Infertility is the inability to naturally conceive a child or the inability to carry a pregnancy to term. There are many reasons why a couple may not be infertile or may not be able to conceive without medical assistance but, regardless of the cause, the physical, emotional, and interpersonal impact of infertility can be crushing.
Infertility is a growing problem in the U.S. The physical and psychological impact of infertility can be devastating to the infertile person and to their partner. It frequently results in anger, depression, anxiety, and feelings
of worthlessness. Psychological counseling and adoption are two of the options open to those individuals and couples for whom infertility cannot be overcome.
The International Council on Infertility Information Dissemination (INCIID) considers a couple to be infertile if they have not conceived after 6 months of unprotected intercourse, or after 12 months if the woman is over 35 years of age; or if there is incapability to carry a pregnancy to term. Healthy couples in their mid-20s having regular sex have a one-in-four chance of getting pregnant in any given month. This is called "Fecundity".
According to the American Society for Reproductive Medicine, infertility affects about 6.1 million people in the U.S., equivalent to ten percent of the reproductive age population. Female infertility accounts for one third of infertility cases, male infertility for another third, combined male and female infertility for another 15%, and the remainder of the cases is "unexplained". "Secondary infertility" is difficulty conceiving after already having conceived and carried a normal pregnancy. Apart from various medical conditions (e.g. hormonal), this may come as a result of age and stress felt to provide a sibling for their first child. Technically, secondary infertility is not present if there has been a change of partners.
Female infertility: Factors relating to female infertility include diseases such as diabetes, thyroid and hypothalamic problems, ovarian factors, tubal/peritoneal factors (such as endometriosis, pelvic adhesions, and pelvic inflammatory disease), uterine, cervical, and vaginal factors, genetic conditions, and psychological factors.
Male infertility: Factors relating to male infertility include pre-testicular causes (such as endocrine problems), drugs, alcohol, and psychological factors, testicular factors (such as varicocele, trauma, and mumps), post-testicular causes (such as vas deferens obstruction, infection, retrograde ejaculation and impotence), and genetic causes.
Combined infertility: 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 also be the case that each partner is independently fertile but the couple cannot conceive together without assistance.
Unexplained infertility: 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, 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
Regardless of the cause, infertility frequently results in a range of psychological and social problems for the woman, the man, and their relationship. The infertile couple may experience social isolation and marital discord. The woman and man may decide to go through the numerous medical infertility options, each of which is accompanied by its own set of physical and psychological as well as financial demands. Invasive medical techniques raise moral, ethical and religious concerns and their invasive and impersonal requirements can rob the reproductive process of its sense of intimacy. The result is that infertility and the infertility process often results in anger, frustration, anxiety and stress, and depression.
Biological infertility treatment includes a wide variety of interventions including fertility medication, surgery, artificially insemination where the sperm is placed into a female's uterus (intrauterine), or cervix (intracervical) using artificial means rather than by natural intercourse), and in vitro fertilization (IVF) in which eggs are removed from the woman, fertilized and then placed in the woman's uterus, bypassing the fallopian tubes.
Variations on IVF include: use of donor eggs and/or sperm in IVF; intracytoplasmic sperm injection (ICSI) in which a single sperm is injected directly into an egg and the fertilized egg is then placed in the woman's uterus as in IVF; zygote intrafallopian transfer (ZIFT) in which eggs are removed from the woman, is fertilized, and then placed in the woman's fallopian tubes rather than the uterus; gamete intrafallopian transfer (GIFT) in which eggs are removed from the woman and placed in one of the fallopian tubes, along with the man's sperm. Other assisted reproductive technology (ART) include assisted hatching, fertility preservation, freezing (cryopreservation) of sperm, eggs, & reproductive tissue, and frozen embryo transfer (FET).
Infertility may have profound psychological effects. The man and/or woman 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 cancer. In many cultures and subcultures the 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.
The psychological aspects of infertility can be dealt with in individual and couples counseling with a mental health professional such as a psychologist, psychiatrist, or clinical social worker. The more you understand about infertility and your options, the better you can cope with its effects.
Additional Infertility Information
|National Institutes of Health|
|Infertility Resources Web Site|
|PubMed Health on infertility|
|Centers for Disease Control: on fertility|
|International Council on Infertility Information Dissemination|
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