Infertility seems to be a growing issue among many men and woman. Infertility can lead to many issues within relationships and negatively affect a person’s well-being as many people view having children as a milestone in their lives. Infertility can be caused by a variety of different things, either naturally occurring or caused by oneself. It is important to assess the causes as well as possible treatments of infertility. The treatments are rather costly therefor it is important to take a look into the reproductive field as there may be easier, more cost effective ways, which we could use to address the issues involved with infertility and possibly correct them and potentially find definite cures. In doing so we can improve the well-being of those who are infertile as they might be able to navigate through their infertility problems, in a less invasive and non-costly manner.
The Main Structures Involved in Human Reproduction:
The Female Reproductive System:
Ovaries: a pair of glands that aid in the production of female hormones, such as estrogen and progesterone, they produce the female gametes, namely ova (eggs). A mature ovum is released from the ovary into the fallopian tube, where it may be fertilized before reaching the uterus, during ovulation.
Fallopian Tubes: a pair of muscular tubes that extend from the ovaries to the uterus. The fallopian tubes end in infundibulum, covered by fimbriae. Fimbriae collect the ovum once released from the ovaries and moves it into the fallopian tube, where it is moved by cilia and smooth muscles which aids in its movement to the uterus.
Uterus (Womb): a muscular organ located posterior and superior to the bladder. Connected to the fallopian tubes and the vagina (via the cervix). During pregnancy, the uterus surrounds and supports the developing fetus. The endometrium (the inner lining) provides support to the embryo during early development, and the visceral muscles contract during childbirth to push the fetus through the birth canal.
Vagina: a muscular tube that connects the cervix to the external body. The vagina acts as a receptor for the penis during copulation and allows the penis to deposit sperm to the cervix to potentially fertilize the ovum, it also serves as a birth canal.
Breasts and Mammary Glands: organs that contain mammary glands, milk ducts, and adipose tissue. The mammary glands are made up of sudoriferous glands which produce milk to feed infants, there are 15 to 20 clusters of mammary glands within each breast, which become activated during pregnancy and stay active until milk is no longer needed. The milk travels through the milk ducts to the nipple, where it exits the body.
The Male Reproductive System:
External:
- Penis: organ used in copulation, opening is connected to the urethra, which transports urine and semen (containing sperm) out of the body.
- Testes (Testicles): oval organs within the scrotum (which ensures optimal temperature for sperm production). The testes are make testosterone and generate sperm ( produced in the seminiferous tubules.
Internal:
- Epididymis: a long, coiled tube in the back of the testes that transports and stores sperm cells.
- Vas deferens: a long, muscular tube that connects the epididymis to the pelvic cavity, it transports sperm into the urethra
- Urethra: a tube that carries urine from the bladder to outside of the body and ejaculating semen out of the body.
- Seminal vesicles: sac-like pouches attached to the vas deferens, that fructose that provides sperm with a source of energy to assistance them with movement.
- Prostate gland: gives additional fluid to the ejaculate, which nourish the sperm.
- Cowper’s glands: produce a clear, slippery fluid into the urethra, to lubricate and neutralize any acidic residue left from urine.
Hormones Involved with Human Reproduction:
- Flow Diagram of Hormone Control In Woman:
- Flow Diagram Of Hormone Control In Men
Human Infertility Statistics in South Africa:
I think it is important to compare how general classifications of people such as race and gender impact fertility and to see if we can find any trends. As well as comparing the economic state of the majority of people in a specific area, such as comparing developed and developing countries and analyzing whether the infertility rates could have a significant impact a countries success or downfall.
Fertility rate, total (births per woman) in South Africa from 1960 to 2019
The graph illustrates a 63% decline in births from 1950 to 2019, having 2.38 less births per woman. It also illustrates that it took 47 years (from 1950 to 1997) to decrease the amount of births from above 6 to 3 births per woman. The decrease in births could be due to several reasons, two of which being increased infertility levels and the introduction of contraceptives. In South Africa 15-20% of the population are infertile, meaning that 1 in every six couples are infertile.
The World Health Organization says that more that 180 million couples have problems with infertility, this may be due to the fact that fertility treatments are heavily neglected in these areas as it is unaffordable and other medical practices are prioritized. It is said that 85% of woman in Sub-Saharan Africa who are infertile, are so, because of infections. Whereas infections only contribute to 33% of infertility causes worldwide. This may be due to the levels of education being of a lower standard or inaccessible in the lower and least developed countries.
There is a great misconception that infertility is caused by woman, but the truth is that it can be caused by men and woman. Both men and woman are equally at risk of becoming infertile.
The Causes Of Infertility
Infertility can be caused by many various factors, the following related causes will be discussed: anatomical, environmental, hormonal and disease related. It is important to study the causes, because if we are able identify frequent traits, modern medicine could be used to look into ways of prevention and treatment.
Anatomical Causes:
Within Women
• Ovarian Cysts: (fluid-filled sacs that grow inside the ovaries), namely Endometrioma, which are filled with blood as a result of endometriosis, and cysts caused by polycystic ovarian syndrome (PCOS)
• Fibroid Tumors: These benign tumors formed on uterine muscles that can change the shape of the uterus or create problems within the cervix. These tumors can cause implantation problems within the uterus
• Uterine Abnormalities: a congenital uterine anomaly which result in an abnormally shaped uterus, such as the formation of a Uterine septum or scarring because of Asherman’s Syndrome.
Within men
• Sperm disorders resulting in problems with production and maturation of sperm, causing sperm to be abnormally shaped or immobile (Immotile cilia syndrome; Kartagener’s syndrome) or produced in exceptionally low numbers (Azoospermia)
• Cystic fibrosis, an inherited condition that could result in obstructive azoospermia, which causes men to be born without a vas deferens.
• Anatomical abnormalities such as the obstructions of the genital tract blockage of the flow of seminal fluid. Obstruction in the tubes or storage ducts of the testes, resulting from congenital defects.
• Varicocele is the abnormal swelling of the veins that drain the testicles.
• Retrograde ejaculation: when semen is released into the bladder as opposed to the outside of the body during a male orgasm.
• Klinefelter’s syndrome: where a male is born with two X chromosomes and only one Y chromosome resulting in abnormal development of the gonads.
• Issues involving sexual intercourse, such as erectile dysfunction, premature ejaculation and other anatomical problems such as urethral opening beneath the penis
Environmental Causes:
• Frequent exposure to Industrial chemical, Heavy metal exposure and Radiation or X-rays, could all lead to infertility.
• Testicles kept too warm, could impair the function and production of sperm, this could possibly happen as a result of wearing tight clothing or frequently working with a laptop on your lap.
• Air pollution reduces sperm quality, motility and sperm morphology.
• Drug and alcohol abuse can result in erectile dysfunction and decreased sperm production
• smoking
• Emotional stress and Depression also decrease the likelihood of pregnancy
• Obesity and being severely underweight have a direct impact on gamete production and result in hormonal changes within the body.
Hormonal Causes
If the following hormones are in excess or there is a deficit of them it will result in female infertility, as it will cause problems with either fertilization, implantation or development of an embryo.
• High levels of FSH in a woman’s blood
• Imbalanced levels of oestradiol (a component in oestrogen)
• Inadequate levels of LH, which trigger the ovaries to release an ovum and initiate progesterone production, (essential for uterus preparation for implantation).
In men if testosterone levels are low, the LH levels are increased by the brain and vice versa, which will affect the FSH levels and in term whether or not to produce sperm if these hormones are imbalance it could result in low sperm count or over producing sperm.
Disease-Related Causes
• Sexually Transmitted Diseases that result in long term affects on the body such as chlamydia and gonorrhea, which can result in tubal blockages.
• Certain diseases medications can also affect infertility, namely antidepressants, tranquilizers, and anti-cancer drugs.
• Endometriosis, a condition where endometrium tissue grows in areas besides the uterus(such as the bladder, ovaries, fallopian tubes and bowels), where it cannot exit the body during menstruation, resulting in scar tissue and cysts (filled with old blood)- which may break open and cause extreme pain. Scar tissue and cysts (sacs that are often filled with old blood) can form.(“Endometriosis | Endocrine Society,” n.d.)
• Diseases caused by ritual circumcision (such as gangrene) can also result in infertility – especially in South Africa.(Merwe et al., 2017)
Infertility Treatment and Solutions:
Surgical Treatments:
In men, surgery can be done to correct varicocele or a blockage in the vas deferens, in woman it can be done to remove tissue preventing fertilization (for instance, endometriosis) or to clear blockage in fallopian tubes.
Hormonal and Medical Treatments:
• Antibiotics can be used to treat infections and diseases which may prevent fertilization.
• Medicine and counseling are used to treat problems involving erections and ejaculation.
• Hormone treatments are used if hormone levels are imbalanced, being to high or to low. Clomiphene or aromatase inhibitors are taken as a will with FSH and LH injections in the case of ovulation disorders.
Advanced technology
• Intrauterine Insemination (IUI): Sperm is taken and deposited directly into a woman’s uterus during ovulation.
• In Vitro Fertilization (IVF): eggs and sperm are collected, and fertilization is brought about within a lab, allowing it to grow for 5 days, until the embryo is inserted into the woman’s
• Gamete Intrafallopian Transfer (GIFT) and Zygote Intrafallopian Transfer (ZIFT): Sperm and eggs are collected and placed into a fallopian tube. GIFT involves placing both sperm and eggs into the fallopian tube, while ZIFT involves fertilizing the eggs with sperm in a lab before placing the eggs back into the fallopian tube.
Other options include hiring a surrogate mother, making use of egg or sperm donors as well as adoption.
The impact of infertility on a population:
• Stage1: pre-industrial society where death rates and birth rates are high and somewhat balanced, this was achieved in the late 18th century in western Europe. Population growth is slow due to limited resource (food) supply and any influx will balance out in the mortality
• Stage 2: Developing country, the death rates fall drastically due to improvements in health and sanitation, such as sewage systems, and personal hygiene.
• Stage 3: declining birth rates as a result of fertility factors such as access to contraception, and urbanization. The birth rate is said to decline although not drastically with the introduction of contraceptives, however it does still have a significant impact,
• Stage 4: low birth and death rates, which could result in shrinking a population, however I expect this to be the same if fertility rates decline. If fertility rates decrease, people will have more money to love healthier lifestyles and could possibly afford better healthcare which would roughly replicate this curve
• Stage five is a hypothesis based of what will happen with the future, either a decline or spike in fertility.
• I think a decline in fertility will have a very drastic change on the quality of life as it would alleviate financial pressures of families in impoverished circumstances. That could result in a higher mortality rate and over long periods of development and change replicate stage 4 that illustrates developing countries
South Africa replicates stage 3 as the birth rates are steadily declining, however it still shows that South Africa is a developing country as our life expectancy is rather average, being 63 years old.
The Effects of Infertility on Relationships and Emotional Well-being
The availability of Assisted Reproductive Technology (ART) is limited in many developing countries due to high costs involved with it. In developing countries, children allow their parents to become more esteemed members of the community, children provide manpower in rural areas, and are seen to provide care to their parents in their old age. Infertility usually leads to instability in marriages, which could result in. In some societies in Africa and Asia women will not be allowed to inherit their husband’s estate if he dies. A vast majority of people refer to parent hood as a goal to fulfil in life.
Infertility can negatively impact your self-worth and identity due to sudden disruption in expected parenthood, resulting in feeling of losing control and doubting of womanhood. Women tend to form better, deeper connections with woman they can relate to, which are more likely to be childbearing. This could in turn result in feeling marginalised or stigmatised.
Infertility places stress on a relationship, which could result in divorce or a deeper connection being formed. Conflict also arises on the bases of which treatment to use and when to stop trying and adopting. Infertility can drastically change friendships, due to a lack of empathy and support from friends.
The common links between infertile people help us to gain information about possible causes and understanding of infertility. It can lead to advancements in modern medicine to possibly lessen the impact of infertility. It is important to be informed on the correct information in order to reduce the growth of infertile people worldwide. Many other factors have led to the decrease in birth rates as people have started using contraceptives and other measures that prevent contraception. These decisions are made by choice rather that being unable to have children. It is important to see that everyone has the choice to reproduce and therefore it is important to further study and investigate infertility to provide these people with cost effective, successful solutions to their infertility.
