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July 30, 2010 |
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The International Council on Infertility Information Dissemination (INCIID) considers a couple to be infertile iffn|1:
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". Primary vs. secondary 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 cases are "unexplained"fn|2. A Robertsonian translocation in either partner may cause habitual abortion|recurrent abortions or complete infertility. "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 are:
Male infertility Factors relating to male infertility includefn|3:
Some causes of male infertility can be determined by analysis of the ejaculate, which contains the sperm. The analysis includes counting the number of sperm and measuring their motility under a microscope:
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 be 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, that 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.
Not everyone has insurance coverage for fertility investigations and treatments, especially when a couple already has children. 2005 approximate costs in US$:
Another way to look at costs is to determine the cost of establishing a pregnancy. Thus if a clomiphene treatment has a chance to establish a pregnancy in 8% of cycles and costs $500, it will cost ~ $6,000 to establish a pregnancy, compared to an IVF cycle (cycle fecundity 40%) with a corresponding cost of ($12,000/40%) $30,000. Most insurances do not cover the cost of infertility treatment. Many states are starting to mandate coverage. There are many ethical issues associated with infertility and its treatment.
Infertility may have profound psychological effects. Partners 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 cancerfn|4. A lot of women find themselves to be in-between worlds, so to speak. That is, infertile couples would be abnormal and fertile couples are normal. It???s about ???us??? vs. ???them,??? and infertile women would often compare themselves to fertile women. Such social comparisons permitted both self-evaluation and self-enhancement; they allowed women to determine where they ???fit into the scheme of things??? and to find the ???slide rule??? that would enable them to measure whether they were better or worse off, or ???at least equal to everybody else.??? If infertility treatment is unsuccessful after several attempts, the most difficult decision a couple faces is whether to keep trying this or another treatment, or to discontinue treatment. In many cultures, 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. There are also legal ramifications as well. Infertility has begun to gain more exposure to legal domains. An estimated 4 million workers in the U.S. used the Family and Medical Leave Act (FMLA) in 2004 to care for a child, parent or spouse, or because of their own personal illness. Many treatments for infertility, including diagnostic tests, surgery and therapy for depression, can qualify you for FMLA leave.
Category:Gynecology Category:Andrology Category:Fertility medicine de:Unfruchtbarkeit fr:St??rilit?? it:Sterilit?? he:?????????? lt:Nevaisingumas ms:Mandul nn:ufrivillig barnl??yse This article is licensed under the GNU Free Documentation License. It uses material from the Wikipedia article "Infertility".
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