Infertility overview

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Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Infertility from other Diseases

Epidemiology and Demographics

Risk Factors

Natural History, Complications and Prognosis

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Diagnosis

History and Symptoms

Physical Examination

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [2] Associate Editor(s)-in-Chief: Sanjana Nethagani, M.B.B.S.[3]

Overview

Infertility primarily refers to the biological inability of a man or a woman to contribute to conception. It is defined as the failure to conceive after 1 or more years of unprotected sex. 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.[1]

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.

Historical perspective

Infertility has always led to socially and emotionally impairment for the woman involved. In addition, most cultures had their own myths and beliefs around fertility which made it even more challenging for women who could not conceive. The male role in infertility was only brought to light after the discovery of the spermatozoa.

Classification

  • Infertility is broadly classified into primary and secondary, where primary infertility is seen in women who have never conceived and secondary infertility is the inability to conceive after a previous pregnancy.
  • Infertility can also be classified based on etiology such as endocrine, metabolic, genetic etc.[2]

Pathophysiology

  • Disorders of ovulation make up at least 25% of the cases of infertility worldwide, according to a study done by WHO.[3]
  • Other pathologies such as genital tract infections, pelvic inflammatory disease, endometriosis make up the bulk of female infertility cases.

Causes

  • A wide range of physical and emotional factors can cause infertility. Infertility may be due to problems in the woman, man, or both.
  • The most common cause of male infertility is sperm abnormalities such as oligospermia, azoospermia etc.
  • Causes of infertility in females are divided into endocrine, ovarian, tubal, uterine, cervical and other anatomical defects.[4]

Differentiating Infertility from Other Diseases

  • 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 fecundityfor the natural improbability to conceive. [5]

Epidemiology and demographics

Risk factors

  • Old age is the most important non modifiable risk factor determining fertility in women.
  • Other risk factors include being overweight, endocrine disorders such as diabetes mellitus and PCOS.
  • Smoking and drug abuse may also cause infertility. [7]

Screening

Routine screening for infertility is not usually done, but fertility evaluation is recommended for women who are above 35 years of age and have not already conceived.

Natural history, Complications and Prognosis

  • Infertility may cause marital discord among couples who wish to conceive. Infertility treatment such as IVF and AI are associated with risks such as multiple gestations and preterm labour.
  • Prognosis is generally good in women who receive treatment for infertility.

Diagnosis

Treatment

Medical Therapy

  • 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. All these come under the gamut of assisted reproductive technology. [9]
  • 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 assisted hatching and PGD.

Surgical therapy

References

  1. Makar RS, Toth TL (2002). "The evaluation of infertility". Am. J. Clin. Pathol. 117 Suppl: S95–103. PMID 14569805.
  2. Hull MG, Cahill DJ (1998). "Female infertility". Endocrinol Metab Clin North Am. 27 (4): 851–76. doi:10.1016/s0889-8529(05)70044-x. PMID 9922911.
  3. "Recent advances in medically assisted conception. Report of a WHO Scientific Group". World Health Organ Tech Rep Ser. 820: 1–111. 1992. PMID 1642014.
  4. Luciano AA, Lanzone A, Goverde AJ (2013). "Management of female infertility from hormonal causes". Int J Gynaecol Obstet. 123 Suppl 2: S9–17. doi:10.1016/j.ijgo.2013.09.007. PMID https://www.ncbi.nlm.nih.gov/pubmed/24139473 Check |pmid= value (help).
  5. Wood JW (1989). "Fecundity and natural fertility in humans". Oxf Rev Reprod Biol. 11: 61–109. PMID 2697833.
  6. American College of Obstetricians and Gynecologists Committee on Gynecologic Practice and Practice Committee (2014). "Female age-related fertility decline. Committee Opinion No. 589". Fertil Steril. 101 (3): 633–4. doi:10.1016/j.fertnstert.2013.12.032. PMID 24559617.
  7. Practice Committee of the American Society for Reproductive Medicine. Electronic address: asrm@asrm.org. Practice Committee of the American Society for Reproductive Medicine (2018). "Smoking and infertility: a committee opinion". Fertil Steril. 110 (4): 611–618. doi:10.1016/j.fertnstert.2018.06.016. PMID 30196946.
  8. Dishuck CF, Perchik JD, Porter KK, Gunn DD (2019). "Advanced Imaging in Female Infertility". Curr Urol Rep. 20 (11): 77. doi:10.1007/s11934-019-0942-0. PMID 31734736.
  9. Szamatowicz M (2016). "Assisted reproductive technology in reproductive medicine - possibilities and limitations". Ginekol Pol. 87 (12): 820–823. doi:10.5603/GP.2016.0095. PMID 28098933.
  10. Tanaka Y, Tajima H, Sakuraba S, Shimokawa R, Kamei K (2011). "Renaissance of surgical recanalization for proximal fallopian tubal occlusion: falloposcopic tuboplasty as a promising therapeutic option in tubal infertility". J Minim Invasive Gynecol. 18 (5): 651–9. doi:10.1016/j.jmig.2011.06.014. PMID 21872171.

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