NDEX
1) What is infertility?
2) What causes infertility?
3) Why addressing infertility is important?
4) What are risk factors for infertility?
5) How is female infertility diagnosed?
6) How is male infertility diagnosed?
7) Howis female infertility treated?
8) Howis male infertility treated?
9) What are fertility treatment for all
genders?
What is infertiliý?
Healthcare providers consider a couple
infertile if they try but fail to get
pregnant within one year. When the
woman is older than 35, the amount of
time trying to conceive drops to six
months for an infertility diagnosis. In
women over 40, immediate evaluation is
warranted. Infertility does not include
miscarrying or being unable to carry a
baby to childbirth.
Infertility is a condition where you cannot
get pregnant after one year of trying to
conceive. In women, cause of infertility
can include endometriosis, uterine
fibroids and thyroid disease. Men with
fertility problems may havea low sperm
count or low testosterone. The risk of
infertility increases as you age.
What causes infertility?
Causes of infertility vary:
> 1in 3 infertile women have a problem
with the female reproductive system.
> 1in 3 couples have a problem that
affects both of them or an
undetermined issue.
> 1in3 infertile men have a problem
with the male reproductive system.
Common Causes Of Infertility
Erectile
Structural defect
Dysfunction
Obstrucction Mobility of
in genetical Sperm
tract
Volume of
Semen
Sperm
Count
Male Infertility
Why addressing nfertility is
important?
Individuals and couples have the right to
decide the number,timing and spacing of their
children. Infertility can negate the realisation
of these essential human rights.
Addressing infertility can also mitigate
gender inequality. Infertility has significant
negative social impacts on the lives of
infertile couples and particularly women, who
frequently experience violence, divorce, social
stigma, emotional stress, depression, anxiety
and low self-esteem.
In such situations, education and awareness
raising interventions to address understanding
of the prevalence and determinants
fertility and infertility is essential.
What are risk factors for
infertility?
These factors increase the risk of infertility in all
people:
> Diabetes.
Eating disorders, including anorexia
nervosa and bulimia.
Excessive alcohol use.
Over-exercising.
Radiation therapy or other cancer treatments.
Sexually transmitted infections (STIs).
Smoking.
Stres s.
Substance abuse.
Weight problems (obesity or underweight).
Age at first marriage >35
Hatory ofdepresion ISecondary infertility
Histery of appendectomy
Posiive PHQ2 Primary infertility
Hyperprelactincmia
Risk
Factor Thyroid disease
Fallopian tube bleckage
Childhood obesity
Polycystic ovarian syndrome
Abnormal vaginal discharge
Husband's absence
Menstrual eyde irregularity
Family history of female infertilily
Age> 35 year
Chronic lower abdominalpehic pain
Second hand smoking
Obesity (BMI2 30)
Steady weight gain since marrisge
0 10 20 30 40 50 60 70
Infertility
FIGURE 5. Prevalence of infertility by type, active component service women of childbearing
potential, U.S. Amed Forces, 2013-2018
200.0
180.0 + 173.6
persons
160.0
-Any origin 142.3
10,000 140.0 -Unspecified origin
-Anovulation
120.0 Other specified origin
per Tubal origin"
100.0+
Prevalence -Uterine origin
81.8
80.0
60.0
51.4
40.0 + 33.7 39.3
29.6 29.4
20.0 + 25.5 19.0
3.0 3.2
0.0
2013 2014 2015 2016 2017 2018
"Block, occlusion, or stenosis of the fallopian tubes.
Structural abnormality of the uterus or nonimplantation (inciudes fibroids).
Male
nterti
AGE,
Environment
Ageing
Radiation exposure
Impaired cellular functions Tight-ftting underwear
Physio Recurrernt hot bachs or saunas
Vulnerability to diseases
Lifestyle Pathology
Modifications of reproductive hormones Exposure to endocrine-disrupting chemicak
Andropause or late-onset hypogonadism Occupational exposure
Genomic instabilty
Genetic susceptibility
Obesity Problems with ejaculation or sexual activity
Alcohol and tobacco consumption Testicular injury and diseases
High energy intake Endocrinal /auto-immune disorders
Nutritionally poor foods Disorders which reduce fertity
Recreational drugs Poor sperm quantity and/or quality
Stress &anxiety STD/ pathogens
How is female infertility
diagnosed?
Your healthcare provider may ask you torecord signs
of ovulation,such as basal body temperature and
cervical mucus. You may also use a home ovulation kit.
These tests can alsohelp diagnose or rule out a
female fertility problem:
1) Pelvic exam: Your provider willperform a pelvic
exam, including a Pap smear to check for
structural problems or siqns of disease.
2) Blood test: Ablood test can check hormone levels,
including thyroid hormones.
3) Transvaginal ultrasound: Your doctor inserts
an ultrasound wand into the vagina to look for
problems with the reproductive system.
4) Hysteroscopy: Your provider inserts a thin,
lighted tube (hysteroscope) into the vagina
examine the uterus.
5) Saline sonohysterogram (SIS): Your provider fills
the uterus with saline (sterilized salt water) and
conducts atransvaginal ultrasound. A full uterus
makes it easier to see inside the uterus.
6) Hysterosalpingogram (HSG): X-rays capture an
injectable dye as it travels through the fallopian
tubes. This test looks for blockages.
7) Laparoscopy: Your provider inserts a laparoscope
(thin tutbe with a camera) into asmall abdominal
incision.
How is male infertility
diagnosed?
These tests can help diagnose or rule out a male
fertility problem:
1) Semen analysis: This test checks for problems
with sperm, such as lowsperm count and poor
mobility. Some men need a needle biopsy to
remove sperm from the testicles and test it.
For most men, this is the only test that will be
needed in the workup of infertility.
2) Blood test: A blood test can check
testosterone, thyroid and other hormone levels.
Geneticblood tests look for chromosomal
abnormalities.
3) Scrotal ultrasound: An ultrasound of the
scrotum identifies varicoceles or other
testicular problems.
Hormonal Vaginal Hysterosalpingography Karyotype
analysis ultrasound
Physical Seminogram Hormonal Karyotype
examination analysis
How is female infertility treated?
Treatments for infertility include:
> Medications: Fertility drugs change
hormone levels to stimulate ovulation.
Surgery: Surgery can open blocked
fallopian tubes and remove uterine fibroids
and
polyps. Surgical treatment of endometriosis
doubles a woman's chances of pregnancy.
Artificial In vitro Surrogacy Complementary
insemination fertilization techniques
How is male infertility treated?
Treatments for male infertility include:
Medications: Medications can raise
testosterone or other hormone levels. There
are also drugs for erectile dysfunction.
Surgery: Some men need surgery to open
blockages in the tubes that store and carry
sperm. Varicocele surgery can make sperm
healthier and can improve the odds of
conception.
What are fertility treatment
options for all genders?
Some couples need more help conceiving. To
increase pregnancy odds, a woman may first take
medications to stimulate ovulation before trying
one of these options:
"Intrauterine insemination (IUI): A healthcare
provider uses a long, thin tube to place sperm
directly into the uterus.
"Invitro fertilization (IVF): IVF is a type of
assisted reproductive technology (ART). It involves
harvesting the eggs at the end of the stimulation
and placingsperm and eggs together in a lab dish,
The sperm fertilize the eggs. A provider transfers
one of the fertilizedeggs (embryo) into the uterus.
"Intracytoplasmic sperm injection (ICSI): This
procedure is similar to IVF. An embryologist
(highly specialized lab technician) directly injects a
single sperm intoeach of the harvested eggs and
thena provider transfers an embryo into the
uterus.
"Third-party ART: Couples may use donor eggs,
donor sperm or donor embryos. Some couples need
a gestational carrier or surrogate. This person
agrees to carry and give birth to your baby.
Invitro Fertilization
3
Transvaginal
Ovarian hyperstimulation 00cyte retrieval Sperm preparation
Sperm and the egg Embryo culture Embryo transfer
are incubated
or
Pregnancy Repeat step 6
