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| Infertility Classification & external resources | |
| ICD-10 | N46., N97.0 |
|---|---|
| ICD-9 | 606, 628 |
| DiseasesDB | 21627 |
| MedlinePlus | 001191 |
| eMedicine | med/3535 med/1167 |
| MeSH | D007246 |
Infertility primarily refers to the biological inability of a man or a woman to contribute to conception. Infertility may also refer to the state of a woman who is unable to carry a pregnancy to full term. There are many biological causes of infertility, some which may be bypassed with medical intervention. Makar RS, Toth TL (2002). "The evaluation of infertility". Am. J. Clin. Pathol. 117 Suppl: S95–103. PMID 14569805.
Women who are fertile experience a natural period of fertility before and during ovulation, and they are naturally infertile during 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.
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There are strict definitions of infertility used by many doctors. However, there are also similar terms, e.g. subfertility for a more benign condition and fecundity for the natural improbability to conceive.
Reproductive endocrinologists, the doctors specializing in infertility, consider a couple to be infertile if:
A couple that has tried unsuccessfully to have a child for a year or more is said to be subfertile. The couple\'s fecundability rate is approximately 3-5%. Many of its causes are the same as those of infertility. Such causes could be endometriosis, or polycystic ovarian syndrome.
(This section needs proper numbers based on detailed statistics and studies. Please expand.)
This section deals with unintentional causes of sterility. For more information about surgical techniques for preventing procreation, see sterilization.
Couples with primary infertility have never been able to conceive,MedlinePlus Medical Encyclopedia: Infertility. Retrieved on 2007-11-21. while, on the other hand, secondary infertility is difficulty conceiving after already having conceived and carried a normal pregnancy. Technically, secondary infertility is not present if there has been a change of partners.
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.
Factors that can cause male as well as female infertility are:
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.
In about 15% of cases the infertility investigation will show no abnormalities. 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.
Treatment of infertility usually starts with medication. In vitro fertilization (IVF) in addition to various forms and developments of it (ICSI, ZIFT, GIFT) is another solution. They all include that the fertilization takes place outside the body. On the other hand, an insemination can make a fertilization inside the body. Other techniques are e.g. tuboplasty, assisted hatching and PGD.
There are several ethical issues associated with infertility and its treatment.
Infertility may have profound psychological effects. Partners may become more anxious to conceive, ironically increasing sexual dysfunction. Marital discord often develops in infertile couples, especially when they are under pressure to make medical decisions. Women trying to conceive often have clinical depression rates similar to women who have heart disease or cancerDomar AD, Zuttermeister PC, Friedman R. The psychological impact of infertility: a comparison with patients with other medical conditions. J Psychosom Obstet Gynaecol. 1993;14 Suppl:45-52. PMID 8142988.. Even couples undertaking IVF face considerable stress, especially the female partner Beutel M, Kupfer J, Kirchmeyer P, Kehde S, Kohn FM, Schroeder-Printzen I, Gips H, Herrero HJG, Weidner W. Treatment-related stresses and depression in couples undergoing assisted reproductive treatment by IVF or ICSI. Andrologia. 31 (1999): 27-35.
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 Schmidt et al. "The Social Epidemiology of Coping with Infertility." Human Reproduction. 20 (2005): 1044-1052..
There are legal ramifications as well. Infertility has begun to gain more exposure to legal domains. An estimated 4 million workers in the U.S. used the Family and Medical Leave Act (FMLA) in 2004 to care for a child, parent or spouse, or because of their own personal illness. Many treatments for infertility, including diagnostic tests, surgery and therapy for depression, can qualify one for FMLA leave.
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