Infertility
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This article is about medical condition. For the soil, see Soil fertility.
Infertility
Specialty
Urology, gynecology
Frequency
113 million (2015)[1]
Infertility is the inability of a person, animal or plant to reproduce by natural means. It is usually not the natural state of a healthy adult, except notably among certain eusocial species (mostly haplodiploid insects).
In humans, infertility is the inability to become pregnant or carry a pregnancy to full term. There are many causes of infertility, including some that medical intervention can treat.[2] Estimates from 1997 suggest that worldwide about five percent of all heterosexual couples have an unresolved problem with infertility. Many more couples, however, experience involuntary childlessness for at least one year: estimates range from 12% to 28%." [3] 20-30% of infertility cases are due to male infertility, 20-35% are due to female infertility, and 25-40% are due to combined problems in both parts.[4] In 10-20% of cases, no cause is found.[4] The most common cause of female infertility is ovulatory problems which generally manifest themselves by sparse or absent menstrual periods.[5] Male infertility is most commonly due to deficiencies in the semen, and semen quality is used as a surrogate measure of male fecundity.[6]
Women who are fertile experience a natural period of fertility before and during ovulation, and they are naturally infertile for 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
[hide]
1 Definition
1.1 World Health Organization
1.2 United States
1.3 United Kingdom
1.4 Other definitions
1.5 Primary vs. secondary infertility
2 Effects
2.1 Psychological
2.2 Social
3 Causes
3.1 Immune infertility
3.2 Sexually transmitted infections
3.3 Genetic
3.4 Other causes
3.5 Females
3.6 Males
3.7 Combined infertility
3.8 Unexplained infertility
4 Diagnosis
5 Treatment
5.1 Medical treatments
5.1.1 In vitro fertilization
5.1.2 Intracytoplasmic sperm injection
5.2 Tourism
6 Epidemiology
7 Society and culture
7.1 Ethics
7.2 Developing countries
8 See also
9 References
10 Further reading
11 External links
Definition[edit]
"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.[7] Currently, female fertility normally peaks at age 24 and diminishes after 30, with pregnancy occurring rarely after age 50.[8] A female is most fertile within 24 hours of ovulation.[8] Male fertility peaks usually at age 25 and declines after age 40.[8] 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.[7] 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 Organization[edit]
The World Health Organization defines infertility as follows:[9]
“ 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 States[edit]
One 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:
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.[6]
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.
United Kingdom[edit]
In the UK, previous NICE guidelines defined infertility as failure to conceive after regular unprotected sexual intercourse for 2 years in the absence of known reproductive pathology.[10] 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.[11]
Other definitions[edit]
Researchers commonly base demographic studies on infertility prevalence on a five-year period.[12] 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 infertility[edit]
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 least 12 months, during which they have not used any contraceptives.[13] 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'.[14]
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.[14]
Thus the distinguishing feature is whether or not the couple have ever had a pregnancy which led to a live birth.
Effects[edit]
Psychological[edit]
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.[15]
Infertility may have psychological effects. Partners may become more anxious to conceive, increasing sexual dysfunction.[16] 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.[17] Emotional stress and marital difficulties are greater in couples where the infertility lies with the man.[18]
Older people with adult children appear to live longer.[19] 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.[19]
Social[edit]
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.[20]
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.[21]
Causes[edit]
Immune infertility[edit]
Antisperm antibodies (ASA) have been considered as infertility cause in around 10–30% of infertile couples.[22] 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, accidental 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.[22][23]
Sexually transmitted infections[edit]
Infections 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.[24][25]
Genetic[edit]
Main article: Genetics of infertility
A Robertsonian translocation in either partner may cause recurrent spontaneous abortions or complete infertility.[citation needed]
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.[26]
Other causes[edit]
Factors that can cause male as well as female infertility are:
DNA damage
DNA damage reduces fertility in female ovocytes, as caused by smoking,[27] other xenobiotic DNA damaging agents (such as radiation or chemotherapy)[28] or accumulation of the oxidative DNA damage 8-hydroxy-deoxyguanosine[29]
DNA damage reduces fertility in male sperm, as caused by oxidative DNA damage,[30] smoking,[27] other xenobiotic DNA damaging agents (such as drugs or chemotherapy)[31] or other DNA damaging agents including reactive oxygen species, fever or high testicular temperature[32]. The damaged DNA related to infertility manifests itself by the increased susceptibility to denaturation inducible by heat or acid [33] and/or by the presence of double-strand breaks that can be detected by the TUNEL assay. [34]
General factors
Diabetes mellitus,[35][36] thyroid disorders,[37] undiagnosed and untreated coeliac disease,[38][39][40][41] adrenal disease[42]
Hypothalamic-pituitary factors
Hyperprolactinemia
Hypopituitarism
The presence of anti-thyroid antibodies is associated with an increased risk of unexplained subfertility with an odds ratio of 1.5 and 95% confidence interval of 1.1–2.0.[43]
Environmental factors
Toxins such as glues, volatile organic solvents or silicones, physical agents, chemical dusts, and pesticides.[44][45] Tobacco smokers are 60% more likely to be infertile than non-smokers.[46]
German scientists have reported that a virus called Adeno-associated virus might have a role in male infertility,[47] though it is otherwise not harmful.[48] Other diseases such as chlamydia, and gonorrhea can also cause infertility, due to internal scarring (fallopian tube obstruction).[49][50][51]
Females[edit]
Further information: 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.[52]
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 and/or scar tissue. For example, endometriosis can cause infertility with the growth of endometrial tissue in the Fallopian tubes and/or around the ovaries. Endometriosis is usually more common in women in their mid-twenties and older, especially when postponed childbirth has taken place.[53]
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,[54] or her age as female fertility declines after the age of 30.[55]
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 (e.g. polycystic ovarian syndrome, PCOS, the leading reason why women present to fertility clinics due to anovulatory infertility.[56])
tubal blockage
pelvic inflammatory disease caused by infections like tuberculosis
age-related factors
uterine problems
previous tubal ligation
endometriosis
advanced maternal age
immune infertility
Males[edit]
Further information: 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.[57] Infertility 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.[58] Antisperm antibodies cause immune infertility. [22][23]
Combined infertility[edit]
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[edit]
Main article: Unexplained infertility
In the US, up to 20% of infertile couples have unexplained infertility.[59] 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.[60] However, a growing body of evidence suggests that epigenetic modifications in sperm may be partially responsible.[61][62]
Diagnosis[edit]
Main article: Fertility testing
If 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.[63]
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[edit]
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.[64] 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 men[65] 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 treatments[edit]
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), a course of ovarian stimulating medication 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 fertilization[edit]
IVF 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 injection[edit]
ICSI 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.
Tourism[edit]
Main article: Fertility tourism
Fertility tourism is the practice of traveling to another country for fertility treatments.[66] 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.
Epidemiology[edit]
Prevalence of infertility varies depending on the definition, i.e. on the time span involved in the failure to conceive.
Infertility rates have increased by 4% since the 1980s, mostly from problems with fecundity due to an increase in age.[67]
Fertility problems affect one in seven couples in the UK. Most couples (about 84%) who have regular sexual intercourse (that is, every two to three days) and who do not use contraception get pregnant within a year. About 92 out of 100 couples who are trying to get pregnant do so within two years.[68]
Women become less fertile as they get older. For women aged 35, about 94% who have regular unprotected sexual intercourse get pregnant after three years of trying. For women aged 38, however, only about 77%. The effect of age upon men's fertility is less clear.[68]
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.[69]
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.[70]
In Sweden, approximately 10% of couples wanting children are infertile.[71] 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.
Society and culture[edit]
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.[72] 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.[72]
Pixar's Up contains a depiction of infertility in an extended life montage that lasts the first few minutes of the film.[73]
Other individual examples are referred to individual subarticles of assisted reproductive technology
Ethics[edit]
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 (e.g. in the US) should be required 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; for example, the Roman Catholic Church views infertility as a calling to adopt or to use natural treatments (medication, surgery, and/or cycle charting) and members must reject assisted reproductive technologies.
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 licensing of fertility treatment under the EU Tissues and Cells directive [74]
Regulatory bodies are also found in Canada [75] and in the state of Victoria in Australia [76]
Developing countries[edit]
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Infertility is often not seen (by the West) as being an issue outside industrialized countries.[77] This is because of assumptions about overpopulation problems and hyper fertility in developing countries, and a perceived need for them to decrease their populations and birth rates.[78] The lack of health care and high rates of life-threatening illness (such as HIV/AIDS) in developing countries, such as those in Africa, are supporting reasons for the inadequate supply of fertility treatment options.[79] Fertility treatments, even simple ones such as treatment for STIs that cause infertility, are therefore not usually made available to individuals in these countries.[80]
Despite this, infertility has profound effects on individuals in developing countries, as the production of children is often highly socially valued and is vital for social security and health networks as well as for family income generation.[81] Infertility in these societies often leads to social stigmatization and abandonment by spouses.[82] Infertility is, in fact, common in sub-Saharan Africa. Unlike in the West, secondary infertility is more common than primary infertility, being most often the result of untreated STIs or complications from pregnancy/birth.[83]
Due to the assumptions surrounding issues of hyper-fertility in developing countries, ethical controversy surrounds the idea of whether or not access to assisted reproductive technologies should comprise a critical aspect of reproductive health or at least, whether or not the distribution and access of such technologies should be subject to greater equity.[84] However, as highlighted by Inhorn [85] the overarching conceptualisation of infertility, to a great extent, disguises important distinctions that can be made within a local context, both demographically and epidemiological and moreover, that these factors are highly significant in the ethics of reproduction. An important factor, argues Inhorn,[85] is the positioning of men within the paradigm of reproductive health, whereby because rates of general infertility mask differences between male and female infertility, men remain a largely invisible facet within the theorisation and discourse surrounding infertility, as well as the related treatments and biotechnologies. This is particularly significant given that male infertility accounts for more than half of all cases of infertility [86] and moreover, it is evident that the attitudes and behaviours of men have profound implications for the reproductive health of both individuals and couples.[87] For example, Inhorn [82] notes that when couples in Egypt are faced with seemingly intractable infertility problems - due to a range of family and societal pressures that centre around the place of children in constituting the gender identity of men and women - it is often the women who is forced to seek continued treatment; this continues to occur, even in known instances of male infertility and that the constant seeking of treatment frequently becomes iatrogenic for the women. Inhorn states that infertility often leads to “marital demise, physical violence, emotional abuse, social exclusion, community exile, ineffective and iatrogenic therapies, poverty, old age insecurity, increased risk of HIV/AIDS, and death”[79] Significantly, Inhorn demonstrates that this phenomenon can not simply be explained by a lack of knowledge, rather it occurs in a complex interaction between the centrality of children in the male gender identity as a symbol of maturity and the relative lack of power of women in Egyptian society, whereby they effectively become scapegoats for a culturally accepted narrative as a site of blame for the lack of childlessness. It should be emphasised that this is not simply an issue of “women oppressed by men” but rather, that men and women both share the burden of this narrative, but in different, unequal and highly complex ways. Therefore, while the notion that reproductive health is a ‘women’s issue’, may have powerful social currency, especially within popular discourse and indigenous systems of meaning, the reality of infertility suggests that medical and health paradigms have a significant part to play in challenging the validity of this entrenched belief . Moreover, the effectiveness of any therapeutic intervention, medical or otherwise will be contingent on such outcomes and has an important part to play in the alleviation of gendered suffering, especially the burden imposed on women, who continue to suffer disproportionately from the effects of infertility.
High costs may also be a factor and research by the Genk Institute for Fertility Technology, in Belgium, claimed a much lower cost methodology (about 90% reduction) with similar efficacy, which may be suitable for some fertility treatment.[88] At the 1994 United Nations International Conference on Population and Development (ICPD) in Cairo, the prevention and treatment of infertility was accepted into the program of action for reproductive healthcare. Infertility has shown to have a greater effect on developing nations than on birth rates or population control, but also on a social level as well. 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, fertility 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 fertility treatment options offered through the private sectors are often costly or not easily accessible. Additionally, counseling is considered an essential aspect of fertility treatment, and due to lack of education and resources such forms of therapy remain scarce as well. While quality fertility 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 birth and population rates are every reason to implement treatment options rather than reject them.[79]
See also[edit]
Advanced maternal age
Childlessness
Conception device
Inherited sterility in insects
Medical ethics
Oncofertility, fertility in cancer patients
Sterility
Surrogate marriage
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^ Jump up to: a b c Restrepo, B.; Cardona-Maya, W. (October 2013). "Antisperm antibodies and fertility association". Actas Urologicas Espanolas. 37 (9): 571–578. doi:10.1016/j.acuro.2012.11.003. ISSN 1699-7980. PMID 23428233.
^ Jump up to: a b Rao, Kamini (2013-09-30). Principles & Practice of Assisted Reproductive Technology (3 Vols). JP Medical Ltd. ISBN 9789350907368.
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^ Jump up to: a b Zenzes MT (2000). "Smoking and reproduction: gene damage to human gametes and embryos". Hum. Reprod. Update. 6 (2): 122–31. doi:10.1093/humupd/6.2.122. PMID 10782570.
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Jump up ^ Jangir RN, Jain GC (May 2014). "Diabetes mellitus induced impairment of male reproductive functions: a review". Curr Diabetes Rev. 10 (3): 147–57. doi:10.2174/1573399810666140606111745. PMID 24919656.
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Jump up ^ Andreeva P (2014). "[Thyroid gland and fertility] [Article in Bulgarian]". Akush Ginekol (Sofiia). 53 (7): 18–23. PMID 25675618.
Jump up ^ Tersigni C, Castellani R, de Waure C, Fattorossi A, De Spirito M, Gasbarrini A, Scambia G, Di Simone N (2014). "Celiac disease and reproductive disorders: meta-analysis of epidemiologic associations and potential pathogenic mechanisms". Hum. Reprod. Update. 20 (4): 582–93. doi:10.1093/humupd/dmu007. PMID 24619876. Physicians should investigate women with unexplained infertility, recurrent miscarriage or IUGR for undiagnosed CD. (...) CD can present with several non-gastrointestinal symptoms and it may escape timely recognition. Thus, given the heterogeneity of clinical presentation, many atypical cases of CD go undiagnosed, leading to a risk of long-term complications. Among atypical symptoms of CD, disorders of fertility, such as delayed menarche, early menopause, amenorrhea or infertility, and pregnancy complications, such as recurrent abortions, intrauterine growth restriction (IUGR), small for gestational age (SGA) babies, low birthweight (LBW) babies or preterm deliveries, must be factored. (...) However, the risk is significantly reduced by a gluten-free diet. These patients should therefore be made aware of the potential negative effects of active CD also in terms of reproductive performances, and of the importance of a strict diet to ameliorate their health condition and reproductive health.
Jump up ^ Lasa, JS; Zubiaurre, I; Soifer, LO (2014). "Risk of infertility in patients with celiac disease: a meta-analysis of observational studies". Arq Gastroenterol. 51 (2): 144–50. doi:10.1590/S0004-28032014000200014. PMID 25003268. Undiagnosed celiac disease is a risk factor for infertility. Women seeking medical advice for this particular condition should be screened for celiac disease. Adoption of a gluten-free diet could have a positive impact on fertility in this group of patients.(...)According to our results, non-diagnosed untreated CD constitutes a risk factor significantly associated with infertility in women. When comparing studies that enrolled patients previously diagnosed with CD, this association is not as evident as in the former context. This could be related to the effect that adoption of a gluten-free diet (GFD) may have on this particular health issue.
Jump up ^ Hozyasz, K (Mar 2001). "Coeliac disease and problems associated with reproduction". Ginekol Pol. 72 (3): 173–9. PMID 11398587. 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.
Jump up ^ Sher, KS; Jayanthi, V; Probert, CS; Stewart, CR; Mayberry, JF (1994). "Infertility, obstetric and gynaecological problems in coeliac sprue". Dig Dis. 12 (3): 186–90. doi:10.1159/000171452. PMID 7988065. 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.
Jump up ^ Reichman DE, White PC, New MI, Rosenwaks Z (Feb 2014). "Fertility in patients with congenital adrenal hyperplasia". Fertil Steril. 101 (2): 301–9. doi:10.1016/j.fertnstert.2013.11.002. PMID 24355046.
Jump up ^ van den Boogaard E, Vissenberg R, Land JA, van Wely M, van der Post JA, Goddijn M, Bisschop PH (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.
Jump up ^ Mendiola J, Torres-Cantero AM, Moreno-Grau JM, Ten J, Roca M, Moreno-Grau S, Bernabeu R (June 2008). "Exposure to environmental toxins in males seeking infertility treatment: a case-controlled study". Reprod Biomed Online. 16 (6): 842–50. doi:10.1016/S1472-6483(10)60151-4. PMID 18549695. [permanent dead link]
Jump up ^ Smith EM, Hammonds-Ehlers M, Clark MK, Kirchner HL, Fuortes L (February 1997). "Occupational exposures and risk of female infertility". J Occup Environ Med. 39 (2): 138–47. doi:10.1097/00043764-199702000-00011. PMID 9048320.
Jump up ^ Regulated fertility services: a commissioning aid – June 2009, from the Department of Health UK
Jump up ^ "Common virus linked to male infertility - 26 October 2001". New Scientist. 2001-10-26. Retrieved 2013-06-17.
Jump up ^ "Virus linked to infertility". BBC News. 2001-10-27. Retrieved 2010-04-02.
Jump up ^ "Infertility & STDs - STD Information from CDC". cdc.gov.
Jump up ^ Martha E. Wittenberg. "STDs That Can Cause Infertility". LIVESTRONG.COM.
Jump up ^ "5 Most Common Causes of Infertility". HowStuffWorks.
Jump up ^ About infertility & fertility problems Archived 29 August 2008 at the Wayback Machine. from the Human Fertilisation and Embryology Authority.
Jump up ^ Lessy, B.A. (2000) Medical management of endometriosis and infertility: 1089-1096.
Jump up ^ "Are You At Your Optimal Weight?". Chelsea Fertility NYC. Retrieved 6 March 2015.
Jump up ^ "Should I Freeze My Eggs". Information on Egg Freezing. Retrieved 6 March 2015.
Jump up ^ Balen AH, Dresner M, Scott EM, Drife JO (2006). "Should obese women with polycystic ovary syndrome receive treatment for infertility?". BMJ. 332 (7539): 434–5. doi:10.1136/bmj.332.7539.434. PMC 1382524  . PMID 16497735.
Jump up ^ Mishail, A., et al. (2009) Impact of a second semen analysis on a treatment decision making in the infertile man with varicocele: 1809-1811
Jump up ^ Avidor-Reiss T, Khire A, Fishman EL, Jo KH (Apr 2015). "Atypical centrioles during sexual reproduction". Front Cell Dev Biol. 3: 21. doi:10.3389/fcell.2015.00021. CS1 maint: Multiple names: authors list (link)
Jump up ^ Unexplained Infertility Background, Tests and Treatment Options Advanced Fertility Center of Chicago
Jump up ^ Altmäe S, Stavreus-Evers A, Ruiz JR, Laanpere M, Syvänen T, Yngve A, Salumets A, Nilsson TK (2010). "Variations in folate pathway genes are associated with unexplained female infertility". Fertility and Sterility. 94 (1): 130–137. doi:10.1016/j.fertnstert.2009.02.025. PMID 19324355.
Jump up ^ Kenneth I. Aston; Philip J. Uren; Timothy G. Jenkins; Alan Horsager; Bradley R. Cairns; Andrew D. Smith; Douglas T. Carrell (December 2015). "Aberrant sperm DNA methylation predicts male fertility status and embryo quality". Fertility and Sterility. 104 (6): 1388–1397. doi:10.1016/j.fertnstert.2015.08.019. PMID 26361204.
Jump up ^ Dada R, Kumar M, Jesudasan R, Fernández JL, Gosálvez J, Agarwal A (2012). "Epigenetics and its role in male infertility". J. Assist. Reprod. Genet. 29: 213–23. doi:10.1007/s10815-012-9715-0. PMID 22290605. CS1 maint: Multiple names: authors list (link)
Jump up ^ Infertility Help: When & where to get help for fertility treatment Archived 25 December 2008 at the Wayback Machine.
Jump up ^ "Failures (with some successes) of assisted reproduction and gamete donation programs". Human Reproduction Update. 19 (4): 354–365. 2013. doi:10.1093/humupd/dmt007. PMID 23459992.
Jump up ^ Edmund S. Sabanegh, Jr. (20 October 2010). Male Infertility: Problems and Solutions. Springer Science & Business Media. pp. 82–83. ISBN 978-1-60761-193-6.
Jump up ^ Paul McFedries. "fertility tourism - Word Spy". wordspy.com.
Jump up ^ Maheshwari, A. (2008). Human Reproduction. pp. 538–542.
^ Jump up to: a b "An error has occurred - NICE". nice.org.uk.
Jump up ^ HFEA Chart on reasons for infertility
Jump up ^ Khan, Khalid; Janesh K. Gupta; Gary Mires (2005). Core clinical cases in obstetrics and gynaecology: a problem-solving approach. London: Hodder Arnold. p. 152. ISBN 0-340-81672-4.
Jump up ^ Sahlgrenska University Hospital. (translated from the Swedish sentence: "Cirka 10% av alla par har problem med ofrivillig barnlöshet.")
^ Jump up to: a b chicagotribune.com Heartache of infertility shared on stage, screen By Colleen Mastony, Tribune reporter. 21 June 2009
Jump up ^ O'Neill Desmond (2009). "Up with ageing". BMJ. 339: b4215. doi:10.1136/bmj.b4215.
Jump up ^ "EUROPA". europa.eu. Archived from the original on 21 May 2008.
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Jump up ^ "Independent Theatre Association". Independent Theatre Association.
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^ Jump up to: a b c (Gerrits and Shaw 2010)
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^ Jump up to: a b (Inhorn 2003 p.1842)
Jump up ^ Gerais AS, Rushwan H (2013-03-25). "Infertility in Africa". Popul Sci. 12: 25–46. PMID 12319540.
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^ Jump up to: a b (2003 p.1839)
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Jump up ^ "IVF as cheap as £170, doctors claim". BBC News. 8 July 2013.
Inhorn MC (2003). "Global infertility and the globalization of new reproductive technologies: illustrations from Egypt". Social Science & Medicine. 56 (9): 1837–1851. doi:10.1016/s0277-9536(02)00208-3.
Lock, Margaret and Vinh-Kim Nguyen. 2011. An anthropology of biomedicine: Wiley-Blackwell.
Gerrits T, Shaw M (2010). "Biomedical infertility care in sub-Saharan Africa: a social science review of current practices, experiences and view points". Facts, Views & Vision in ObGyn. 2 (3): 194–207.
Further reading[edit]
Fertility: Assessment and Treatment for People with Fertility Problems. London: RCOG Press. 2004. ISBN 1-900364-97-2.
Anjani Chandra et al. (2013). Infertility and Impaired Fecundity in the United States, 1982-2010: Data from the National Survey of Family Growth. Hyattsville, Md.: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Health Statistics.
Pamela Mahoney Tsigdinos (2009). Silent Sorority: A Barren Woman Gets Busy, Angry, Lost and Found. BookSurge Publishing. p. 218. ISBN 1-4392-3156-7.
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ICD-10: N46, N97.0
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MeSH: D007246
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Wikimedia Commons has media related to Infertility.
RCOG clinical guidelines for infertility (concise guidelines)
Fertility: Assessment and Treatment for People with Fertility Problems, 2004 (extensive guidelines)
GeneReviews/NCBI/NIH/UW entry on CATSPER-Related Male Infertility
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ul
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a
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ul
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ul
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a
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ul
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li
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ul
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tr
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a
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a
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a
href title
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li
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a
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li
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a
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html
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li
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local
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li
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a
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li
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local
ul
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div
style
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scope class style
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html
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html
local
a
href title
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local
li
html
local
a
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local
li
html
local
a
href title
/wiki/Reproductive_endocrinology_and_infertility Reproductive endocrinology and infertility
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li
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a
href title
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li
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ul
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div
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td
class style
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tr
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th
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html
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a
href title
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a
class
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li
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local
a
href title
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local
li
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a
href title
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href title
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a
href title
/wiki/Sexual_health_clinic Sexual health clinic
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li
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ul
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local
li
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ul
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div
style
padding:0em 0.25em
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td
class style
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local
tr
style
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html
local
th
scope class style
row navbox-group width:1%
html
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a
href title
/wiki/One-child_policy One-child policy
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local
li
html
local
a
href title
/wiki/Family_planning_in_India Family planning in India
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local
li
html
local
a
href title
/wiki/Family_planning_in_Iran Family planning in Iran
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local
li
html
local
a
href title
/wiki/Contraception_in_the_Republic_of_Ireland Contraception in the Republic of Ireland
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local
li
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local
a
href title
/wiki/Family_planning_in_Pakistan Family planning in Pakistan
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local
li
html
local
a
href title
/wiki/Responsible_Parenthood_and_Reproductive_Health_Act_of_2012 Responsible Parenthood and Reproductive Health Act of 2012
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li
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local
a
href title
/wiki/Population_planning_in_Singapore Population planning in Singapore
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local
li
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href class title
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local
li
html
local
ul
html
local
li
html
local
a
href title
/wiki/Family_planning_in_the_United_States Family planning in the United States
html
local
a
href title
/wiki/Teenage_pregnancy_in_the_United_States Teenage pregnancy in the United States
html
local
li
html
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a
href title
/wiki/Birth_control_in_the_United_States Birth control in the United States
html
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li
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ul
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li
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ul
html
local
div
style
padding:0em 0.25em
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tr
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th
scope class style
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a
href title
/wiki/Birth_control_movement_in_the_United_States Birth control movement in the United States
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li
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a
href title
/wiki/History_of_condoms History of condoms
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th
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a
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local
li
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a
href title
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local
li
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a
href title
/wiki/Baby_bonus Baby bonus
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li
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a
href title
/wiki/Bachelor_tax Bachelor tax
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a
href title
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div
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View this template ;;background:none transparent;border:none;-moz-box-shadow:none;-webkit-box-shadow:none;box-shadow:none;
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/wiki/Template:Assisted_reproductive_technology Template:Assisted reproductive technology
html
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li
class
nv-view
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title style
Discuss this template ;;background:none transparent;border:none;-moz-box-shadow:none;-webkit-box-shadow:none;box-shadow:none;
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Edit this template ;;background:none transparent;border:none;-moz-box-shadow:none;-webkit-box-shadow:none;box-shadow:none;
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class href
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class
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a
href title
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div
id style
Assisted_reproductive_technology font-size:114%;margin:0 4em
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a
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li
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a
href title
/wiki/Male_infertility Male infertility
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local
li
html
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a
href title
/wiki/Fertility_clinic Fertility clinic
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li
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a
href title
/wiki/Fertility_testing Fertility testing
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a
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/wiki/Fertility_tourism Fertility tourism
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style
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navbox-list navbox-odd hlist text-align:left;border-left-width:2px;border-left-style:solid;width:100%;padding:0px
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tr
style
display: none;
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a
href title
/wiki/Fertility_medication Fertility medication
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th
scope class style
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a
href class title
/wiki/Estrogen_antagonist mw-redirect Estrogen antagonist
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a
href title
/wiki/Aromatase_inhibitor Aromatase inhibitor
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/wiki/Clomifene Clomifene
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ul
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a
href title
/wiki/Follicle-stimulating_hormone Follicle-stimulating hormone
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a
href title
/wiki/Gonadotropin-releasing_hormone_agonist Gonadotropin-releasing hormone agonist
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a
href title
/wiki/Gonadotropin Gonadotropin
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a
href title
/wiki/Menotropin Menotropin
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ul
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a
href title
/wiki/Human_chorionic_gonadotropin#Use_as_medication Human chorionic gonadotropin
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tr
style
display: none;
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a
href title
/wiki/In_vitro_fertilisation In vitro fertilisation
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br
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th
scope class style
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html
local
a
href title
/wiki/Assisted_zona_hatching Assisted zona hatching
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li
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a
href title
/wiki/Autologous_endometrial_coculture Autologous endometrial coculture
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local
li
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a
href class title
/wiki/Cytoplasmic_transfer mw-redirect Cytoplasmic transfer
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a
href title
/wiki/Embryo_transfer Embryo transfer
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li
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a
href class title
/wiki/Gestational_carrier mw-redirect Gestational carrier
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local
li
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a
href title
/wiki/In_vitro_maturation In vitro maturation
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li
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a
href title
/wiki/Intracytoplasmic_sperm_injection Intracytoplasmic sperm injection
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li
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a
href title
/wiki/Oocyte_selection Oocyte selection
html
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li
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a
href title
/wiki/Controlled_ovarian_hyperstimulation Controlled ovarian hyperstimulation
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/wiki/Preimplantation_genetic_diagnosis Preimplantation genetic diagnosis
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/wiki/Snowflake_children Snowflake children
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href title
/wiki/Transvaginal_oocyte_retrieval Transvaginal oocyte retrieval
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href title
/wiki/Zygote_intrafallopian_transfer Zygote intrafallopian transfer
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padding:0em 0.25em
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tr
style
display: none;
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th
scope class style
row navbox-group width:1%
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a
href title
/wiki/Artificial_insemination Artificial insemination
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a
href title
/wiki/Sperm_donation Sperm donation
html
local
li
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local
ul
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local
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a
href title
/wiki/Cryopreservation Cryopreservation
html
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a
href title
/wiki/Embryo_cryopreservation Embryo cryopreservation
html
local
li
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a
href title
/wiki/Oocyte_cryopreservation Oocyte cryopreservation
html
local
li
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a
href title
/wiki/Ovarian_tissue_cryopreservation Ovarian tissue cryopreservation
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a
href title
/wiki/Semen_cryopreservation Semen cryopreservation
html
local
li
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ul
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li
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a
href title
/wiki/Gamete_intrafallopian_transfer Gamete intrafallopian transfer
html
local
li
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a
href title
/wiki/Reproductive_surgery Reproductive surgery
html
local
a
href title
/wiki/Vasectomy_reversal Vasectomy reversal
html
local
li
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local
ul
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local
li
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local
a
href title
/wiki/Semen_collection Semen collection
html
local
li
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local
a
href title
/wiki/Sex_selection Sex selection
html
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li
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a
href title
/wiki/Surrogacy Surrogacy
html
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ul
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local
div
style
padding:0em 0.25em
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local
td
class style
navbox-list navbox-even hlist text-align:left;border-left-width:2px;border-left-style:solid;width:100%;padding:0px
html
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tr
style
display: none;
html
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th
scope class style
row navbox-group width:1%
html
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a
href title
/wiki/Donor_registration Donor registration
html
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li
html
local
a
href title
/wiki/Donor_Sibling_Registry Donor Sibling Registry
html
local
li
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local
a
href title
/wiki/Egg_donation Egg donation
html
local
li
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a
href title
/wiki/Embryo_donation Embryo donation
html
local
li
html
local
a
href title
/wiki/Sperm_donation Sperm donation
html
local
li
html
local
a
href title
/wiki/Sperm_bank Sperm bank
html
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li
html
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a
href title
/wiki/Ova_bank Ova bank
html
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ul
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div
style
padding:0em 0.25em
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local
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class style
navbox-list navbox-odd hlist text-align:left;border-left-width:2px;border-left-style:solid;width:100%;padding:0px
html
local
tr
style
display: none;
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th
scope class style
row navbox-group width:1%
html
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a
href title
/wiki/Accidental_incest Accidental incest
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local
li
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a
href title
/wiki/Genetic_diagnosis_of_intersex Genetic diagnosis of intersex
html
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li
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href title
/wiki/Religious_response_to_assisted_reproductive_technology Religious response to assisted reproductive technology
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href class title
/wiki/Mitochondrial_donation mw-redirect Mitochondrial donation
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style
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class style
navbox-list navbox-even hlist text-align:left;border-left-width:2px;border-left-style:solid;width:100%;padding:0px
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tr
style
display: none;
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th
scope class style
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a
href title
/wiki/Sperm_donation#Fictional_representation Sperm donation
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i
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li
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/wiki/Reproduction_and_pregnancy_in_speculative_fiction Reproduction and pregnancy in speculative fiction
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navbox-list navbox-odd hlist text-align:left;border-left-width:2px;border-left-style:solid;width:100%;padding:0px
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View this template ;;background:none transparent;border:none;-moz-box-shadow:none;-webkit-box-shadow:none;box-shadow:none;
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/wiki/Template:Female_diseases_of_the_pelvis_and_genitals Template:Female diseases of the pelvis and genitals
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class
nv-view
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Discuss this template ;;background:none transparent;border:none;-moz-box-shadow:none;-webkit-box-shadow:none;box-shadow:none;
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/wiki/Template_talk:Female_diseases_of_the_pelvis_and_genitals Template talk:Female diseases of the pelvis and genitals
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/wiki/Category:Wikipedia_articles_needing_clarification_from_September_2016 Category:Wikipedia articles needing clarification from September 2016
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/wiki/Category:All_Wikipedia_articles_needing_clarification Category:All Wikipedia articles needing clarification
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/wiki/Portal:Contents Guides to browsing Wikipedia
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/wiki/Special:Random Load a random article [ctrl-alt-x] x
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https://donate.wikimedia.org/wiki/Special:FundraiserRedirector?utm_source=donate&utm_medium=sidebar&utm_campaign=C13_en.wikipedia.org&uselang=en Support us
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/wiki/Wikipedia:Community_portal About the project, what you can do, where to find things
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/wiki/Special:RecentChanges A list of recent changes in the wiki [ctrl-alt-r] r
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/w/index.php?title=Infertility&oldid=836413300 Permanent link to this revision of the page
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/w/index.php?title=Infertility&action=info More information about this page
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/w/index.php?title=Special:CiteThisPage&page=Infertility&id=836413300 Information on how to cite this page
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https://ta.wikipedia.org/wiki/%E0%AE%AE%E0%AE%B2%E0%AE%9F%E0%AF%8D%E0%AE%9F%E0%AF%81%E0%AE%A4%E0%AF%8D%E0%AE%A4%E0%AE%A9%E0%AF%8D%E0%AE%AE%E0%AF%88 மலட்டுத்தன்மை – Tamil ta ta interlanguage-link-target
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