Infertility is fundamentally the inability to conceive offspring. Infertility also refers to the state of a woman who is unable to carry a pregnancy to full term. There are many biological causes of infertility, including some that medical intervention can treat. Infertility has increased by 4 percent since the 1980s, mostly from problems with fecundity due to an increase in age. About 40 percent of the issues involved with infertility are due to the man, another 40 percent due to the woman, and 20 percent result from complications with both partners.
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.
This section deals with unintentional problems of sterility.
Problems could be either sex
Factors that can cause male as well as female infertility are:
• DNA damage
o DNA damage reduces fertility in female ovocytes, as caused by smoking, other xenobiotic DNA damaging agents (such as radiation or chemotherapy) or accumulation of the oxidative DNA damage 8-hydroxy-deoxyguanosine
o DNA damage reduces fertility in male sperm, as caused by oxidative DNA damage, smoking, other xenobiotic DNA damaging agents (such as drugs or chemotherapy)[21] or other DNA damaging agents including reactive oxygen species, fever or high testicular temperature
• Genetic factors
o A Robertsonian translocation in either partner may cause recurrent spontaneous abortions or complete infertility.
• General factors
o Diabetes mellitus, thyroid disorders, adrenal disease
• Hypothalamic-pituitary factors
o Hyperprolactinemia
o Hypopituitarism
o The presence of anti-thyroid antibodies is associated with an increased risk of unexplained subfertility with an odds ratio of 1.5 and 95% confidence interval of 1.1–2.0.
• Environmental factors
o Toxins such as glues, volatile organic solvents or silicones, physical agents, chemical dusts, and pesticides. Tobacco smokers are 60% more likely to be infertile than non-smokers.
German scientists have reported that a virus called Adeno-associated virus might have a role in male infertility, though it is otherwise not harmful. Mutation that alters human DNA adversely can cause infertility, the human body thus preventing the tainted DNA from being passed on.
Specific female causes
The following causes of infertility may only be found in females. For a woman to conceive, certain things have to happen: intercourse must take place around the time when an egg is released from her ovary; the systems that produce eggs and sperm have to be working at optimum levels; and her hormones must be balanced. For women, problems with fertilisation arise mainly from either structural problems in the Fallopian tube or uterus or problems releasing eggs. Infertility may be caused by blockage of the Fallopian tube due to malformations, infections such as chlamydia and/or scar tissue. For example, endometriosis can cause infertility with the growth of endometrial tissue in the Fallopian tubes and/or around the ovaries. Endometriosis is usually more common in women in their mid-twenties and older, especially when postponed childbirth has taken place.
Another major cause of infertility in women may be the inability to ovulate. Malformation of the eggs themselves may complicate conception. For example, polycystic ovarian syndrome is when the eggs only partially developed within the ovary and there is an excess of male hormones. Some women are infertile because their ovaries do not mature and release eggs. In this case synthetic FSH by injection or Clomid (Clomiphene citrate) via a pill can be given to stimulate follicles to mature in the ovaries.
Other factors that can affect a woman’s chances of conceiving include being overweight or underweight, or her age as female fertility declines after the age of 35.
Sometimes it can be a combination of factors, and sometimes a clear cause is never established.
Common causes of infertility of females include:
• ovulation problems (e.g. polycystic ovarian syndrome, PCOS, the leading reason why women present to fertility clinics due to anovulatory infertility.
• tubal blockage
• pelvic inflammatory disease
• age-related factors
• uterine problems
• previous tubal ligation
• endometriosis
• advanced maternal age
Specific male causes
The main cause of male infertility is low semen quality. In men who have the necessary reproductive organs to procreate, infertility can be caused by low sperm count due to endocrine problems, drugs, radiation, or infection. There may be testicular malformations, hormone imbalance, or blockage of the man’s duct system. Although many of these can be treated through surgery or hormonal substitutions, some may be more indefinite. Infertility associated with viable, but immotile sperm may be caused by primary ciliary dyskinesia.
Treatment depends on the cause of infertility, but may include counselling, fertility treatments, which include in vitro fertilization. According to ESHRE recommendations, couples with an estimated live birth rate of 40% or higher per year are encouraged to continue aiming for a spontaneous pregnancy. Treatment methods for infertility may be grouped as medical or complementary and alternative treatments. Some methods may be used in concert with other methods. Drugs used for women include Clomiphene citrate, Human menopausal gonadotropin, Follicle-stimulating hormone, Human chorionic gonadotropin, Gonadotropin-releasing hormone analogs, Aromatase inhibitor, Metformin.
At-home conception kit
In 2007 the FDA cleared the first at home tier one medical conception device to aid in conception. The key to the kit are cervical caps for conception. This at home [cervical cap] insemination method allows all the semen to be placed up against the cervical os for six hours allowing all available sperm to be placed directly on the cervical os. For low sperm count, low sperm motility, or a tilted cervix using a cervical cap aids conception. This is a prescriptive medical device, but not commonly prescribed by physicians.
Assisted Natural Conception
For some causes of infertility, assisted natural conception can provide couples with a pregnancy rate at least as high as the one provided by fertility treatment. This is typically for couples with unexplained infertility, sperm count above 5M/ml, one tube blocked, or other mild infertility causes.
Medical treatments
Medical treatment of infertility generally involves the use of fertility medication, medical device, surgery, or a combination of the following. If the sperm are of good quality and the mechanics of the woman’s reproductive structures are good (patent fallopian tubes, no adhesions or scarring), physicians may start by prescribing a course of ovarian stimulating medication. The physician or WHNP may also suggest using a conception cap cervical cap, which the patient uses at home by placing the sperm inside the cap and putting the conception device on the cervix, or intrauterine insemination (IUI), in which the doctor or WHNP introduces sperm into the uterus during ovulation, via a catheter. In these methods, fertilization occurs inside the body.
If conservative medical treatments fail to achieve a full term pregnancy, the physician or WHNP may suggest the patient undergo in vitro fertilization (IVF). IVF and related techniques (ICSI, ZIFT, GIFT) are called assisted reproductive technology (ART) techniques.
ART techniques generally start with stimulating the ovaries to increase egg production. After stimulation, the physician surgically extracts one or more eggs from the ovary, and unites them with sperm in a laboratory setting, with the intent of producing one or more embryos. Fertilization takes place outside the body, and the fertilized egg is reinserted into the woman’s reproductive tract, in a procedure called embryo transfer.
Other medical techniques are e.g. tuboplasty, assisted hatching, and Preimplantation genetic diagnosis.

• Makar RS, Toth TL (2002). “The evaluation of infertility”. Am J Clin Pathol. 117 (Suppl): S95–103. PMID 14569805.
• Maheshwari, A. (2008). Human Reproduction. pp. 538–542.
• Hudson, B. (1987). The infertile couple. Churchill-Livingstone, Edinburgh.
• Gurunath, S.; Pandian, Z.; Anderson, R. A.; Bhattacharya, S. (2011). “Defining infertility–a systematic review of prevalence studies”. Human Reproduction Update 17 (5): 575–88. doi:10.1093/humupd/dmr015. PMID 21493634.
• “WHO | Infertility”. 2013-03-19. Retrieved 2013-06-17.
• Cooper TG, Noonan E, von Eckardstein S, et al. (2010). “World Health Organization reference values for human semen characteristics”. Hum. Reprod. Update 16 (3): 231–45. doi:10.1093/humupd/dmp048. PMID 19934213.
• [1] Fertility: Assessment and Treatment for People with Fertility Problems. London: RCOG Press. 2004. ISBN 1-900364-97-2.

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