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infertility
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{{About|the medical condition|the soil|Soil fertility}}{{Use dmy dates|date=February 2012}}- the content below is remote from Wikipedia
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| name | Infertility | image = | caption = | field = Urology, gynecology| symptoms =| complications =| onset =| duration =| causes =| risks = | diagnosis =| differential =| prevention =| treatment =| medication =| prognosis = Definition"Demographers tend to define infertility as childlessness in a population of women of reproductive age," whereas "the epidemiological definition refers to "trying for" or "time to" a pregnancy, generally in a population of women exposed to" a probability of conception.JOURNAL, Gurunath S, Pandian Z, Anderson RA, Bhattacharya S, Defining infertility--a systematic review of prevalence studies, Human Reproduction Update, 17, 5, 575–88, 2011, 21493634, 10.1093/humupd/dmr015, Currently, female fertility normally peaks at age 24 and diminishes after 30, with pregnancy occurring rarely after age 50. A female is most fertile within 24 hours of ovulation.BOOK, Diseases of the Human Body, Tamparo, Carol, Lewis, Marcia, F.A. Davis Company, 2011, 9780803625051, Philadelphia, PA, 459, Male fertility peaks usually at age 25 and declines after age 40. The time needed to pass (during which the couple tries to conceive) for that couple to be diagnosed with infertility differs between different jurisdictions. Existing definitions of infertility lack uniformity, rendering comparisons in prevalence between countries or over time problematic. Therefore, data estimating the prevalence of infertility cited by various sources differs significantly. A couple that tries 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 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.World Health OrganizationThe World Health Organization defines infertility as follows:WEB,weblink WHO | Infertility, Who.int, 2013-03-19, 2013-06-17, {{cquote|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 amenorrhoea). 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.}}United StatesOne definition of infertility that is frequently used in the United States by reproductive endocrinologists, doctors who specialize in infertility, to consider a couple eligible for treatment is:
United KingdomIn the UK, previous NICE guidelines defined infertility as failure to conceive after regular unprotected sexual intercourse for two years in the absence of known reproductive pathology.BOOK, Fertility: Assessment and Treatment for People with Fertility Problems, RCOG Press, London, 2004, 978-1-900364-97-3,weblink yes,weblink 3 August 2010, dmy-all, Updated NICE guidelines do not include a specific definition, but recommend that "A woman of reproductive age who has not conceived after 1 year of unprotected vaginal sexual intercourse, in the absence of any known cause of infertility, should be offered further clinical assessment and investigation along with her partner, with earlier referral to a specialist if the woman is over 36 years of age."WEB,weblink Fertility: assessment and treatment for people with fertility problems, section: Defining infertility, NICE Clinical guidelines, CG156, February 2013,Other definitionsResearchers commonly base demographic studies on infertility prevalence on a five-year periodweblink 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 infertilityPrimary 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 12 months, during which they have not used any contraceptives.WEB,weblink WHO | Infertility definitions and terminology, 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'.WEB,weblink WHO | Infertility definitions and terminology, 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 12 months 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.EffectsPsychologicalThe 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.JOURNAL, Cousineau TM, Domar AD, Psychological impact of infertility, Best Pract Res Clin Obstet Gynaecol., 21, 2, 293–308, 2007, 17241818, 10.1016/j.bpobgyn.2006.12.003, Infertility may have psychological effects. Partners may become more anxious to conceive, increasing sexual dysfunction.Donor insemination Edited by C.L.R. Barratt and I.D. Cooke. Cambridge (England): Cambridge University Press, 1993. 231 pages., page 13, citing Berger (1980) Marital discord often develops, especially when they are under pressure to make medical decisions. Women trying to conceive often have depression rates similar to women who have heart disease or cancer.JOURNAL, Domar AD, Zuttermeister PC, Friedman R, The psychological impact of infertility: a comparison with patients with other medical conditions, J Psychosom Obstet Gynaecol, 14, Suppl, 45–52, 1993, 8142988, Emotional stress and marital difficulties are greater in couples where the infertility lies with the man.Donor insemination Edited by C.L.R. Barratt and I.D. Cooke. Cambridge (England): Cambridge University Press, 1993. 231 pages., page 13, in turn citing Connolly, Edelmann & Cooke 1987Older people with adult children appear to live longer. Why this is the case is unclear and may dependent in part on those who have children adopting a healthier lifestyle, support from children, or the circumstances that led to not having children.BOOK, Childlessness in Europe: Contexts, Causes, and Consequences, 2017, Springer, 978-3-319-44667-7, 352,SocialIn 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.JOURNAL, Schmidt L, Christensen U, Holstein BE, The social epidemiology of coping with infertility, Hum. Reprod., 20, 4, 1044–52, Apr 2005, 15608029, 10.1093/humrep/deh687, In the United States some treatments for infertility, including diagnostic tests, surgery and therapy for depression, can qualify one for Family and Medical Leave Act leave. It has been suggested that infertility be classified as a form of disability.JOURNAL, Khetarpal A, Singh S, Infertility: Why can't we classify this inability as disability?, The Australasian Medical Journal, 5, 6, 334–9, 2012, 22848333, 3395292, 10.4066/AMJ.2012.1290,CausesImmune infertilityAntisperm antibodies (ASA) have been considered as infertility cause in around 10–30% of infertile couples.JOURNAL, Restrepo, B., Cardona-Maya, W., October 2013, Antisperm antibodies and fertility association, Actas Urologicas Espanolas, 37, 9, 571–578, 10.1016/j.acuro.2012.11.003, 1699-7980, 23428233, In both men and women, ASA production are directed against surface antigens on sperm, which can interfere with sperm motility and transport through the female reproductive tract, inhibiting capacitation and acrosome reaction, impaired fertilization, influence on the implantation process, and impaired growth and development of the embryo. Factors contributing to the formation of antisperm antibodies in women are disturbance of normal immunoregulatory mechanisms, infection, violation of the integrity of the mucous membranes, rape and unprotected oral or anal sex. Risk factors for the formation of antisperm antibodies in men include the breakdown of the blood‑testis barrier, trauma and surgery, orchitis, varicocele, infections, prostatitis, testicular cancer, failure of immunosuppression and unprotected receptive anal or oral sex with men.BOOK,weblink Principles & Practice of Assisted Reproductive Technology (3 Vols), Rao, Kamini, 2013-09-30, JP Medical Ltd, 9789350907368, en,Sexually transmitted infectionsInfections with the following sexually transmitted pathogens have a negative effect on fertility: Chlamydia trachomatis and Neisseria gonorrhoeae. There is a consistent association of Mycoplasma genitalium infection and female reproductive tract syndromes. M. genitalium infection is associated with increased risk of infertility.JOURNAL, Lis, R., Rowhani-Rahbar, A., Manhart, L. E., Mycoplasma genitalium Infection and Female Reproductive Tract Disease: A Meta-Analysis, Clinical Infectious Diseases, 2015, 1058-4838, 10.1093/cid/civ312, 25900174, 61, 3, 418–26, JOURNAL, Ljubin-Sternak, Suncanica, Mestrovic, Tomislav, Review: Clamydia trachonmatis and Genital Mycoplasmias: Pathogens with an Impact on Human Reproductive Health, Journal of Pathogens, 183167, 2014, 2014, 183167, 10.1155/2014/183167, 25614838, 4295611,GeneticA Robertsonian translocation in either partner may cause recurrent spontaneous abortions or complete infertility.{{citation needed|date=March 2016}}Mutations to NR5A1 gene encoding Steroidogenic Factor-1 (SF-1) have been found in a small subset of men with non-obstructive male factor infertility where the cause is unknown. Results of one study investigating a cohort of 315 men revealed changes within the hinge region of SF-1 and no rare allelic variants in fertile control men. Affected individuals displayed more severe forms of infertility such as azoospermia and severe oligozoospermia.JOURNAL, Ferraz-de-Souza, Bruno, Lin, Lin, Achermann, John C., 2011-04-10, Steroidogenic factor-1 (SF-1, NR5A1) and human disease, Molecular and Cellular Endocrinology, 336, 1–2, 198–205, 10.1016/j.mce.2010.11.006, 0303-7207, 3057017, 21078366,Other causesFactors that can cause male as well as female infertility are:
| FIRST= K | DATE= MAR 2001 | VOLUME= 72 | PAGES=173–9 | QUOTE= COELIAC MEN MAY HAVE REVERSIBLE INFERTILITY, AND AS IN WOMEN, IF GASTROINTESTINAL SYMPTOMS ARE MILD OR ABSENT THE DIAGNOSIS MAY BE MISSED. IT IS IMPORTANT TO MAKE DIAGNOSIS BECAUSE THE GIVING OF GLUTEN FREE DIET MAY RESULT IN CONCEPTION AND FAVOURABLE OUTCOME OF PREGNANCY., SHER >FIRST= KS | FIRST2= V | FIRST3= CS | FIRST4= CR | FIRST5= JF | DATE= 1994 | VOLUME= 12 | PAGES=186–90 | QUOTE= THERE IS NOW SUBSTANTIAL EVIDENCE THAT COELIAC SPRUE IS ASSOCIATED WITH INFERTILITY BOTH IN MEN AND WOMEN. (...) IN MEN IT CAN CAUSE HYPOGONADISM, IMMATURE SECONDARY SEX CHARACTERISTICS AND REDUCE SEMEN QUALITY. (...) HYPERPROLACTINAEMIA IS SEEN IN 25% OF COELIAC PATIENTS, WHICH CAUSES IMPOTENCE AND LOSS OF LIBIDO. GLUTEN WITHDRAWAL AND CORRECTION OF DEFICIENT DIETARY ELEMENTS CAN LEAD TO A RETURN OF FERTILITY BOTH IN MEN AND WOMEN. | adrenal diseaseREICHMAN DE, WHITE PC, NEW MI, ROSENWAKS Z | JOURNAL = FERTIL STERIL | ISSUE = 2 | DATE = FEB 2014 | DOI = 10.1016/J.FERTNSTERT.2013.11.002,
Females{{Further|Female infertility}}The following causes of infertility may only be found in females.For a woman to conceive, certain things have to happen: vaginal 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.About infertility & fertility problems {{webarchive|url=https://web.archive.org/web/20080829125837weblink |date=29 August 2008 }} from the Human Fertilisation and Embryology Authority.For women, problems with fertilisation arise mainly from either structural problems in the Fallopian tube or uterus or problems releasing eggs. Infertility may be caused by blockage of the Fallopian tube due to malformations, infections such as chlamydia or scar tissue. For example, endometriosis can cause infertility with the growth of endometrial tissue in the Fallopian tubes or around the ovaries. Endometriosis is usually more common in women in their mid-twenties and older, especially when postponed childbirth has taken place.Lessy, B.A. (2000) Medical management of endometriosis and infertility: 1089-1096.Another major cause of infertility in women may be the inability to ovulate. Malformation of the eggs themselves may complicate conception. For example, polycystic ovarian syndrome is when the eggs only partially developed within the ovary and there is an excess of male hormones. Some women are infertile because their ovaries do not mature and release eggs. In this case synthetic FSH by injection or Clomid (Clomiphene citrate) via a pill can be given to stimulate follicles to mature in the ovaries.Other factors that can affect a woman's chances of conceiving include being overweight or underweight,WEB, Are You At Your Optimal Weight?,weblink Chelsea Fertility NYC, 6 March 2015, or her age as female fertility declines after the age of 30.WEB, Should I Freeze My Eggs,weblink Information on Egg Freezing, 6 March 2015, Sometimes it can be a combination of factors, and sometimes a clear cause is never established.Common causes of infertility of females include:
Males{{Further|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.Mishail, A., et al. (2009) Impact of a second semen analysis on a treatment decision making in the infertile man with varicocele: 1809-1811Infertility associated with viable, but immotile sperm may be caused by primary ciliary dyskinesia. The sperm must provide the zygote with DNA, centrioles, and activation factor for the embryo to develop. A defect in any of these sperm structures may result in infertility that will not be detected by semen analysis.JOURNAL, Avidor-Reiss T, Khire A, Fishman EL, Jo KH, Apr 2015, Atypical centrioles during sexual reproduction, Front Cell Dev Biol, 3, 21, 10.3389/fcell.2015.00021, 25883936, 4381714, Antisperm antibodies cause immune infertility. Cystic fibrosis can lead to infertility in men.Combined infertilityIn 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 infertilityIn the US, up to 20% of infertile couples have unexplained infertility.Unexplained Infertility Background, Tests and Treatment Options Advanced Fertility Center of Chicago 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.JOURNAL, Altmäe S, Stavreus-Evers A, Ruiz JR, Laanpere M, Syvänen T, Yngve A, Salumets A, Nilsson TK, Variations in folate pathway genes are associated with unexplained female infertility, Fertility and Sterility, 94, 1, 130–137, 2010, 19324355, 10.1016/j.fertnstert.2009.02.025, However, a growing body of evidence suggests that epigenetic modifications in sperm may be partially responsible.JOURNAL, Kenneth I. Aston, Philip J. Uren, Timothy G. Jenkins, Alan Horsager, Bradley R. Cairns, Andrew D. Smith, Douglas T. Carrell, Aberrant sperm DNA methylation predicts male fertility status and embryo quality, Fertility and Sterility, December 2015, 104, 6, 1388–1397, 10.1016/j.fertnstert.2015.08.019, 26361204, JOURNAL, 22290605, 10.1007/s10815-012-9715-0, 29, 3, Epigenetics and its role in male infertility, 2012, J. Assist. Reprod. Genet., 213–23, Dada R, Kumar M, Jesudasan R, Fernández JL, Gosálvez J, Agarwal A, 3288140,DiagnosisIf both partners are young and healthy and have been trying to conceive for one year without success, a visit to a physician or women's health nurse practitioner (WHNP) could help to highlight potential medical problems earlier rather than later. The doctor or WHNP may also be able to suggest lifestyle changes to increase the chances of conceiving.Infertility Help: When & where to get help for fertility treatment {{webarchive|url=https://web.archive.org/web/20081225235604weblink |date=25 December 2008 }}Women over the age of 35 should see their physician or WHNP 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 doctor or WHNP takes a medical history and gives 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. If necessary, they refer patients to a fertility clinic or local hospital for more specialized tests. The results of these tests help determine the best fertility treatment.Treatment{{See also|Male infertility#Hormonal therapy}}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.JOURNAL, Failures (with some successes) of assisted reproduction and gamete donation programs, Human Reproduction Update, 19, 4, 354–365, 2013, 23459992, 10.1093/humupd/dmt007, ESHRE Capri Workshop Group, 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 menBOOK, Edmund S. Sabanegh, Jr., Male Infertility: Problems and Solutions,weblink 20 October 2010, Springer Science & Business Media, 978-1-60761-193-6, 82–83, 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 treatmentsMedical 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 ovulation induction maybe used. The physician or WHNP 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 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 or WHNP 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.In vitro fertilizationIVF is the most commonly used ART. It has been proven useful in overcoming infertility conditions, such as blocked or damaged tubes, endometriosis, repeated IUI failure, unexplained infertility, poor ovarian reserve, poor or even nil sperm count.Intracytoplasmic sperm injectionICSI technique is used in case of poor semen quality, low sperm count or failed fertilization attempts during prior IVF cycles. This technique involves an injection of a single healthy sperm directly injected into mature egg. The fertilized embryo is then transferred to womb.TourismFertility tourism is the practice of traveling to another country for fertility treatments.WEB,weblink fertility tourism - Word Spy, Paul McFedries, wordspy.com, 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.Stem cell therapyNowadays, there are several treatments (still in experimentation) related with stem cell therapy. It is a new opportunity, not only for partners with lack of gamets, but also for homosexuals and single people who wants to have offspring. Theoretically, with this therapy, we can get artificial gamets in vitro. There are different studies, for both women and men.JOURNAL, Vassena, R, Eguizabal, C, Heindryckx, B, Sermon, K, Stem cells in reproductive medicine: Ready for the patient?, Hum. Reprod., 30, 9, 2014–2021, 2015, 10.1093/humrep/dev181, 26202914,
EpidemiologyPrevalence of infertility varies depending on the definition, i.e. on the time span involved in the failure to conceive.
Society and culturePerhaps 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.chicagotribune.com Heartache of infertility shared on stage, screen By Colleen Mastony, Tribune reporter. 21 June 2009 Yet, the number 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.Pixar's Up contains a depiction of infertility in an extended life montage that lasts the first few minutes of the film.JOURNAL, O'Neill Desmond, 2009, Up with ageing, BMJ, 339, b4215, 10.1136/bmj.b4215, Other individual examples are referred to individual subarticles of assisted reproductive technologyEthicsThere are several ethical issues associated with infertility and its treatment.
See also
References{{Reflist|30em}}
Further reading
External links{hide}Medical condition classification and resources| DiseasesDB = 21627
| ICD10 = {{ICD10|N|46||n|40{edih}, {{ICD10|N|97|0|n|80}}
}}{{commons category}} | ICD9 = {{ICD9|606}}, {{ICD9|628}} | ICDO = | OMIM = | MedlinePlus = 001191 | eMedicineSubj = med | eMedicineTopic = 3535 | eMedicine_mult = {{eMedicine2|med|1167}} | MeshID = D007246
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