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Science For Health Professionals

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Science For Health Professionals

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Infertility is a disease of the reproductive system well-defined by the inability to attain a clinical pregnancy after 12 months or more of regular unprotected sexual intercourse (WHO, 2016). Purpose statement: Around 10-30% couples experience unintentional childlessness and this is due infertility in 20-30 % men, 20-35 % women, 25-40 % both together and 10-20 % unknown reasons. Different aspects of the infertility are discussed in this report. Background information: Infertility is a medical and social problem since the existence of human. Records of treatment for gynecological disorders are available back to 1900 BC. Hippocrates also mentioned about infertility. Scope, aims, limits, size, and complexity of the reports: As there is increasing trend in the occurrence of infertility, hence there is need to evaluate and discuss causes, effects and management options available for infertility. In this report these aspects are disused based on the available evidences for both men and women infertility. Infertility is a complex topic because around 20 % cases causes of infertility are unknown or unexplained and treatment options varied on individual basis (Kumar & Singh, 2015). 
Etiology: Female factors responsible for infertility are impairment in the interaction of mucus-sperm interaction, irregular menstrual cycle, failure to ovulate, defect in the uterus and fallopian tube, anatomical or physiological defects due to infection and adhesions (Tarin et al., 2015). Male factors responsible for infertility are pre-testicular, testicular and post-testicular. Pretesticular factors include diseases of hypothalamus and pituitary gland. Testicular reasons are genetic or nongenetic like infection.  Post testicular factors are related to the delivery of sperm and include obstruction of vas deferens, ejaculatory duct obstruction and backward ejaculation. Male infertility also caused by obesity and stress. Factors affecting infertility in both the sexes include environmental, excessive exercise, inadequate diet, advanced age and consumption of tobacco and related products (Pizzol et al., 2014).  
Clinical manifestation: Clinical manifestations of infertility in women include irregular bleeding in abnormal periods, irregular periods, absence of periods, genital and pelvic infection, miscarriages, endocrine dysfunction, polycystic ovarian disease (PCOD), uterine leiomyomas or fibroids, pelvic pain and back pain during periods. Other clinical manifestation include endometriosis, reduced sex drive, loss of hair, hair growth on chin and chest, weight gain, discharge from nipples and painful experience during sex. In men, clinical manifestation of infertility include less alteration in hair growth, reduced sex desire, pain and swelling in testicles, difficult erections and ejaculations and small testicles (Fritz & Speroff, 2011).
Effects: Infertility affects more to women as compared to men, in psychological and social terms. This is because women express more intention for child as compared to the men. There is literature available for the social sufferings in these childless women. In case of infertility, capability of women ovary to produce eggs that are capable of fertilization is reduced and results in unsucceful pregnancy. Follicles disappear due to apoptosis or enter in the growth phase. In case infertility, there is more level of FSH due to high growth rate of follicles. In infertile women, due to reduced endometrial receptivity and reduced quality of oocytes, there are more chances of abortions. Infertility in females can result in primary infertility, pregnancy wastage and premature delivery. In case of male infertility, there is the reduced level of semen volume, sperm count, sperm motility and also there is the alteration in the normal morphology of sperm. There is also, alteration in the vascularization of testicles, reduced number of sertoli and leydig cell and reduced level of testosterone hormone in the serum. It has also been reported that there is the possibility of developmental defects in the offsprings due to both infertile men and women because spontaneous mutation rate is higher in such offsprings. (Tao et al., 2011).    
Treatment: There are multiple options available for the treatment of infertility and these treatments are basically based on the intensity, invasiveness and related risks. Two most widely accepted treatment options are medicines to induce ovulation and techniques to manipulate eggs and sperm. Medicines available for infertility in women are for ovulation induction and controlled ovarian hyperstimulation (COH). These medicines include clomiphene citrate, letrozole, gonadotropins (FSH, LH, human menopausal gonadotropin (hMG)), chorionic gonadotropin (hCG), bromocriptine, cabergoline, GnRH, GnRH analogs and insulin-sensitizing agents like metformin. Ovulation stimulation results in growth, maturation and ovulation of single follicle. In case of COH, growth of several follicles achieved by stimulation and maturation achieved with the help of medicines. COH is useful in the assisted reproductive techniques (ART). Most widely accepted ART is in vitro fertilization in which eggs manipulate and fertilize outside the body. ART is differentiating itself from ovulation induction in terms more invasiveness and complexity of the technique. However, both ovulation induction and ART requires medicines for growth, development and maturation of eggs. As mentioned, in ART multiple follicles get matured and later there are retrieved and transferred to incubator for fertilization. Obtained embryo can be used for implantation in the uterus or can be cryopreserved for future use (Mathur, 2015). In case of male infertility, administration of antiestrogens, gonadotropin and antioxidants like zinc, vitamin E and L-carnitine showed more live birth rates. In case of varicocele, there is evidence available for the improvement in the semen quality. Intrauterine insemination and in vitro fertilization both proved to be useful in male infertility. If there is no identified cause for infertility in both men and women, chances of pregnancy can be improved with frequent intercourse (Taymor, 2012).
Research has indicated that there are multiple factors responsible for infertility in men and women. Prevalence of infertility is more in women as compared to the men. Infertility has effects on multiple aspects of life like social, psychological and biological. There are numerous treatment options available based on the intensity and stage of the disease. Along with the medical management, there is also the requirement of social acceptance and psychological support for the people with infertility. Both the assessment and treatment for the infertility varies based on the individual cases because different people need treatment at different phases and for different purposes. All these factors making infertility a complex disease.    
Infertility is a complex disease with problems in diagnosis due to multiple causative factors and many cases of unexplained infertility. In men there are not definitive symptoms of infertility and more emphasis has been given to the women infertility as compared to the men infertility. There is no evidence available to exhibit one method of treatment is superior to another because treatment is mainly based on the intensity and age of the patient.
More research should be directed towards evaluating long term impact of infertility on both men and women specifically importance should be given to the stress related to the infertility. Because stress is also one of the major causative factor for infertility. In future more focus should be emphasized on combined studies of infertility on men and women and seeking more understanding of the men infertility.
Fritz, M. A., & Speroff, L. (2011). Clinical Gynecologic Endocrinology and Infertility. (8th edition). Lippincott Williams & Wilkins.
Kumar, N., & Singh, A.K. (2015). Trends of male factor infertility, an important cause of infertility: A review of literature. Journal of Human Reproductive Sciences, 8(4), 191-6.
Mathur, R. (2015). Reducing Risk in Fertility Treatment. Springer.
Pizzol, D., Bertoldo, A., & Foresta, C. (2014). Male infertility: biomolecular aspects. BioMolecular Concepts, 5(6), 449-56. doi: 10.1515/bmc-2014-0031.
Tao, P., Coates, R., & Maycock, B. (2011). The impact of infertility on sexuality: A literature review. Australasian Medical Journal, 4(11), 620–627.
Taymor, M.L. (2012). Infertility: A Clinician’s Guide to Diagnosis and Treatment. Plenum Medical Book Company 
World Health Organization (WHO). (2016). Retrieved from
 https://www.who.int/reproductivehealth/topics/infertility/definitions/en/ on 15 September 2016.

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