Infertility: Main Topics of Disease

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Infertility is an inability to conceive children. It is a serious public health concern issue regarding financial, ethical and legal aspects and it is responsible to examine physical and psychological consequences for affected couples. Infertility rates differ among different countries, less than 5% to over 30%. In spite the fact that 40% of infertility are male-related, 40% are female-related and 20% are related to both. There are two types of infertility. Primary infertility is defined as no pregnancy attain after 1 year or more of regular unprotected sexual intercourse. 

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Secondary infertility is determined as the inability to become pregnant following a previous pregnancy. Some major causes of female infertility includes Anovulatory infertility, Polycystic ovaries, Endometriosis, Tubal peritoneal infertility, Uterine infertility etc and some major causes of male infertility includes Ejaculatory dysfunction, Varicocele, systemic and iatrogenic causes. One More reason behind reduced infertility can be badly treated systemic diseases, e.g. diabetes. Being under- or overweight reduces female infertility and at the same time increases the risk of miscarriages. 

Furthermore overweight reduces the quality of sperm. Immoderate smoking impairs the function of the ovaries and sperm quality. Excessive alcohol consumption disturbs sperm production and effects on female infertility. Sometimes exposure to hazardous occupational substances may play a role behind subfertility. Sperm production may be abnormal due to infection, surgery or trauma or torsion of the testes or epididymis and problems associated with the descent of testes may also hamper sperm production. 

Some medicines impair the production of semen, e.g. testosterone, cytotoxic drugs, calcium channel blockers and long acting sulpha drugs. Additionally the use of anabolic steroids hampers sperm production and may lead to azoospermia, what means a total absence of sperm. One of the most important factors in assessing a couple with fertility problems is the age of the woman. A desire to become pregnant at ~40 years of age does not only entail a low possibility of success, but also an increased risk of developing maternal pregnancy ailments such as pre-eclampsia, hypertension and diabetes, as well as fetal chromosomal abnormalities and miscarriages. 

The decline in female fertility starts at 30 years of age and becomes more pronounced at 40. The possibility for pregnancy at age 40 is half that of younger women, whilst the incidence of spontaneous abortion doubles or trebles. Infertility sometimes is accompanied by existential crises and emotional tensions such as anxiety, interpersonal problems and suppressed anger, unsatisfactory in interpersonal, frustration, inferiority feeling, depression, rejected feeling and unconscious guilt feeling. 

These couples with a history of failure in Assisted Reproductive Technique (ART) have shown personality maladjustment. Cook found that in couples embarking upon infertility treatment, both men and women showed high levels of anxiety compared with the general population as measured by the State-Trait Anxiety Inventory. Psychological pressures and concerns about infertility have direct effects on normal physiology of body and can have double effect on fertility outcomes. 

Over all percentage of psychological problem in infertile couples ranges between 25 and 60%  psychological distress refers to the general concept of maladaptive psychological functioning in the face of stressful life events’. The unique discomforting, emotional state experienced by an individual in response to a specific stressor or demand that results in harm, either temporary or permanent, to the person. (Sheila H. Ridner, 2003). Psychological distress has five defining attributes: (1) perceived inability to cope effectively, (2) change in emotional status, (3) discomfort, (4) communication of discomfort, and (5) harm. 

Many of the stress stimuli originate in the environment, some are derived from the response of the individual to environmental factors, and some are psychogenic and in certain cases may be the result of the interaction of what the individual perceives from the environment and the elicited response. Cultural, occupational, and many other behavioral differences can modify or sensitize the stress response and the ensuing change in reproductive function.

Although infertility is an unanticipated circumstance that carries both emotional and psychosocial consequences of varying intensity for both individuals and couples, infertility research tends to focus on the woman and her experience. With the exception of Phipps, few studies have addressed the male experience with infertility, or examined the similarities and differences in the infertility experience of partners. 

Based on the findings from this study, the researchers suggested that women show poorer adjustment to being infertile than men, and that women tend to view reproduction ae a more central component of their gender role identity. There are groups of patients whose infertility remains unexplained after the completion of all available diagnostic tests and no anatomical, physiological or pathological causes are found. Thus for these groups of patients some may argue that perhaps ‘psychological’ factors may be the cause of their infertility. 

In line with the evidence from executions of men and women it was concluded that psychological states such as depression, anxiety and fear may have an impact on physiological, including endocrinological, functioning, and therefore this reduce the likelihood of conception. Some believed that infertility was a defence mechanism and that if this intra-psychic conflicts regarding parenthood and pregnancy is resolved, it could lead to pregnancy. Some other authors believed that infertility was a manifestation of total personality disturbance.      

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