INTRODUCTION

Infertility is a condition with psychological, economic, medical implications resulting in trauma,

stress, particularly in a social set-up like ours, with a strong emphasis on childbearing.
According to the International Committee for Monitoring Assisted Reproductive Technology,
World Health Organization (WHO), infertility is a disease of reproductive system defined by
failure to achieve the clinical pregnancy after 12 months or more of regular unprotected sexual
intercourse.
Infertility has become ominous problem, on an average, about 10% of all couples face difficulty
in starting a family, infertility can affect anyone and has many causes and this creates a feeling of
great personal failure, particularly in India where religious and socio-economic traditions have
made it almost imperative for everyone to have children.
Infertility is a problem that affects both men and women of reproductive ages in all areas of the
world. Although estimates of how common infertility is are not very accurate and vary from
region to region, some 8 to 15 per cent of couples experience problems in achieving a pregnancy
during their reproductive lives. This represents some 50 to 80 million people, and it is well
recognized that infertility can cause considerable personal suffering and disruption to family life.
Some studies of South-eastern Nigeria, have demonstrated a 65% and 35% prevalent rate for
primary and secondary infertility respectively. Causes of infertility can include ovulatory
disorders, endometriosis, low sperm count or low testosterone. The risk of infertility increases as
one age. Many treatment options are available for people with infertility. Infertility affects men
and people assigned male at birth (AMAB) and women and people assigned female (AFAB) at
birth equally. Infertility is very common. In the United States, 1 in 5 women between 15 and 49
years old struggle with primary infertility and about 1 in 20 women struggle with secondary
infertility. Approximately 48 million couples live with infertility around the world.

Infertility can be divided into primary infertility and secondary infertility. In men primary
infertility is the case, when the man has never impregnated a woman, while secondary infertility
applies when the man has some time impregnated a woman, even if the women are not the
partner in the present couple.
The male infertility can be complete or partial termed as subfertility. A significant association
had been found between impaired semen quality including sperm count, motility and
morphology. It possibly due to reduced number of spermatozoa (oligozoospermia), reduced
sperm motility (asthenozoospermia), reduced sperm vitality (necrozoospermia), abnormal sperm
morphology (teratozoospermia) or any combination of these. Majority of the cases of sub-
fertility are caused by an intrinsic testicular disorder.

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Should I use bullets here?
WHAT IS INFERTILITY?
Infertility is a condition of your reproductive system that causes people to be unable to get
pregnant (conceive).

TYPES OF INFERTILTY

TYPES OF INFERTILITY IN WOMEN:

Primary infertility: the woman has never conceived despite cohabitation, regular unprotected
sexual intercourse and exposure to pregnancy for 2 years.
Secondary infertility: the woman has conceived previously but is subsequently unable to
conceive, i.e. the woman can’t get pregnant again after having at least one successful pregnancy.
Pregnancy wastage: the woman is able to conceive but unable to produce a live birth.

TYPES OF INFERTILITY IN MEN:

In men primary infertility is the case, when the man has never impregnated a woman, while
secondary infertility applies when the man has some time impregnated a woman, even if the
women are not the partner in the present couple.

Subfertility: Clinicians define this as the difficulty experienced by some couples, both of whom
may have reduced fertility, jointly to conceive.

Unexplained infertility: Fertility testing hasn’t found a reason that a person or couple is unable
to get pregnant.

Getting pregnant involves several steps:

 Your brain must produce reproductive hormones that control ovarian function.
 An egg must mature in your ovary.
 Your ovary must release an egg (ovulation).
 Your fallopian tube must pick up the egg.

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  Sperm must travel up your vagina and through the uterus to your fallopian tube.
 The sperm fertilizes the egg to create an embryo.
 The embryo travels through your fallopian tube to the uterus where it implants.

A pregnancy can’t occur if anything in this process doesn’t happen.

Symptoms and Causes

What are signs of infertility?

The main sign of infertility is being unable to get pregnant after six months or one year of
regular, unprotected sex. One may not have any other symptoms. But some people may show
physical symptoms such as:

 Pelvic or abdominal pain.

 Irregular vaginal bleeding, irregular periods or no periods.
 Penile disorders or issues with ejaculation.

What causes infertility?

While causes of infertility vary, studies show that:

33% of infertility involves the partner with a uterus and ovaries.

33% of infertility involves the partner with a penis and testicles.

33% of infertility involves both partners or is unexplained.

Twenty-five percent of infertile couples have more than one factor that contributes to their
infertility.

Infertility causes

Some causes of infertility affect just one partner, while others affect both partners. Risk factors
for infertility include:

 Age, particularly being in your late 30s or 40s. For men, age begins affecting fertility
closer to 50.
 Eating disorders, including anorexia nervosa and bulimia.
 Excessive alcohol consumption.
 Exposure to environmental toxins, such as chemicals, lead and pesticides.
 Over-exercising.
 Radiation therapy or chemotherapy.
 Sexually transmitted infections (STIs).
 Smoking and using tobacco products. (This behavior plays a role in about 13% to 15% of
infertility cases.)

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  Substance abuse.
 Having obesity or being underweight.
 Abnormalities of the hormone-producing centers of your brain (hypothalamus or
pituitary).
 Chronic conditions and diseases.

Infertility causes for women and people assigned female at birth

Ovulation disorders are the most common cause of infertility in people with ovaries. Ovulation is
the process in which your ovary releases an egg to meet sperm for fertilization.

These factors can contribute to female infertility:

 Endometriosis.
 Structural abnormalities of your vagina, uterus or fallopian tubes.
 Autoimmune conditions like celiac disease or lupus.
 Kidney disease.
 Pelvic inflammatory disease (PID) which can be caused by a microorganism named
chlamydia. Untreated chlamydia is a risk factor for infertility because it leads to pelvic
inflammatory disease (PID). PID is an infection that can permanently damage your
fallopian tubes, uterus or ovaries.
 Hypothalamic and pituitary gland disorders.
 Polycystic ovary syndrome (PCOS).
 Primary ovarian insufficiency or poor egg quality.
 Sickle cell anemia.
 Uterine fibroids or uterine polyps.
 Thyroid disease.
 Prior surgical sterilization (tubal ligation or salpingectomy).
 Genetic or chromosomal disorders.
 Sexual dysfunction.
 Surgical or congenital absence of the ovaries.
 Infrequent or absent menstrual periods.

Infertility causes for men and people assigned male at birth

The most common cause of male infertility involves problems with the shape, movement
(motility) or amount (low sperm count) of sperm.

Other causes of male infertility include:

 Enlarged veins (varicocele) in your scrotum, the sac that holds your testicles.
 Genetic disorders, such as cystic fibrosis.
 Chromosomal disorders, such as Klinefelter syndrome.

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 High heat exposure to your testicles from tight clothing, frequent use of hot tubs and
saunas, and holding laptops or heating pads on or near your testes.
 Injury to your scrotum or testicles.
 Low testosterone (hypogonadism).
 Misuse of anabolic steroids.
 Sexual dysfunction, such as erectile dysfunction, anejaculation, premature ejaculation or
retrograde ejaculation.
 Undescended testicles.
 Previous chemotherapy or radiation therapy.
 Surgical or congenital absence of testes.
 Prior surgical sterilization (vasectomy).

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 Diagnosis and Tests

How is female infertility diagnosed?

First, your healthcare provider will get your full medical and sexual history.

Fertility for people with a uterus involves ovulating healthy eggs. This means your brain has to
send hormonal signals to your ovary to release an egg to travel from your ovary, through your
fallopian tube and to your uterine lining. Fertility testing involves detecting an issue with any of
these processes.

These tests can also help diagnose or rule out problems:

 Pelvic exam: Your provider will perform a pelvic exam to check for structural problems
or signs of disease.
 Blood test: A blood test can check hormone levels to see if hormonal imbalance is a
factor or if you’re ovulating.
 Transvaginal ultrasound: Your provider inserts an ultrasound wand into your vagina to
look for issues with your reproductive system.
 Hysteroscopy: Your provider inserts a thin, lighted tube (hysteroscope) into your vagina
to examine your uterus.
 Saline sonohysterogram (SIS): Your provider fills your uterus with saline (sterilized salt
water) and conducts a transvaginal ultrasound.
 Sono hysterosalpingogram (HSG): Your provider fills your fallopian tubes with saline
and air bubbles during an SIS procedure to check for tubal blockages.
 X-ray hysterosalpingogram (HSG): X-rays capture an injectable dye as it travels through
your fallopian tubes. This test looks for blockages.
 Laparoscopy: Your provider inserts a laparoscope (thin tube with a camera) into a small
abdominal incision. It helps identify problems like endometriosis, uterine fibroids and
scar tissue.

How is male infertility diagnosed?

Diagnosing infertility in people with a penis typically involves making sure a person ejaculates
healthy sperm. Most fertility tests look for problems with sperm.

These tests can help diagnose or rule out problems:

 Semen analysis: This test checks for low sperm count and poor sperm mobility. Some
people need a needle biopsy to remove sperm from their testicles for testing.

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  Blood test: A blood test can check thyroid and other hormone levels. Genetic blood tests
look for chromosomal abnormalities.
 Scrotal ultrasound: An ultrasound of your scrotum identifies varicoceles or other
testicular problems.
 Management and Treatment

TREATMENT OF INFERTILITY

How is infertility treated?

Treatment for infertility depends mostly on the cause and your goals. Your age, how long you’ve
been trying to conceive and your personal preferences are factors in deciding on a treatment.
Sometimes, one person needs treatment, but other times, treatment involves both partners.

In most cases, people and couples with infertility have a high chance of pregnancy. Things like
medication, surgery or assisted reproductive technology (ART) can help. Often, lifestyle changes
or improving the frequency and timing of intercourse can improve your chances of pregnancy.
Treatment can also include a combination of methods.

Infertility treatment for women

Treatments for infertility in women and people assigned female at birth include:

 Lifestyle modification: Gaining or losing weight, stopping smoking or using drugs, and
improving other health conditions can improve your chance of pregnancy.
 Medications: Fertility drugs stimulate your ovaries to ovulate more eggs, which increases
your chance of getting pregnant. [LIST EXAMPLES HERE]
 Surgery: Surgery can open blocked fallopian tubes and remove polyps, fibroids or scar
tissue.

Providers may make suggestions on how you can improve your odds of conceiving. These may
include things like:

 Tracking ovulation through basal body temperature, using a fertility tracking app and
noting the texture of your cervical mucus.
 Using a home ovulation kit, a kit you can purchase at the drug store or online to help
predict ovulation.

Infertility treatment for men

Treatments for infertility if you have a penis or testes include:

 Medications: Medications can raise testosterone or other hormone levels. There are also
drugs for erectile dysfunction to help you maintain an erection during sex.

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  Surgery: Some men need surgery to open blockages in the tubes that carry sperm or to
repair structural problems. Varicocele surgery can make sperm healthier and improve the
odds of conception.

What are common fertility treatments?

Some couples need more help conceiving using assisted reproductive technology (ART). ART is
any fertility treatment that involves a healthcare provider handling the sperm or egg. To increase
pregnancy odds, you can take medications to stimulate ovulation before trying one of these
options:

 In vitro fertilization (IVF): IVF involves retrieving eggs from your ovary, then placing
them with sperm in a lab dish. The sperm fertilizes the eggs. A provider transfers one to
three of the fertilized eggs (embryos) into your uterus.
 Intracytoplasmic sperm injection (ICSI): This procedure may be performed during the
IVF process. An embryologist injects a single sperm directly into each egg. Then, a
provider transfers one to three of the embryos into your uterus.
 Intrauterine insemination (IUI): A healthcare provider uses a long, thin tube to place
sperm directly into your uterus. IUI is sometimes called artificial insemination.
 Assisted hatching: A process that involves opening the outer layer of an embryo to make
it easier for it to implant in your uterine lining.
 Third-party ART: Couples may use donor eggs, donor sperm or donor embryos. Some
couples need a gestational carrier or surrogate.

What are complications of treatment?

Complications of infertility treatment include:

 Higher chance of multiples (twins, triplets or more): Producing multiple eggs and
transferring more than one embryo increases your risk of becoming pregnant with more
than one fetus. Complications such as miscarriage, premature birth, low birth weight,
neonatal death, and long-term health complications are more common in people pregnant
with multiple fetuses.
 Ovarian hyperstimulation syndrome (OHSS): A condition that causes painful and swollen
ovaries as a result of fertility medications. It can become serious and require immediate
medical attention.
 Ectopic pregnancy: IVF has an increased risk of ectopic pregnancy.
 Failed cycles: A failed cycle is when you go through infertility treatment and it doesn’t
end in pregnancy.

Can infertility be cured?

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Yes, but it depends on the cause. In 85% to 90% of cases, lifestyle modification, medication,
ART or surgery can treat infertility and allow a person to conceive.

Prevention

 Eat a well-balanced diet and maintain a weight that’s healthy for you.
 Don’t smoke, misuse drugs or drink alcohol.
 Get treated for STIs.
 Limit exposure to environmental toxins.
 Stay physically active, but don’t overdo exercise.
 Don’t delay conception until an advanced age.
 Undergo fertility preservation procedures (freezing eggs or sperm).

REFERENCES

American Academy of Family Physicians. Infertility.

(https://familydoctor.org/condition/infertility/) Accessed 4/19/2023.
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American Society of Reproductive Medicine. Quick Facts About Infertility.
(https://www.reproductivefacts.org/faqs/quick-facts-about-infertility/) Accessed 4/19/2023.

Centers for Disease Control and Prevention. Assisted Reproductive Technology (ART)
(https://www.cdc.gov/art/whatis.html) & Reproductive Health: Infertility FAQs.
(https://www.cdc.gov/reproductivehealth/infertility/index.htm) Accessed 4/19/2023.

Eunice Kennedy Shriver National Institute of Child Health and Human Development. What
Infertility Treatments Are Available?
(https://www.nichd.nih.gov/health/topics/infertility/conditioninfo/treatments) Accessed
4/19/2023.

Hormone Health Network. Reproductive Infertility. (https://www.endocrine.org/patient-

engagement/endocrine-library/infertility%C2%A0) Accessed 4/19/2023.

Office on Women’s Health. Infertility. (https://www.womenshealth.gov/a-z-topics/infertility)

Accessed 4/19/2023.

Planned Parenthood. Infertility Signs, Symptoms and Causes.

(https://www.plannedparenthood.org/learn/pregnancy/infertility) Accessed 4/19/2023.

The National Infertility Association (Resolve). Insurance Coverage by State.

(https://resolve.org/learn/financial-resources-for-family-building/insurance-coverage/insurance-
coverage-by-state/) Accessed 4/19/2023.

Vander Borght M, Wyns C. Fertility and infertility: Definition and epidemiology.

(https://pubmed.ncbi.nlm.nih.gov/29555319/) Clin Biochem. 2018 Dec;62:2-10. Accessed
4/19/2023.

Walker MH, Tobler KJ. Female Infertility. (https://pubmed.ncbi.nlm.nih.gov/32310493/) 2022

May 26. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-.
Accessed 4/19/2023.

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