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infertility

 
American Heritage Dictionary:

in·fer·til·i·ty

(ĭn'fər-tĭl'ĭ-tē) pronunciation
n.
  1. Absent or diminished fertility.
  2. The persistent inability to conceive a child.

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Inability of a couple to conceive and reproduce. It is defined as failure to conceive after one year of regular intercourse without contraception. Inability to conceive when desired can result from a defect at any of the stages required for fertility (see reproductive system). About one in every eight couples is infertile. Most cases involve the female partner, 30 – 40% involve the male, and 10% are caused by unknown factors. In women, causes include ovulation or hormone problems, fallopian-tube disorders, and a chemical balance that is hostile to sperm; in men, causes include impotence, low sperm count, and sperm abnormalities. Either partner can have a blockage of the pathways the sperm must travel, often treatable by surgery. Emotional factors may contribute; return of normal fertility may require only counseling. Fertility drugs can stimulate the release of eggs (often more than one, leading to multiple births). Low sperm count may be overcome by limiting intercourse to the time of ovulation, the most fertile period. If these methods are unsuccessful, couples may try artificial insemination, in vitro fertilization, or surrogate motherhood, or they may choose adoption instead.

For more information on infertility, visit Britannica.com.

Inability to conceive or induce conception. Of all cases of infertility, 35% may be attributed to the male and 55% to the female; the remaining 10% is undetermined.

The principal cause of increasing rates of infertility is the postponement of pregnancy: adverse effects of increasing age on reproductive capacity include decreased conception rates and increased pregnancy losses. The increasing incidence of pelvic inflammatory disease is also thought to be a major cause. Pelvic infections lead to scar formation around the ovaries and the fallopian tubes, thereby impeding the transport of oocytes for fertilization.

Ovulatory dysfunction accounts for approximately 20% of cases of infertility. Ovulation is dependent on the timely secretion of the two gonadotropic hormones from the pituitary gland, follicle-stimulating hormone (FSH) and luteinizing hormone (LH). Gonadotropic hormone release can be impeded by certain medications and by many disease states, including stress, anorexia nervosa, weight loss, and thyroid disease. Anovulation can be treated by replacing the deficient gonadotropins with human menopausal gonadotropin, a mixture of follicle-stimulating and luteinizing hormones. In addition, the drug clomiphene citrate increases the endogenous secretion of those hormones from the pituitary gland. See also Pituitary gland.

Fallopian tube and uterine abnormalities account for 25% of the cases of infertile couples. These abnormalities include defective development as well as scar formation after surgery or infection. Not uncommonly the region of the fallopian tube closest to the uterus may be obstructed by scar tissue, but the obstruction can be microscopically removed or the fallopian tube can be surgically cut and reconnected.

In endometriosis, tissue that normally lines the uterus is found on the pelvic lining. Severe forms of endometriosis involve the ovaries and fallopian tubes, which doubles the likelihood of infertility in those women. The condition is treated either by surgical excision of the aberrant tissue or by subsequent medical treatment. See also Ovarian disorders.

Abnormalities in cervical mucus production may result from trauma, surgery, and diethylstilbestrol (DES) exposure before birth. The treatment of cervical abnormalities remains controversial, but may include estrogen; or another approach is to bypass this obstruction by using intrauterine transfer of semen (artificial insemination).

Male infertility resulting from abnormal semen may be due to developmental defects, genitourinary infections, or varicocele. An evaluation of sperm count, motility, and morphology is helpful, but in most cases the cause of the abnormality remains undetermined. No treatment other than donor insemination is available for these couples.

In approximately 10% of infertile couples, a thorough evaluation reveals no cause, and unexplained infertility is diagnosed. In nearly 50% of women with unexplained infertility, pelvic abnormalities are found and are most often caused by endometriosis and scar formation.

One method of assisted reproduction is in vitro fertilization, which takes place through the controlled hyperstimulation of ovulation followed by surgical extraction of mature oocytes from the ovaries. In another method of assisted reproduction, gamete intrafallopian tube transfer (GIFT), ovulation is stimulated, as with in vitro fertilization, but the extracted oocytes are placed directly into the fallopian tube with the semen specimen. Incubation occurs within the fallopian tube rather than outside the body. See also Pregnancy; Reproductive system; Reproductive system disorders; Reproductive technology.


Infertility may be primary or secondary. Primary infertility is when no pregnancy has ever occurred. Secondary infertility is when there have been one or more pregnancies but a further pregnancy has proved impossible. It has been estimated that the chances of conception for a given couple having regular sexual intercourse without any contraception are 80% and 90% after 12 months and 18 months respectively. It is therefore usual to begin investigations after one year. At this time some problems may be discovered and it should be possible, the basic tests having been done, to offer a realistic prognosis and a possible treatment outline. It is important to discover if there are any obvious abnormalities because with the new methods of treatment that have become available over the last twenty years it is frequently possible to offer real hope of success.

Female physiology

The Fallopian tubes lead from the ovaries, where the eggs are made, to the uterus. Each month, around 12-14 days from the last menstrual period, an egg (ovum) is released from the ovary. The ovum passes down the tube and its passage is facilitated by the moving cilia of the lining cells, which waft the ovum along. If intercourse occurs around this time the sperm swims up through the uterus to the tube and one of them joins the egg in the tube. The fertilized egg then continues down the tube to the uterus which has been prepared by hormones to receive the egg.

Causes of infertility

Unexplained27%
Male factor24%
Anovulation21%
Tubal factors14%
Endometriosis6%
Sexual dysfunction6%
Mucus hostility3%

Unexplained infertility is not easy to define. The more investigations that a clinic is able to perform the lower is the incidence of unexplained infertility. Hopefully some time in the future all will be explained.

Male infertility It is not always recognized how commonly the male partner is the infertile one. The average amount of seminal fluid ejaculated each time is 2-5 ml. Persistent low volume may indicate an abnormality. If the number of sperm is less than 10 million/ml this makes fertilization less likely. The mobility of the sperm is also a factor, as is the ability of the sperm to penetrate the egg. These factors can all be tested in the laboratory. An important cause of reduced sperm numbers is a history of mumps, as the testicles are damaged in some cases.

Anovulation means that for some reason no ovum is produced in each menstrual cycle.

Tubal factors The main tubal factor is blockage, which may result from infection from sexually transmitted disease or a previous miscarriage. The blockage prevents the union of sperm and ovum so that no pregnancy occurs. Sometimes, although the tube may not be blocked, the cilia, which assist the passage of the ovum down the tube, are damaged so that the ovum gets stuck in the tube and union with the sperm does not occur. Sometimes the sperm does manage to fertilize the stuck egg and this results in a pregnancy occurring in the tube — an ectopic pregnancy. As this pregnancy grows the tube may rupture, with serious consequences due to bleeding into the abdominal cavity.

Endometriosis is a condition where, for unknown reasons, portions of the lining of the uterus grow in other parts of the pelvis such as the ovaries. The reason why this causes infertility is not clear.

Sexual dysfunction occurs sometimes due to psychological factors that prevent proper intercourse.

Mucus hostility means that the secretion from the neck of the womb (cervix) is abnormal, and kills the sperm so that they cannot travel through the uterus to the tubes.

Investigations

At an infertility clinic both partners are given a full physical examination and a detailed medical history is taken.

In the male a good proportion of infertility is due to deficiencies in semen, so a proper seminal examination is essential. This involves measurement of the volume of the ejaculate — the sperm count — which should be 20 million/ml or more; the swimming ability of the sperm; and the numbers of abnormal forms present. A history of mumps or sexually transmitted disease or genital trauma are important, as are previous hernia operations. A social history of drug and alcohol intake may be relevant, as may occupations involving working at extremes of temperature or at altitude. Physical examinations may reveal some testicular or penile abnormality.

There is still controversy as to what constitutes normal semen. With modern methods of assisted reproduction many men with very low sperm counts can produce enough sperm which can be used to fertilize eggs ‘in vitro’ (IVF). Our ideas as to what constitutes an infertile male have radically altered in the last twenty years.

In the case of the female partner the occurrence of ovulation can be tested by Basal Body Temperature measurement (the temperature rises 1 degree following ovulation in the second half of the menstrual cycle) and by measurement of the female hormones, oestrogen and progesterone. The use of ultrasound can visualize the ovum in the ovary, and taking a sample of the lining of the uterus can show whether or not the uterus is being prepared properly in each cycle for reception of a fertilized ovum. Assessment of the state of the tubes can be achieved by injecting dye through the cervix. This fills the uterine cavity, and, with the use of a small telescope (laparoscope) inserted into the abdomen, dye will be seen flowing from the tubal opening at the ovary if the tube is patent. If no dye is seen the tube is blocked. A newer method, falloscopy, involves the introduction of a tiny telescope (falloscope) into the tube through the tubal opening in the uterus and allows evaluation of the state of the tubal lining — so important for the transport of the egg. The mucus at the cervix can be sampled and tested to see if it kills sperm; if it does, there are methods of avoiding this.

A small telescope (hysteroscope) can also be used to examine the inside of the uterus to see if there any abnormalities of shape and to exclude the presence of tumours. All these tests are available at properly equipped infertility centres.

A history of pelvic infection may be relevant — perhaps after a miscarriage or previous abdominal operation, or due to sexually transmitted disease. An abnormal menstrual history may suggest a hormonal disturbance. Previous use of hormonal contraception (the Pill) can result in anovulation, and use of the intrauterine device can cause infection and blocked tubes.

The success of infertility treatment varies enormously depending on the cause. In the most favourable cases treatment may be 90% successful. In cases it may be quite unsuccessful. Nowadays, with proper investigation and treatment the results are incomparably better than a quarter of a century ago.

— Malcolm Macnaughton

See also assisted reproduction; fertility; impotence; menstrual cycle; ovum; pregnancy; testis.

Roget's Thesaurus:

infertility

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noun

    The state or condition of being unable to reproduce sexually: barrenness, sterility, sterilization. See reproduction/barrenness, rich/poor.

Inability of a woman to conceive or of a man to induce conception. Strenuous regular physical activity of more than 1 h each day may be a factor contributing to the infertility of some women since such activity can disrupt menstruation (see amenorrhoea) and it may even prevent ovulation in some women. The abuse of certain drugs as ergogenic substances may also lead to infertility. For example, anabolic steroids can cause testicular atrophy, which may lead to infertility because of lack of sperm. Usually, this situation is resolved after withdrawal of the drugs, but the sperm count may remain abnormally low for 12-24 months.

Columbia Encyclopedia:

infertility

Top
infertility, inability to conceive or carry a child to delivery. The term is usually limited to situations where the couple has had intercourse regularly for one year without using birth control. The term sterility is restricted to lack of sperm production or inability to ovulate. Approximately 40% of reported cases of infertility are due to problems in the male; another 40% to problems in the female; the remaining 20% are of unknown cause or due to problems in both the male and female.

Causes

Infertility can be caused by any interruption in the usual process of fertilization, pregnancy, and birth, which includes ejaculation of normal amounts of healthy sperm, passage of the sperm through the cervix and into the fallopian tube of the female, passage of an ovum (egg) down the fallopian tube from an ovary, fertilization in the fallopian tube, implantation of the fertilized egg in a receptive uterus, and the ability to carry the fetus to term. In women, the most common problems are failure to ovulate and blockage of the fallopian tubes. In men, low sperm count is the most common problem.

Underlying problems include disease, such as diabetes or mumps in adult men, hormonal imbalances, endometriosis, pelvic inflammatory disease (often caused by sexually transmitted diseases, e.g., chlamydia), the abuse of alcohol and other drugs, and exposure to workplace hazards or environmental toxins. Uterine irritation or infection that sometimes accompanies IUD use can also reduce fertility. Occasionally there is a chemical or immunological incompatibility between male and female. Psychological factors are difficult to evaluate because of the stressful nature of infertility itself.

The number of couples seeking treatment for infertility has increased as more of them have postponed childbearing to a later age. In women, fertility begins to decline in the mid-twenties, and continues to decline, more and more sharply, until menopause. Male fertility declines gradually until age forty, then declines more quickly.

Evaluation and Treatment

Evaluation includes examination of sperm, observation of basal body temperature or luteinizing hormone peaks (see gonadotropic hormone) in the female to determine whether ovulation is taking place, the ruling out of obstructions of the fallopian tubes or vas deferens, and blood tests that measure hormone levels. Treatment is geared to the specific problem. The first step may be treatment of underlying disease and, in men, avoidance of substances that might affect sperm count. Fertility drugs, some of which increase the likelihood of multiple births, are often prescribed. If necessary, surgical correction of blocked tubes can be attempted.

Artificial insemination, in which the man's sperm or donor sperm from a sperm bank is inserted directly into the woman or a surrogate mother may be attempted. Another method is in vitro fertilization, in which an egg is taken from the mother or an egg donor and fertilized outside the body by the father's sperm. The resulting embryo is then inserted into the mother's uterus. Gamete intrafallopian transfer (GIFT) mixes the egg and sperm outside the body, then, using laparoscopic surgery (see endoscope), introduces them into the fallopian tube. For men with low sperm count or sperm of low quality, a procedure called intracytoplasmic sperm injection can help by inserting a single sperm directly into an egg. If none of these measures succeeds, adoption is sometimes considered.

Some controversy has surrounded infertility treatment. Many of the procedures are very expensive, and some question whether insurance plans should be responsible for the cost. The multiple births that sometimes occur with fertility drugs can put great strain on a family's resources. The legal rights of surrogate mothers and sperm donors are also of concern to all parties and have sometimes been resolved only after extended court cases. The wisdom of stretching the definition of "the childbearing years" has come into question as well, as methods used for treating infertility have been used to allow postmenopausal women to have children. Some are uncomfortable with the ability to choose the sex of the child or the screening of sperm or egg donors for characteristics such as height and intelligence.

See also gynecology; obstetrics.


The inability to conceive and produce viable offspring. In agricultural animals there are requirements that the animals reproduce prolifically and at a particular time chosen to best suit the availability of feed. A decision as to when infertility can be said to be present varies with the species and with the mating pair, and also with the state of the environment. For example, a dairy cow mated three times without conceiving to proven fertile semen by artificial insemination or by natural breeding to a known fertile bull is judged to require treatment for infertility. Infertility is a diagnosis about a mating rather than an individual animal; the error may be with the male or the female and it may be permanent or temporary. As a herd problem it provides a major brake on production in all species. In many instances the problem is man-made and in many of those there is in fact nothing wrong with the animals but there is with the management program, especially the nutritional regimen, which affects a mating at a time when fertility is marginal.

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Wikipedia on Answers.com:

Infertility

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Infertility
Classification and external resources
ICD-10 N46, N97.0
ICD-9 606, 628
DiseasesDB 21627
MedlinePlus 001191
eMedicine med/3535 med/1167
MeSH D007246

Infertility primarily refers to the biological inability of a person to contribute to conception. Infertility may also refer to the state of a woman who is unable to carry a pregnancy to full term. There are many biological causes of infertility, some which may be bypassed with medical intervention.[1]

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.

Contents

Definition

Definitions of infertility differ, with demographers tending to define infertility as childlessness in a population of women of reproductive age, while the epidemiological definition is based on "trying for" or "time to" a pregnancy, generally in a population of women exposed to a probability of conception.[2]

One definition of infertility that is frequently used by reproductive endocrinologists, the doctors specializing in infertility, to consider a couple eligible for treatment if:

  • a woman under 35 has not conceived after 12 months of contraceptive-free intercourse. Twelve months is the lower reference limit for Time to Pregnancy (TTP) by the World Health Organization.[3]
  • a woman over 35 has not conceived after 6 months of contraceptive-free sexual intercourse.

These time intervals would seem to be reversed; this is an area where public policy trumps science. The idea is that for women beyond age 35, every month counts and if made to wait another 6 months to prove the necessity of medical intervention, the problem could become worse. The corollary to this is that, by definition, failure to conceive in women under 35 isn't regarded with the same urgency as it is in those over 35.

Alternatively, the NICE guidelines define infertility as failure to conceive after regular unprotected sexual intercourse for 2 years in the absence of known reproductive pathology.[4]

A couple that has tried unsuccessfully to have a child after a certain period of time (often a short period, but definitions vary) is sometimes said to be subfertile, meaning less fertile than a typical couple. Both infertility (see above for definitions) and subfertility are defined as the inability to conceive after a certain period of time (the length of which vary), so often the two terms overlap.

Primary vs. secondary infertility

Couples with primary infertility have never been able to conceive,[5] while, on the other hand, secondary infertility is difficulty conceiving after already having conceived (and either carried the pregnancy to term or had a miscarriage). Secondary infertility is not present if there has been a change of partners (this follows tautologically from the convention of speaking of couples, rather than individuals, as being infertile; if there is a change of partners, then a new couple is created, with its own chances to be infertile.)

Prevalence

  • Generally, worldwide it is estimated that one in seven couples have problems conceiving, with the incidence similar in most countries independent of the level of the country's development.[citation needed]
  • Fertility problems affect one in seven couples in the UK. Most couples (about 84 out of every 100) who have regular sexual intercourse (that is, every 2 to 3 days) and who do not use contraception will get pregnant within a year. About 92 out of 100 couples who are trying to get pregnant do so within 2 years.[6]
  • Women become less fertile as they get older. For women aged 35, about 94 out of every 100 who have regular unprotected sexual intercourse will get pregnant after 3 years of trying. For women aged 38, however, only 77 out of every 100 will do so. The effect of age upon men's fertility is less clear.[6]
  • In people going forward for IVF in the UK, roughly half of fertility problems with a diagnosed cause are due to problems with the man, and about half due to problems with the woman. However, about one in five cases of infertility has no clear diagnosed cause.[7]
  • In Britain, male factor infertility accounts for 25% of infertile couples, while 25% remain unexplained. 50% are female causes with 25% being due to anovulation and 25% tubal problems/other.[8]
  • In Sweden, approximately 10% of couples wanting children are infertile.[9] In approximately one third of these cases the man is the factor, in one third the woman is the factor, and in the remaining third the infertility is a product of factors on both parts.

Causes

Data from UK, 2009.[10]

This section deals with unintentional causes of sterility. For more information about surgical techniques for preventing procreation, see Sterilization (surgical procedure).

Causes in either sex

Factors that can cause male as well as female infertility are:

German scientists have reported that a virus called Adeno-associated virus might have a role in male infertility,[14] though it is otherwise not harmful.[15] Mutation that alters human DNA adversely can cause infertility, the human body thus preventing the tainted DNA from being passed on[citation needed].

Specific female causes

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 systems that produce eggs and sperm have to be working at optimum levels; and her hormones must be balanced.[16]

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.

Problems affecting women include endometriosis or damage to the fallopian tubes (which may have been caused by infections such as chlamydia).

Other factors that can affect a woman's chances of conceiving include being over- or underweight, or her age as female fertility declines sharply after the age of 35. 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
  • tubal blockage
  • age-related factors
  • uterine problems
  • previous tubal ligation
  • endometriosis

Specific male causes

The main cause of male infertility is low semen quality.

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.[17] 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, that 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.[18]

Assessment

If both partners are young and healthy and have been trying to conceive for 12 months to one year without success, a visit to the family doctor could help to highlight potential medical problems earlier rather than later. The doctor may also be able to suggest lifestyle changes to increase the chances of conceiving.[19]

Women over the age of 35 should see their family doctor after six months as fertility tests can take some time to complete, and age may affect the treatment options that are open in that case.

A family doctor will take a medical history and give a physical examination. They can also carry out some basic tests on both partners to see if there is an identifiable reason for not having achieved a pregnancy yet. If necessary, they can refer patients to a fertility clinic or a local hospital for more specialized tests. The results of these tests will help determine which is the best fertility treatment.

Treatment

Treatment methods for infertility may be grouped as medical or complementary and alternative treatments. Some methods may be used in concert with other methods.

At-home conception kit

In 2007 the FDA cleared the first at home tier one medical conception device to aid in conception. The key to the kit are cervical caps for conception. This at home [cervical cap] insemination method allows all the semen to be placed up against the cervical os for six hours allowing all available sperm to be placed directly on the cervical os. For low sperm count, low sperm motility, or a tilted cervix using a cervical cap will aid in conception. This is a prescriptive medical device, but not commonly prescribed by physicians. [20]

At-home assessment

Prior to undergoing expensive fertility procedures many women and couples will turn to online sources to determine their estimate chances of success. A take-home baby assessment can provide a best guess estimate compared with women who have succeeded with in vitro fertilization, based on variables such as maternal age duration of infertility and number of prior pregnancies.[21]

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), physicians may start by prescribing a course of ovarian stimulating medication. The physician may also suggest using a 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 intrauterine insemination (IUI), in which the doctor 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 (IVF). IVF and related techniques (ICSI, ZIFT, GIFT) are called assisted reproductive technology (ART) techniques.

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 Preimplantation genetic diagnosis.

Complementary and alternative treatments

Three complementary or alternative female infertility treatments have been scientifically tested, with results published in peer-reviewed medical journals.

  1. Group psychological intervention: A 2000 Harvard Medical School study examined the effects of group psychological intervention on infertile women (trying to conceive a duration of one to two years). The two intervention groups—a support group and a cognitive behavior group—had statistically significant higher pregnancy rates than the control group.[22]
  2. Acupuncture: Acupuncture performed 25 minutes before and after IVF embryo transfer increased IVF pregnancy rates in a German study published in 2002.[23] In a similar study conducted by The University of South Australia in 2006, there was no statistically significant difference in fertility between the group which received acupuncture and the control group.[24] Although definitive results of the effects of acupuncture on embryo transfer remain a topic of discussion, study authors state that it appears to be a safe – although not necessarily effective – adjunct to IVF.[24][25]
  3. Manual physical therapy: The Wurn Technique, a manual manipulative physical therapy treatment, was shown in peer reviewed publications to improve natural and IVF pregnancy rates in infertile women in a 2004 study,[26] and to open and return function to blocked fallopian tubes in a 2008 study.[27] The therapy was designed to address adhesions restricting function and mobility of the reproductive organs.[26][27]

Tourism

Fertility tourism is the practice of traveling to another country for fertility treatments.[28] It may be regarded as a form of medical tourism. The main reasons for fertility tourism are legal regulation of the sought procedure in the home country, or lower price. In-vitro fertilization and donor insemination are major procedures involved.

Ethics

There are several ethical issues associated with infertility and its treatment.

  • High-cost treatments are out of financial reach for some couples.
  • Debate over whether health insurance companies should be forced to cover infertility treatment.
  • Allocation of medical resources that could be used elsewhere
  • The legal status of embryos fertilized in vitro and not transferred in vivo. (See also Beginning of pregnancy controversy).
  • Pro-life opposition to the destruction of embryos not transferred in vivo.
  • 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.
  • Religious leaders' opinions on fertility treatments.
  • 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 ICSI) only defer the underlying problem to the next male generation.

Many countries have special frameworks for dealing with the ethical and social issues around fertility treatment.

  • One of the best known is the HFEA – The UK's regulator for fertility treatment and embryo research. This was set up on 1 August 1991 following a detailed commission of enquiry led by Mary Warnock in the 1980s
  • 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 [29]
  • Regulatory bodies are also found in Canada [30] and in the state of Victoria in Australia [31]

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.[32]

Infertility may have profound psychological effects. Partners may become more anxious to conceive, ironically increasing sexual dysfunction.[33] 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.[34] Even couples undertaking IVF face considerable stress.[35]

Emotional stress and marital difficulties are greater in couples where the infertility lies with the man.[36]

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 are the most likely to respond in this way.[37]

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. [38] 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.

Fictional representation

Perhaps except for infertility in science fiction, films and other fiction depicting emotional struggles of assisted reproductive technology have had an upswing first in the latter part of the 2000s decade, although the techniques have been available for decades.[39] Yet, the amount of people that can relate to it by personal experience in one way or another is ever growing, and the variety of trials and struggles is huge.[39]

Any individual examples are referred to individual subarticles of assisted reproductive technology

See also

References

  1. ^ Makar RS, Toth TL (2002). "The evaluation of infertility". Am J Clin Pathol. 117 Suppl: S95–103. PMID 14569805. 
  2. ^ Gurunath, S.; Pandian, Z.; Anderson, R. A.; Bhattacharya, S. (2011). "Defining infertility--a systematic review of prevalence studies". Human Reproduction Update 17 (5): 575. doi:10.1093/humupd/dmr015.  edit
  3. ^ Cooper TG, Noonan E, von Eckardstein S, et al. (2010). "World Health Organization reference values for human semen characteristics". Hum. Reprod. Update 16 (3): 231–45. doi:10.1093/humupd/dmp048. PMID 19934213. 
  4. ^ [1] Fertility: Assessment and Treatment for People with Fertility Problems. London: RCOG Press. 2004. ISBN 1-900364-97-2. 
  5. ^ MedlinePlus Encyclopedia Infertility
  6. ^ a b NICE fertility guidance
  7. ^ HFEA Chart on reasons for infertility
  8. ^ Khan, Khalid; Janesh K. Gupta; Gary Mires (2005). Core clinical cases in obstetrics and gynaecology: a problem-solving approach. London: Hodder Arnold. pp. 152. ISBN 0-340-81672-4. 
  9. ^ Sahlgrenska University Hospital. (translated from the Swedish sentence: "Cirka 10% av alla par har problem med ofrivillig barnlöshet.")
  10. ^ a b Regulated fertility services: a commissioning aid – June 2009, from the Department of Health UK
  11. ^ Van Den Boogaard, E.; Vissenberg, R.; Land, J. A.; Van Wely, M.; Van Der Post, J. A. M.; Goddijn, M.; Bisschop, P. H. (2011). "Significance of (sub)clinical thyroid dysfunction and thyroid autoimmunity before conception and in early pregnancy: A systematic review". Human Reproduction Update 17 (5): 605–619. doi:10.1093/humupd/dmr024. PMID 21622978.  edit
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Further reading

  • Fertility: Assessment and Treatment for People with Fertility Problems. London: RCOG Press. 2004. ISBN 1-900364-97-2. 
  • Pamela Mahoney Tsigdinos (2009). Silent Sorority: A Barren Woman Gets Busy, Angry, Lost and Found. USA: BookSurge Publishing. pp. 218. ISBN 1-439231-56-7. 

External links


 
 

 

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