Infertility is the ability to achieve pregnancy after one year of unprotected sexual intercourse. Couples who have been having unprotected sex for a year and have not been able to conceive need to go for an infertility evaluation, especially if they desire to have children. However, for those couples over the age of 35, evaluation after failing to conceive after 6 months of unprotected sex is recommended. Issues of fertility and infertility have become common matters in the contemporary world due to the desire of most couples to have children of their own. Due to the rising prevalence of infertility, it is important to understand the causes and ways of preventing infertility. This paper will address the preventive measures of infertility and ways in which the public health can unite to minimize cases of infertility through awareness creation.
Challenges towards successful fertility stem from a myriad of factors ranging from genetic abnormalities, environmental agents and delayed childbearing to certain behaviors and certain diseases. Awareness of these potential risks is beneficial as it may make others adopt corrective behaviors and maintain fertility. Usually, couples do not understand the cause of their infertility. Much of the problem to do with infertility is that the causes are usually not obvious. It could be an obvious cause or a hidden pathology. Couples need to discover that infertility is a multi-pronged issue that needs to be investigated thoroughly; otherwise, it will lead to frustrations for those involved. As a result of this, it is important to create awareness so that society is aware of the causes of infertility.
Infertility is a significant problem on a global scale. In America alone, it is reported that over 10 women aged between 15 and 44 have impaired fertility. These values are according to the National Survey of Family Growth (NSFG). These figures have been rising because 2002 estimates revealed that the number was approximately 7.3 billion. Usually, the emphasis is placed on women, but men too play a significant role in these statistics even though there is an unfair spotlight on women. The desire to have children is powerful and widespread for any couple, for this reason, this issue needs to be tackled through widespread awareness and partnership of all the concerned stakeholders. It is frustrating for people to desire children and then fail to do so due to an intrinsic problem. As a result, people need to be helped through the provision of information and through awareness creation on timely interventions and the options available in the contemporary world on issues to do with fertility. Community partnership is also important since there is a stigma associated with infertility. Couples need to have a forum for airing their challenges and for reporting any problems they have. The community also needs to have noteworthy public health interventions that will manage this condition at the community level instead of depending on the hospital setting.
With the advent of technology, inventions have also been effected in the fields of reproduction. In order to combat infertility, scientists have come up with the latest diagnostic tools for determining the causes of infertility. There has also been the advent of new methods of managing infertility. These methods are accurate and beneficial in the current world. However, the expenses involved have precluded the use of these methods in other couples. There needs to be an awareness of the different options available for the management of infertility. This is because; some of the measures put in place are not a hundred percent effect. Infertile couples need to make informed choices concerning their reproductive lives without any coercion. The health condition of these people, coupled with the socio-economic implications makes them vulnerable, but due to these situations, supporting their reproductive rights becomes a priority.
Misconceptions exist about the causes of infertility. Usually, females are blamed unfairly for being the cause. Infertility is caused by a combination of male and female factors. There is a wide array of these factors. However, other factors also play a role in infertility. Some of these are unknown (idiopathic) and some are due to age-related decline in infertility.
Causes and Prevention
1) Female infertility -30%
Female infertility accounts for approximately 30% of all infertile cases. These factors need to be assessed well so that they are ruled out completely before thinking of other factors. Many of the female pathologies are treatable and preventable conditions. Based on this, health practitioners should be able to pick out these pathologies and manage them before they spill into worse forms. It also helps them to rule out other conditions. Female infertility may be caused by pelvic, cervical and ovulatory factors. The female reproductive system has a system of tubes called Fallopian tubes, ovaries, the uterus and the vagina. When any part of this system is affected, infertility results since it distorts the normal transit of sperms and ova in the system. Based on this, these factors need to be ruled out in details before picking on that.
The pelvic region has many structures that may predispose to infertility. Many of these pelvic conditions can be prevented or well managed before the conditions spill into infertility. Pelvic inflammatory disease (PID) causes tubal scarring that leads to 18% of infertility cases. This condition can be prevented through early detection of STDs like Chlamydia, which complicate to PID. Appendicitis is another condition that leads to infertility. This is a treatable condition when picked early or late. Uterine adhesions (Asherman’s Syndrome) impair implantation in the uterus. This leads to infertility. This condition is also managed surgically when picked early. Finally, DES exposure in utero predisposes to infertility. DES exposure in utero can be minimized or prevented in utero. Myomas can also be managed well surgically and medically before they spill to infertility impairment.
Normal ovulation leads to normal conception. However, any impairment to the hypothalamo-pituitary axis leads to anovulation or abnormal ovulation. This impairs fertility. For instance, hyperprolactinemia is treated by surgery and drugs. Ovarian tumors are well managed through early management. Metabolic diseases like obesity, renal disease and liver disease can all be managed early and effectively. Cervical causes also impair fertility, and due to this, any cervical incompetence or pathology needs to be addressed in time.
Male infertility also contributes immensely to infertility cases. Many factors lead to this. Endocrine disorders like pituitary failure and hyperprolactinemia need to be investigated and managed early and effectively. Anatomical disorders should also be investigated early and corrected. Varicocoele is also reported to be a common cause of male infertility. More than two thirds male infertility hospital visits in the US. This condition is easily treated. Infectious causes like orchitis are also preventable conditions in males.
Finally, environmental and occupational hazards that predispose to the other causes of infertility loss can be mitigated and avoided.
The goals for the evaluation of the causes of infertility are: to determine probable cause of infertility, provide accurate information on prognosis, counseling, support and education to the affected and guidance on treatment options. When this is done, all those affected are well managed and the public health bodies associated with this master the approach to use in managing these patients.
Management through history
The patient history is significant in managing infertility. Some of the most significant issues from the history include medical history for female factor infertility, in utero DES exposure, history of pubertal development, contraceptive history, prior pregnancy outcomes, previous pelvic surgeries, prior infections, history of abnormal pap smear and treatment, prior drugs, prior paternity –males, frequency of intercourse, previous surgery, and general health condition. These are pointers on the cause of infertility. Picking out these elements from the history enables the caregiver to determine the present cause of infertility. Failing to pick any of these may lead to missing out on important details that may assist in patient management. Summary in Management of infertility
Managing of infertility involves the following:
- Addressing and managing risk factors for infertility
- Addressing social and economic barriers to care
- The role of the public health community in combating infertility and creating awareness
These three prongs need to be emphasized since infertility is an issue that is caused by a wide array of issues. There needs to be widespread awareness.
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