What is infertility?

• not being able to get pregnant after at least one year of trying.

• Women who are able to get pregnant but then have repeat miscarriages are also said to be infertile.

• About 12 percent of women (7.3 million) in the United States aged 15-44 had difficulty getting pregnant or
carrying a baby to term in 2002, according to the National Center for Health Statistics of the Centers for
Disease Control and Prevention.

• One-third of cases is infertility due to the woman (female factors).

• One third of cases, infertility is due to the man (male factors).

• The remaining cases are caused by a mixture of male and female factors or by unknown factors.

There are two types of infertility,

• primary infertility which is defined as neither partner having achieved a pregnancy.

• secondary infertility which is defined as when a pregnancy has previously been achieved by the couple but
regular, unprotected intercourse has not resulted in a second pregnancy.

Causes of infertility

• Environmental and occupational factors

Certain environmental factors may cause men to produce a less concentrated sperm, according to a
government report. Exposure to lead, other heavy metals, and pesticides has also been associated with male
infertility. Many other factors, such as excessive heat exposure, microwave radiation, ultrasound, and other
health hazards, are more controversial as to whether they induce infertility.

• Toxic effects related to tobacco, marijuana, and other drugs

Smoking may cause infertility in both men and women. In experimental animals, nicotine has been shown
to block the production of sperm and decrease the size of a man's testicles. In women, tobacco changes the
cervical mucus, thus affecting the way sperm reach the egg.

Marijuana may disrupt a woman's ovulation cycle (release of the egg). Marijuana use affects men by
decreasing the sperm count and the quality of the sperm.Heroin, cocaine, and crack cocaine use induces
similar effects but places the user at increased risk for PID and HIV infection associated with risky sexual
behavior.In women, the effects of alcohol are related more to severe consequences for the fetus.
Nevertheless, chronic alcoholism is related to disorders in ovulation and, therefore, interferes with fertility.
Alcohol use by men interferes with the synthesis of testosterone and has an impact on sperm concentration.
Alcoholism may delay a man's sexual response and may cause impotence (unable to have an erection).

• Exercise
 Exercise should be encouraged as part of normal activities. However, too much exercise is dangerous,
especially for long-distance runners. For women, it may result in disruption of the ovulation cycle, cause no
menstrual periods, or result in miscarriages (loss of pregnancy). In men, overexercise may cause a low
sperm count.

• Inadequate diet associated with extreme weight loss or gain

Obesity has an impact on infertility only when a woman's weight reaches extremes.Weight loss with
anorexia or bulimia can create problems with menstrual periods (no periods) and thyroid levels, thus
disrupting normal ovulation.

• Age

A woman becomes less fertile as she ages into her fifth decade of life (age 40-49 years). Among men, as
they age, levels of testosterone fall, and the volume and concentration of sperm change.Healthy couples

younger than 30 years who have regular sexual intercourse and use no birth control methods have a 25-30%
chance of achieving pregnancy each month. A woman's peak fertility is early in the third decade of life. As
a woman ages beyond 35 years (and particularly after age 40 years), the likelihood of becoming pregnant is
less than 10% .

Overcoming infertility

Treatment for men:

• General sexual problems. Addressing impotence or premature ejaculation can improve fertility. Treatment
for these problems often is with medication or behavioral approaches.

• Lack of sperm. If a lack of sperm is suspected as the cause of a man's infertility, surgery or hormones to
correct the problem or use of assisted reproductive technology is sometimes possible. For example,
varicocele can often be surgically corrected. For blockage of the ejaculatory duct or in the case of
retrograde ejaculation, sperm can be taken directly from the testicles or recovered from the bladder and
injected into an egg in the laboratory setting.

Treatment for women

Fertility drugs are the main treatment for women who are infertile due to ovulation disorders. These medications
regulate or induce ovulation. In general, they work like natural hormones — such as follicle-stimulating hormone
(FSH) and luteinizing hormone (LH) — to trigger ovulation.

• Surgery
Depending on the cause, surgery may be a treatment option for infertility. Blockages or other problems in
the fallopian tubes can often be surgically repaired. Laparoscopic techniques allow delicate operations on
the fallopian tubes. Infertility due to endometriosis often is difficult to treat. Although hormones such as
those found in birth control pills are effective for treating endometriosis and relieving pain, they haven't
been useful in treating infertility. If you have endometriosis, your doctor may treat you with ovulation
 therapy, in which medication is used to stimulate or regulate ovulation, or in vitro fertilization, in which the
egg and sperm are joined in the laboratory and transferred to the uterus.

• Assisted reproductive technology (ART)

ART has revolutionized the treatment of infertility. Each year thousands of babies are born in the United
States as a result of ART. Medical advances have enabled many couples to have their own biological child.
An ART health team includes physicians, psychologists, embryologists, laboratory technicians, nurses and
allied health professionals who work together to help infertile couples achieve pregnancy.

The most common forms of ART include:

 In vitro fertilization (IVF). This is the most effective ART technique. IVF involves retrieving mature eggs
from a woman, fertilizing them with a man's sperm in a dish in a laboratory and implanting the embryos in the
uterus three to five days after fertilization. IVF often is recommended when both fallopian tubes are blocked. It's
also widely used for a number of other conditions, such as endometriosis, unexplained infertility, cervical factor
infertility, male factor infertility and ovulation disorders. IVF increases your chances of having more than one
baby at a time because multiple fertilized eggs are often implanted into your uterus so that there is a greater
chance one will develop into a baby. IVF also requires frequent blood tests and daily hormone injections.

 Electric or vibratory stimulation to achieve ejaculation. Electric or vibratory stimulation brings about
ejaculation to obtain semen. This procedure can be used in men with a spinal cord injury who can't otherwise
achieve ejaculation.

 Surgical sperm aspiration. This technique involves removing sperm from part of the male reproductive
tract, such as the epididymis, vas deferens or testicle. This allows retrieval of sperm if the ejaculatory duct is
blocked.

 Intracytoplasmic sperm injection (ICSI). This technique consists of a microscopic technique

(micromanipulation) in which a single sperm is injected directly into an egg to achieve fertilization in conjunction
with the standard IVF procedure. ICSI has been especially helpful in couples who have previously failed to
achieve conception with standard techniques. For men with low sperm concentrations, ICSI dramatically
improves the likelihood of fertilization.

 Assisted hatching. This technique attempts to assist the implantation of the embryo into the lining of the
uterus.

ART works best when the woman has a healthy uterus, responds well to fertility drugs, and ovulates naturally or
uses donor eggs. The man should have healthy sperm, or donor sperm should be available. The success rate of ART
is lower after age 35.

Complications of treatment
Certain complications exist with the treatment of infertility. These include:

 Multiple pregnancy. The most common complication of ART is multiple pregnancy. The number of
quality embryos kept and matured to fetuses and birth ultimately is a decision made by the couple. If too many
 babies are conceived, the removal of one or more fetuses (multifetal pregnancy reduction) is possible to improve
survival odds for the other fetuses.

 Bleeding or infection. As with any invasive procedure, there is a risk of bleeding or infection with assisted
reproductive technology.

 Low birth weight. The greatest risk factor for low birth weight is a multiple pregnancy. In single live
births, there may be a greater chance of low birth weight associated with ART.

 Birth defects. There is some concern about the possible relationship between ART and birth defects. More
research is necessary to confirm this possible connection. Weigh this factor if you're considering whether to take
advantage of this treatment. ART is the most successful fertility-enhancing therapy to date.

 Contraception

 Birth control refers to a set of intentional behaviors, medications or devices followed in order to
deliberately prevent or reduce the likelihood of impregnation. Birth control is an essential component of family
planning. Strategies and devices which are intended to reduce the risk of fertilization of an ovum by a
spermatozoon can be referred to as contraception.

1)Condoms-

act as a mechanical barrier; they prevent pregnancy and reproductive tract infections by stopping sperm from going
into the vagina. They should be placed on the penis before it enters a partner's vagina. Condoms are made of latex
(often called "rubbers"), polyurethane (plastic), or natural membranes (often called "skins" and made from the
intestine of sheep). Polyurethane condoms may be used by couples when either partner is allergic to latex. Condoms
are one of the only methods of contraception that are also effective for use with oral sex, sex toys and anal sex.
Condoms resemble a long thin deflated balloon. Male condoms are considered to be between 85-98% effective.
Among typical couples, about 15% will experience an accidental pregnancy in the first year. If condoms are used
consistently and correctly, about 2% will become pregnant over the course of an entire year.

2)Spermicides

are substances that kill sperm. Usually they are used to increase the effectivity of contraceptive barrier methods
such as diaphragms, condoms, and cervical caps as they are only somewhat effective alone. Various contraceptive
sponges use spermicides.

3) Diaphragm
 is a rubber dome-shaped device which the woman places over her cervix (opening to the uterus). A diaphragm is
held in place by a woman's vaginal muscles. When combined with use of a spermicide (a gel which kills sperm), a
diaphragm can provide a successful barrier to prevent sperm from entering the uterus (womb).

4)Pills
Combined birth control pills contain two hormones, an estrogen and a progestin. They work by stopping ovulation
(release of an egg) and by making the lining of the uterus thinner. Among typical couples who initiate use of
combined pills about 8% will experience an accidental pregnancy in the first year. This is because sometimes pills
are not used correctly. If pills are used consistently and correctly, just three in 1,000 women will become pregnant.
Use a backup contraceptive for the first 7 days of your first pack of pills. You do not need to use a backup method
during the hormone-free days of your pill pack.

5)Intrauterine Device

An IUD is a small, flexible T-shaped object that is placed in the uterus during a physicians visit to protect against
pregnancy. IUDS are one of the most commonly used birth control methods around the world. IUDS are extremely
effective at preventing pregnancy (99.2-99.9% effective), but provide no protection against sexually transmitted
infections

6)Sterilization
Tubal ligation - sterilization is an operation which blocks the tubes carrying a woman's egg to her uterus. This is the
most commonly used method of birth control worldwide. Often the operation is accomplished through using a
laparoscope. This instrument is inserted through a small incision in the abdomen. The tubes are visualized so the
surgeon can place rings, apply clips or burn the tubes. After this operation your eggs will have no way to get to your
uterus, and the man's sperm will have no way to get to your egg. The effectiveness of tubal sterilization differs
slightly by the method of sterilization and by the woman's age. This operation should be considered permanent.

Vasectomy is the sterilization for men which is an operation which blocks the tubes (called the vas deferens) that
carry a man's sperm to the outside. It is performed in an office or clinic and involves cutting and tying off or
cauterizing (burning) the vas deferens - the tubes that transport sperm out of the scrotum (sac) from the testicles.
This operation should be considered permanent. You should be certain you want no more children and will not
change your mind.

7)Rhythm method

A married couple avoid engaging in copulation during the woman’s fertile period, that is , the period when the
woman is about to ovulate. It is most likely that an ovum is present in the fallopian tube. A married couple should
only gace sexual intercourse during the safe period which , theoretically , will not result in pregnancy.

Moral issues related to the application of reproductive technologies

(a) Should humans clone?

(b) Is It wrong to destroy the extra embryos in IVF?

(c) The use of sperms and ova from donors raises legal and moral issues on the parentage of the child.
.