Infertility 08

What is infertility ?

Infertility is the inability for a couple to have a child after one year of unprotected sexual intercurse.
For women, this means that they cannot conceive, while for men this consists in an inability to impregnate. One of every seven couples have difficulties conceiving. But a great majority, 85% of couples, will conceive naturally in one year if they have regular unprotected intercurse. Over 100 couples trying to conceive naturally:

• 20 will conceive within a month,
• 70 will conceive within six months,
• 85 will conceive within one year,
• 90 will conceive within 18 months, and
• 95 will conceive within two years.

Then people will be diagnosed as infertile if they have not managed to have a baby after two years of trying. If they have never conceived a child, it is known as primary infertility.

Secondary infertility is when people have had one or more babies in the past, but they are having difficulties conceiving again.

What is the difference between infertility and sterility?

These two words are often used as synonyms, but don't mean exactly the same.
Infertility is the inability to conceive, which may be because of different internal or external factors, that might not be related to the reproductive track. These factors, such as the age, the sexual transmitted diseases(STDs), etc., will be explained precisely in the article below.
Sterility is defined when the person is unable to reproduce sexually, which may be caused because of abnormalities in the reproductive system. These abnormalities can be for example the lack of sperm production or if the ovulation cannot occur. In the contrary, to pronounce a diagnostic of an infertility, the sperm must be present, the fallopian tubes must be open and the ovulation must be able to occur.

What are the causes of infertility and what are the different symptoms?

There are many causes of infertility. Below are listed some main ones :

• Women

• age : the likelihood to be pregnant reduce with age. (see Annex 6)
• sexually transmitted diseases: the Pelvic Inflammatory Disease (PID): It is a general term for infections and inflammations, caused most of the time by bacteria such as gonorrhea and chlamydia, in the different reproductive regions (ovaries, fallopian tubes or uterus). Infections cause damages that cause infertility
• genital damages/abnormalities: endometriosis is one of the most common: the endometriosis is characterized by abnormal locations of the uterine mucous membrane (ovaries, horns). The endometriosis causes in organism the secretion of disadvantageous substances to conception and to development of the embryo and can therefore be responsible for an infertility. Fibroid or non-cancerous tumor block the fallopian tubes that does not allow the egg to grow and create infertility.
• anovulatory cycle (no ovulation)
• anorexia or bulimia: the both disrupt menstrual cycles and thyroid levels that does not allow normal ovulation
• smoking, drugs, alcohol: they may affect ovarian cycles, cervical mucus, and foetus

• Men:

• smoking, drugs, alcohol
• overheating of the testicles caused by exercise, hot water, tight clothing, excessive sitting (truck drivers) and other conditions and situations
• sexually transmitted diseases
• use of some medications (antihypertensives, antidepressants, male hormones, cancer treatment)
• genital damages/abnormalities
• low sperm count (the most common cause in men infertility)
• ejaculatory disfunction

Symptoms There are no specific symptoms of infertility. As said above, infertility is the fact of not becoming pregnant after one year of unprotected intercourse. Only a exam can make the diagnostic an infertility.

(See Annex 1 and 2)

What are the different solutions for these infertile people and the issues ?

There are two solutions for infertile people:

• Assisted conception techniques
• Adoption

Assisted conception technics

There are several assisted conception technics, but the two main ones are In Vitro Fertilization (IVF) and Intrauterine Insemination (IUI), which are explained below. Intra-cytoplasmic Sperm Injection and Intra-Cytoplasmic Morphologically-selected Sperm Injection (IMSI)are also assisted conception techniques since they are very similar to IVF and IUI we only mention them.

1. In Vitro Fertilization classical method

In Vitro Fertilization (IVF) was developed in the 1970's. First the women are given fertility drugs to stimulate the production of eggs, to increase the chances of success and, they (the eggs) would be surgically removed from the ovaries. After the removal, the women are given hormones to prepare them to pregnancy. The eggs are fertilized with the sperm in a laboratory and then the embryos are implanted in the mother's uterus.

2. Intrauterine insemination
Intrauterine insemination (IUI) is another method, which involves the introduction of selected sperm cells directly into the uterus. This increases the number of healthy sperm cells that may reach the fallopian tubes and fertilize an egg. (Sperm washing, selection of healthy and strong sperm cells, can be used in IVF techniques also.) IUI is generally accompanied by ovarian stimulation (drugs and hormones) in order to increase the egg production and improve the rate of success. Sometimes egg selection may be needed too, to have only the healthiest ones.
This means that the parents can decide to have a boy or a girl.


3. Intra-cytoplasmic Sperm Injection'
4. Intra-Cytoplasmic Morphologically-selected Sperm Injection (IMSI)

What are the risks ?

They are many risks with assisted conception techniques. For women undergoing IVF there can be some side effects from fertility drugs or eggs retrieval. There are two main side effects for women:

1.Ovarian hyper-stimulation syndrome (OHSS)

OHSS is a non-common but a known side effect of IVF. This happens when the fertility drugs are too successful and the ovaries cannot deal with a so high number of eggs. If the overstimulation is severe it can produce blood clots and sometimes ovaries damage.

2.Multiple births

This occurs because more than one embryo is put back in the womb with IVF, in order to increase the chances of success. Multiple births increase problems during pregnancy or labour and the risks of cesarean Morever, this can be dangerous for the woman's physical and mental health. Because of that the NICE (National Institute for Clinical Excellence) recommends a maximum of two embryos are put back into the womb during the treatment.

What are the chances of success?

The success rate of IVF is highly determined to the age of the woman undergoing the treatment. Younger women tend to have healthier eggs which increase the chances of success.

Here are some statistics from the UK :

28% for women who are under 35 years of age,
24% for women who are between 35-37 years of age,
18% for women who are between 38-39 years of age, and
11% for women who are between 40-42 years of age.

Some ethical questions

Since they are not natural, these technics are controverted, and some ethical questions are asked.

IVF is criticized because of the person hood question ; during the process, several pre-embryos are destroyed, but some say that having an individual genetic code means that they have the right to live, and destroying them is murdering. The debate is about "when can we consider the embryo as a human being ?" ; some say this is at conception, others after 12 weeks of gestation.
Moreover, this technology being not perfect, there are risks for the future baby to have birth defects (low birth weight, preterm birth), and the parents who choose IVF are sometimes criticised because their choice could be the cause of the eventual infirmity or problems for their offspring . It also induces questions about contraception and at different moments they acts during process of fertilization and the conception of a baby.

see also Contraception Ethics [[1]]

Adoption

Lastly, the adoption method is proposed when all the solutions above didn't work.

Adoption is a great decision to take but it is even greater when it is taken as a solution to infertility. Parents who will adopt are usually confronted to the same problems, fears, this are some of infertile people :

-Deal with the fact that you are not biologically the real parent
-Getting Pregnant after adopting ( a good or a bad thing?)
-Does Adoption means losing the hope of having a biological child?

Prevention

One important step when trying to get pregnant is to have a healthy life. This means having a balanced diet, women who are under or overweight ovulate less regularly or not at all. So having a balanced diet in order to have a healthy weight is quite important.
Then you should stop smoking if you are trying to get pregnant, smoking is linked with babies with a low birth weight. Same with alcohol because studies have shown that alcohol affects seriously damage a baby's development. Drugs have also a bad effect on fertility and will damage the baby's development if you get pregnant.
Finally you should do regularly medical tests. Make sure that you don't have any sexually transmitted infections (STIs, infections, such as chlamydia, may not have any symptoms, but can cause infertility if left untreated. Indeed most of infections and diseases can be avoid if they are quickly spotted.

References

http://infertility.adoption.com/ http://www.palmbeachfertility.com/pbf-faqs.htm http://www.womenhealthfocus.com/women-health-articles/information-on-infertility.php
http://www.nhs.uk/Conditions/Infertility/Pages/Introduction.aspx?url=Pages/What-is-it.aspx
http://www.nhs.uk/Conditions/IVF/Pages/Introduction.aspx?url=Pages/Overview.aspx
http://pedsinreview.aappublications.org/cgi/content/full/20/8/e28
http://www.101lifestyle.com/health/infertility/infertility.html
http://www.chu-toulouse.fr/-l-infertilite-
http://www.ncbi.nlm.nih.gov/pubmed/12268268
http://www.emedicinehealth.com/infertility/article_em.htm
wordnet.princeton.edu/perl/webwn
http://www.andrologia.org/eng/maschile_engl.htm

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