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Infertility is the inability to naturally conceive, carry or deliver a healthy child.
The International Council on Infertility Information Dissemination (INCIID) considers a couple to be infertile if they have not conceived "after a year of unprotected intercourse in women under 35, or after six months in women over 35"[1] (http://www.inciid.org/faq/general1.html), or if they are incapable of carrying a pregnancy to term.
Causes may depend on factors in both the male and the female partner. Infertile couples can have profound psychological and social impacts. If removal of the cause is unlikely, assisted conception, in-vitro fertilization and adoption are some remaining options.
Causes
According to the American Society for Reproductive Medicine, infertility affects about 6.1 million people in the U.S., equivalent to ten percent of the reproductive age population. Female infertility accounts for one third of infertility cases, male infertility for another third, combined male and female infertility for another 15%, and the remainder of cases are "unexplained"2.
Female infertility
Factors relating to female infertility are:
- General problems
- Hypothalamic-pituitary problems:
- Ovarian problems
- Tubal/peritoneal problems
- Uterine factors
- Cervical factors
- Cervical stenosis
- Antisperm antibodies
- Vaginal problems
Male infertility
Factors relating to male infertility include:
- Pretesticular causes
- Testicular factors
- Posttesticular causes
To detect some causes of male infertility, one examination is analysis of the ejaculate, which contains the sperm. These are interpreted by counting the number of sperm and their motility under a microscope:
- Producing few or no sperm, or oligospermia and azoospermia respectively.
- Sperm that is normal in number but has poor motility, or asthenozoospermia.
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. While usually hard to diagnoses, the causes may be immunological or genetic. This may mean that both partners are independantly fertile but cannot conveive together.
Treatment
There are various treatments for infertility, depending what the problem is. These treatments include:
- Fertility drugs to assist with problems ovulating (e.g. clomifene citrate, which stimulates ovulation)
- Surgery to restore patency of obstructed fallopian tubes
- In vitro fertilization (IVF) in which eggs are removed from the woman, fertilized and then placed in the woman's uterus, bypassing the fallopian tubes.
- Alternative (and somewhat controversial) methods:
- Intracytoplasmic sperm injection (ICSI) in which a single sperm is injected directly into an egg; the fertilized egg is then placed in the woman's uterus as in IVF.
- Gamete intrafallopian transfer (GIFT) in which eggs are removed from the woman, and placed in one of the fallopian tubes, along with the man's sperm. This allows fertilization to take place inside the woman's body.
- Zygote intrafallopian transfer (ZIFT) in which eggs are removed from the woman, fertilized and then placed in the woman's fallopian tubes rather than the uterus.
- Egg donation by another woman (in combination with IVF, GIFT or ZIFT). This happens when a woman's eggs are unusable, or she has a genetic disease that she does not want to run the risk of passing on.
- Donor insemination which involves the woman being artificially inseminated with donor sperm.
- Using a surrogate mother to carry the child.
Ethics
There are many ethical issues associated with infertility and its treatment, particular with regard to any treatment involving embryos.
Recent increases over the last few years in the number of multiple births (the best known being the McCaughey Septuplets) have also provoked concern; the greater the number of babies in a single pregnancy, the more likely they are to have a low birth weight, to be born prematurely and to consequently suffer medical problems.
Some religions (e.g. Catholicism) frown on some or all fertility treatments. Other issues include whether infertility treatment should be funded through health care.
Psychological impact
Infertility may have a profound psychological impact, with guilt playing a vital role. Partners may become more anxious to conceive, paradoxically increasing sexual dysfunction. Marital discord, especially when under pressure to take medical decisions, often develops in infertile couples. For those couples that cannot conceive at all, adoption is an option that is often frought with difficulties and disappointments.
Social impact
In many cultures, inability to conceive bears a stigma.
See also
Notes
External links
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