
may be used in concert with
other methods. Drugs used for both women and men include
clomiphene citrate, human menopausal gonadotropin (HMG),

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follicle-stimulating hormone (FSH), human chorionic
gonadotropin (HCG), gonadotropin-releasing hormone
(GnRH)analogues, aromatase inhibitors, and metformin.

FEMALE INFERTILITY TESTS:

1) HYSTROSALPINGOGRAPHY:
This procedure involves ultrasound or X-rays of
your reproductive organs. A doctor injects either dye
or saline and air into your cervix, which travels up
through your fallopian tubes. With this method, your
doctor can check to see if the tubes are blocked.
2) LAPAROSCOPY:
Your doctor puts a laparoscope-a slender tube fitted
with a tiny camera – through a small cut near your belly
button. This lets them view the outside of your uterus,
ovaries and fallopian tube to check abnormal growths.
The doctor can also see if your fallopian tubes are
blocked.

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 TREATMENTS FOR FEMALE INFERTILITY:
Involves the use of medication development of one or more
mature follicles. Success rate vary considerably and depend upon
the age of women, the types of medication used, whether there are
other infertility factors present in the couple and theother reasons.
The treatments are:
1. Laparoscopy:
If you've beendiagnosed with
tubal or pelvic disease, one option
is to get surgery to reconstruct
your reproductive organs. Doctor
puts a laparoscope through a cut
near your belly button to get rid of
scartissue, treat endometriosis,
openblocked tubes, or remove
ovarian cysts, which are fluid-
filled sacs that can form in the
ovaries.
2. Hysteroscopy:

In thisprocedure, Doctor places a

hysteroscope into your uterus
through your cervix. It's used to
remove polyps and fibroid
tumors, divide scar tissue, and
open up blocked tubes.

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 3. Medication:
If you have ovulation problems,
you may beprescribed drugs
such as clomiphene citrate
gonadotropins or letrozole.

Gonadotropins can trigger ovulation when Clomid or Serophene

don't work. These drugs also can also help you get pregnant by
causing your ovaries to release multiple eggs. Metformin
(Glucophage) is another type of medication that may help you ovulate
normally if you have insulin resistance or PCOS.
4. In vitro-fertilization:
Taking of gonadotropins that
trigger the development of more
than one egg. When the eggs are
mature, the doctor uses an
ultrasound for guidance and
collects them with a needle. Sperm
are then collected, washed, and
added to the eggs in the dish under
strict laboratory conditions. Several
days later, embryos or fertilized
eggs,get put back into your uterus
with a devicecalled an intrauterine
inseminationcatheter.
In vitro fertilization is the most
commonly used assisted
reproductive technologies (ART).

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This results in a zygote or famously known as a test-tube baby.
This method is commonly performed in case of women with
damaged or clogged Fallopian tubes
5. Zygote intra-fallopian
transfer:
(ZIFT), also known as Tubal
Embryo Transfer isanalogous to
IVF. ZIFT is an ART procedure
wherefertilization happens in a
laboratory. The thus formed
zygote is then conveyed to the
Fallopian tube of the mother
using laparoscopy. ZIFT
proceeds as follow: egg retrieval from ovaries, fertilization,
carrying the zygote into the uterine tubes for implantation and
further development. ZIFT is not for women with abnormal
uterine tubes.
6. Gamate inrta-fallopian transfer:
GIFT is an in-vivo fertilization
procedure where the gametes –
sperm and ova are conveyed
directly into the fallopian tube. In
GIFT, fertilization and zygote
formation is more natural as it
takes place within the female
body.

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 MALE INFERTILITY TEST:
 SPERM AND SEMAN ANALYSIS:
They provide a private room (and magazine). You
provide a fresh sample of semen. Experts then assess your
sperm count, their shape , movement, and other variables.
 PHYSICAL EXAMINATION:
A thorough physical exam can detect varicocele and give
clues to hormone problem. This should be performed by a
urologist.
 HORMONE EVALUTION:
Testosterone and multiple hormones made in the brain to
control sperm production. However, hormones are not the
main problem in 97% of infertile men.
 TESTICULAR BIOSPY:
This is done for men with very low or no sperm in their
semen. A needle biopsy of the testicle can show whether a
man is making a healthy sperm. If abundant good sperm are
found in the testicle, there’s blockage somewhere.
 GENETIC TEST:
Genetic test can identify specific obstacles to fertile and
problems with sperm. Experts differ as to when genetic tests
should be done.
TREATMENT FOR MALE INFERTILITY:
Male factor infertility is a generally term that describes
a situation in which the inability to conceive is associated with an
alteration identified in the male partner. This dysfunction may be
associated with low sperm concentration, poor sperm mobility or
abnormal sperm morphology.

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 1) Intrauterine insemination
(IUD):
At the time of ovulation,
sperm are injected directly up
into uterus. Medicines are
usually given to women first
to increase the number of egg
they release.

2) Intracytoplasmic sperm
injection (ICSI):
A single sperm is injected
through a tiny needle into an
egg. The fertilized egg is then
implanted in the uterus. ICSI
can be performed when sperm
counts are extremely low or
abnormal.

WHEN TREATMENT DOESN’T WORK:

In rare cases, male fertility problem can’t be treated,
and its impossible for a man to father a child. Your doctor might
suggest that you and your partner consider using sperm from a
donor or adopting a child.

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 CONCLUSION

Reproduction is a large aspect of life for many cultures within

developing nations, and infertility can lead to social and familial
problems such as rejection or abandonment as well as personal
psychological issues. Currently, infertility treatment options and
programs are only available through private health sectors in
developing nations and little-to-no treatment is available through
public health sectors, the infertility treatment option offered
through the private sectors are often costly or not easily accessible.

Additionally, counseling is considered an essential aspect

of infertility treatment, and due to lack of education and resources
such forms of therapy remain scarce as well. while quality
infertility care is not readily available in developing nations (such
as sub-Saharan African countries), a standard procedure of care
could be easily implemented for a low cost as a basic intervention.
The lack of fertility treatment is problematic. And high v=birth and
population rates are every reasons to implement treatment option
rather than reject them.

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BIBLIOGRAPHY

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