Female infertility refers to infertility in female humans. It affects about 48 million women with the highest prevalence of infertility affecting people in South Asia, Sub-Saharan Africa, North Africa/Middle East, and Central/Eastern Europe and Central Asia. Infertility is caused by many sources, including nutrition, disease, and other malformations of the uterus. Infertility affects women from all over the world, and the surrounding cultural and social stigma varies.
Video Female infertility
Definisi
There is no clear definition of female infertility, because the definition depends on social and physical characteristics that may vary by culture and situation. The NICE Guide states that: "A woman of reproductive age who is not pregnant after 1 year of unprotected vaginal sex, in the absence of a known cause of infertility, should be offered clinical judgment and further investigation with her partner." It is recommended that consultation with a fertility specialist should be done earlier if the woman is 36 years of age or older, or there is a known clinical cause of infertility or a history of predisposing factors for infertility. According to the World Health Organization (WHO), infertility can be described as an inability to become pregnant, sustain a pregnancy, or bring a pregnancy to live birth. The clinical definition of infertility by WHO and ICMART is "a disease in the reproductive system defined by failure to achieve a clinical pregnancy after 12 months or more of unprotected sexual intercourse on a regular basis." Subsequent infertility can be broken down into primary and secondary infertility. Primary infertility refers to the inability to give birth either because of not being able to conceive, or bringing the child to live birth, which may include a miscarriage or a stillborn child. Secondary infertility refers to an inability to conceive or give birth when there is an earlier pregnancy or live birth.
Maps Female infertility
Prevalence
Female infertility varies greatly according to geographical location around the world. In 2010, there were an estimated 48.5 million infertile couples worldwide, and from 1990 to 2010 there was little change in infertility rates in most parts of the world. In 2010, countries with the lowest female infertility rates included South American countries Peru, Ecuador and Bolivia, as well as in Poland, Kenya, and the Republic of Korea. The highest-level regions include Eastern Europe, North Africa, the Middle East, Oceania, and Sub-Saharan Africa. The prevalence of primary infertility has increased since 1990, but secondary infertility has declined overall. The rate of decline (though not prevalence) of female infertility in high-income areas, Central/Eastern Europe, and Central Asia.
Africa
Sub-Saharan Africa has experienced a decrease in primary infertility rates from 1990 to 2010. In the Sub-Saharan region, the lowest rates are in Kenya, Zimbabwe and Rwanda, while the highest rates in Guinea, Mozambique, Angola, Gabon and Cameroon together with North Africa near the Middle East. According to a 2004 DHS report, rates in Africa are highest in Central Africa and Sub-Saharan, with East African levels closing behind.
Asia
In Asia, the highest primary and secondary infertility rates are in the South Central region, and then in the Southeast, with the lowest rates in the West.
Latin America and the Caribbean
The prevalence of female infertility in the Latin American/Caribbean region is usually lower than the global prevalence. However, the greatest levels occur in Jamaica, Suriname, Haiti, and Trinidad and Tobago. Central America and West America have some of the lowest prevalence rates. The highest regions in Latin America and the Caribbean are in the Caribbean Islands and in less developed countries.
Causes and factors
The cause or factor of female infertility can basically be classified as to whether they are acquired or genetically, or strictly based on location.
Although female infertility factors can be classified as acquired or genetically, female infertility is usually more or less a combination of nature and parenting. Also, the presence of single female infertility risk factors (such as smoking, mentioned further below) does not necessarily lead to infertility, and even if a woman is definitely infertile, infertility can not be blamed on a single risk factor even if risk factors (or have been) present.
Acquired
According to the American Society for Reproductive Medicine (ASRM), Age, Smoking, Sexually Transmitted Infections, and Weight Loss or Weight Loss may affect fertility.
In a broad sense, practical factors include any factor not based on genetic mutations, including intrauterine exposure to toxins during fetal development, which may appear as infertility years later as adults.
Age
A woman's fertility is affected by her age. The average age of the first period of a girl (menarche) is 12-13 (12.5 years in the United States, 12.72 in Canada, 12.9 in the UK), but, in postmenarchal girls, about 80% of the cycle anovulatory at the beginning of the year after menarche, 50% in the third year and 10% in the sixth year. Peak fertility of a woman in the early and mid 20s, after which began to decline, with this decrease accelerated after age 35. However, a definite estimate of a woman's chances of conceiving after a certain age is unclear, with studies giving different results. The possibility of a partner to successfully become pregnant at an advanced age depends on many factors, including women's general health and male partner's fertility.
Smoking tobacco
Tobacco smoking is harmful to the ovaries, and the extent of damage depends on the amount and length of time a woman smokes or is exposed to a smoke-filled environment. Nicotine and other harmful chemicals in cigarettes interfere with the body's ability to create estrogen, the hormone that governs folliculogenesis and ovulation. Also, smoking cigarettes interfere with follicologenesis, embryonic transport, endometrial receiving power, endometrial angiogenesis, uterine blood flow and uterine myometrium. Some damage can not be changed, but quitting smoking can prevent further damage. Smokers are 60% more likely to be infertile than non-smokers. Smoking reduces the likelihood of IVF resulting in live births by 34% and increasing the risk of miscarriage of IVF by 30%. Also, female smokers have an early onset of menopause about 1-4 years.
Sexually transmitted sexually transmitted infections
Sexually transmitted infections are a major cause of infertility. They often show little, if any visible symptoms, at the risk of failing to find the right treatment in time to prevent the decline in fertility.
Weight loss and eating disorder
Twelve percent of all cases of infertility are the result of a woman either thin or overweight. The fat cells produce estrogen, in addition to the main sex organs. Too much body fat causes too much estrogen production and the body begins to react as if it were to birth control, limiting the chances of getting pregnant. Too little body fat causes insufficient estrogen production and menstrual cycle disruption. Both underweight and overweight women have irregular cycles in which ovulation does not occur or is inadequate. Proper nutrition early in life is also a major factor for future fertility.
A study in the US showed that about 20% of infertile women had eating disorders in the past or present, which are five times higher than the prevalence rate of a general lifetime.
A review from 2010 concluded that overweight and obese middle-aged subfertile women had a lower likelihood of successful fertility treatment and their pregnancies were associated with more complications and higher costs. In a hypothetical group of 1000 women undergoing fertility treatments, the study calculated about 800 live births for normal weight and 690 live births for overweight and obese anovulum women. For ovulation women, this study calculated about 700 live births for normal weight, 550 live births for overweight and 530 live births for obese women. Increased cost per live birth in overweight and obesity anovulatory women, respectively 54 and 100% higher than their normal weight peers, for their ovulation women 44 and 70% higher, respectively.
Chemotherapy
Chemotherapy high-risk infertility. Chemotherapy with high infertility risk including procarbazine and other alkylating drugs such as cyclophosphamide, ifosfamide, busulfan, melfalan, chlorambucil and chloretin. Medium-risk drugs include doxorubicin and platinum analogs such as cisplatin and carboplatin. On the other hand, low-risk therapies of gonadotoxicity include plant derivatives such as vincristine and vinblastine, antibiotics such as bleomycin and dactinomycin and antimetabolites such as methotrexate, mercaptopurine and 5-fluorouracil.
Female infertility by chemotherapy appears to be secondary to premature ovarian failure by loss of primordial follicles. This loss is not always a direct effect of a chemotherapy agent, but can be caused by an increase in the rate of growth initiation to replace damaged follicles. The number of antral follicles decreases after three series of chemotherapy, while follicle stimulating hormone (FSH) reaches menopausal level after four series. Other hormonal changes in chemotherapy include decreased levels of the B hormone and anti-MÃÆ'¼llerian.
Women may choose between several methods of fertility preservation prior to chemotherapy, including cryopreservation of ovarian tissue, oocytes or embryos.
Immune Infertility
Antisperm antibodies (ASA) have been considered to cause infertility in about 10-30% of infertile couples. ASA production is directed against the surface antigen of the sperm, which can interfere with sperm motility and transport through the female reproductive tract, inhibiting capacitance and acrosome reactions, impaired fertilization, implantation effects, and impaired growth and development of the embryo. Factors contributing to the formation of antisperm antibodies in women are impaired normal immunoregulation mechanisms, infections, mucosal integrity violations, unintentional rape and unprotected oral or anal sex.
Other factors obtained
- Secondary adhesions to surgery in the peritoneal cavity are the major causes of infertility acquired. A meta-analysis in 2012 came to the conclusion that there is little evidence for a surgical principle that uses less invasive techniques, introduces less foreign matter or causes less ischemia to reduce the level and severity of adhesion.
- Diabetes mellitus. A review of type 1 diabetes comes to the result that, despite modern treatment, women with diabetes are at increased risk of female infertility, as reflected by delayed puberty and menarche, menstrual irregularities (especially oligomenorrhoea), mild hyperandrogenism, polycystic ovary syndrome, fewer children born alive and possibly early menopause. Animal models show that abnormalities at the molecular level caused by diabetes include leptin defects, insulin and kisspeptin signaling.
- celiac disease. The symptoms of non-gastrointestinal celiac disease may include impaired fertility, such as delayed menarche, amenorrea, infertility or early menopause; and pregnancy complications, such as intrauterine growth restriction (IUGR), small for infant gestational age (SGA), recurrent abortion, premature or low birth weight (LBW). However, a gluten-free diet reduces the risk. Some authors suggest that doctors should investigate the presence of undiagnosed celiac disease in women with unexplained infertility, recurrent miscarriage or IUGR.
- Significant liver or kidney disease
- Thrombophilia
- Smoking marijuana, such as marijuana causes disruption of the endocannabinoid system, potentially causing infertility
- Radiation, as in radiation therapy. The dose of radiation to the ovaries that generally causes permanent female infertility is 20.3 Gy at birth, 18.4 Gy at 10 years, 16.5 Gy at 20 years and 14.3 Gy at 30 years. After total body irradiation, recovery of gonad function occurs in 10-14% of cases, and the number of pregnancies observed after hematopoietic stem cell transplantation involving such a procedure is lower than 2%.
Genetic factors
There are many genes where mutations cause female infertility, as shown in the table below. Also, there are additional conditions involving female genetic infertility that are believed to be genetic but where no single gene is found to be responsible, especially Mayer-Rokitansky-KÃÆ'¼stner-Hauser Syndrome (MRKH). Finally, a number of unknown genetic mutations lead to a state of subfertility, which in addition to other factors such as environments that can manifest as bright infertility.
Chromosomal abnormalities that cause female infertility include Turner's syndrome. Oocyte donation is an alternative for patients with Turner syndrome.
Some of these gene or chromosome abnormalities cause intersex conditions, such as androgen insensitivity syndrome.
By location
Hypothalamic-pituitary factors
- Hypothalamic dysfunction
- Hyperprolactinemia
Ovarian factors
- Chemotherapy (as described earlier) with a particular agent has a high toxicity risk on the ovaries.
- Many genetic defects (as well as before) also interfere with ovarian function.
- Polycystic ovary syndrome (see also infertility in polycystic ovary syndrome)
- Anovulation. Female infertility caused by anovulation is called "anovulatory infertility," as opposed to "ovulation infertility" in which ovulation is present.
- Reduced ovarian reserve, also see Poor Ovarium Reserve
- Early menopause
- Menopause
- Luteal dysfunction
- Gonadal dysgenesis (Turner syndrome)
- Ovarian cancer
Tubal (ectopic)/peritoneal factor
- Endometriosis (see also endometriosis and infertility)
- Pelvic adhesion
- Pelvic inflammatory disease (PID, usually due to chlamydia)
- Tubal occlusion
- Tubal dysfunction
- Previous ectopic pregnancy. A randomized study in 2013 came to the result that intrauterine gestational rates 2 years after ectopic pregnancy treatment were about 64% with radical surgery, 67% with drugs, and 70% with conservative surgery. For comparison, the cumulative pregnancy rate of women under age 40 in the general population over 2 years is over 90%.
Factor uterus
- uterine malformation
- Uterine fibroids
- Asherman's Syndrome
- Implant failure without a known primary cause. This results in a negative pregnancy test even if it has been done eg embryo transfer.
Previously, bikornuate uterus was thought to be associated with infertility, but recent studies have not confirmed such a relationship.
Cervical factors
- Cervical Stenosis
- Antisperm antibody
- Non-receptive cervical mucus
Vaginal Factor
- Vaginismus
- Vaginal obstruction
Diagnosis
The diagnosis of infertility begins with medical history and physical examination. Healthcare providers may order tests, including the following:
- Lab test
- hormone test, to measure female hormone levels at certain times during the menstrual cycle
- day 2 or 3 size of FSH and estrogen, to assess ovarian reserve
- measurement of thyroid function (thyroid stimulating hormone level (TSH) between 1 and 2 is considered optimal for conception)
- measurement of progesterone in the second half of the cycle to help ensure ovulation
- Anti-MÃÆ'¼llerian Hormone to estimate ovarian reserve.
- Inspection and imaging
- endometrial biopsy, to verify ovulation and examine the lining of the uterus
- laparoscopy, which allows the provider to examine pelvic organs
- fertiloscopy, a relatively new surgical technique used for early diagnosis (and immediate treatment)
- Pap smear, to check for signs of infection
- pelvic examination, to look for abnormalities or infections
- postcoital test, conducted immediately after sexual intercourse to check for problems with live sperm in cervical mucus (not commonly used today due to unreliable test)
- Hysterosalpingography or sonosalpingography, to check the tube patency
- Sonohysterography to check for uterine abnormalities.
There is a genetic testing technique that is being developed to detect mutations in genes associated with female infertility.
Initial diagnosis and treatment of infertility is usually done by a gynecologist or a female health nurse practitioner. If initial treatment is unsuccessful, referrals are usually performed for physicians trained as reproductive endocrinologists. Reproductive endocrinologists are usually obstetricians/gynecologists with advanced training in reproductive endocrinology and infertility (in North America). These doctors treat reproductive disorders that affect not only women but also men, children, and adolescents.
Usually endocrine reproduction & amp; Infertility medical practices do not see women for general maternity care. This practice is mainly focused on helping their women to become pregnant and fixing problems related to recurrent recurrent miscarriage.
Prevention
Female infertility acquired can be prevented through identified interventions:
- Maintain a healthy lifestyle. Excessive exercise, caffeine and alcohol consumption, and smoking are all associated with decreased fertility. Eating a well-balanced diet, with plenty of fresh fruits and vegetables, and maintaining normal weight, on the other hand, have been linked to better fertility prospects.
- Treat or prevent existing diseases. Identifying and controlling chronic diseases such as diabetes and hypothyroidism enhances the prospect of fertility. Safe lifetime practice reduces the possibility that sexually transmitted diseases will damage fertility; getting proper care for sexually transmitted diseases reduces the likelihood that such infections will cause significant damage. Regular physical examination (including pap smears) helps to detect early signs of infection or abnormalities.
- Do not delay the parent. Fertility ultimately does not stop before menopause, but begins to decline after age 27 and drops to a somewhat greater level after age 35. Women whose biological mothers have unusual or abnormal problems associated with getting pregnant may be at special risk for some conditions, such as early menopause, which can be reduced by not delaying parents.
- Frozen eggs. A woman can freeze her eggs to keep her fertility. By using egg freezing while at the peak of the reproductive year, a woman's oocyte is cryogenically frozen and ready for future use, reducing the likelihood of female infertility.
Society and culture
Social stigma
Social stigma due to infertility is seen in many cultures around the world in various forms. Often, when women can not get pregnant, blame is given to them, even when about 50% of infertility problems come from the man. In addition, many societies only tend to value a woman if she is able to produce at least one child, and marriage can be considered a failure when a couple can not get pregnant. The act of childbearing can be attributed to the perfection of the marriage partner, and reflects their social role in society. This is seen in the "African infertility belt", where infertility is prevalent in Africa that includes countries stretching from Tanzania in the east to Gabon in the west. In this region, infertility is highly stigmatized and can be considered a couples failure for their community. This is shown in Uganda and Nigeria where there is considerable pressure imposed on children and its social implications. This is also seen in some Muslim societies including Egypt and Pakistan.
Wealth is sometimes measured by the number of children a woman owns, as well as the property heritage. Children can affect financial security in many ways. In Nigeria and Cameroon, land claims are determined by the number of children. Also, in some Sub-Saharan countries, women may be denied the right of inheritance if they do not bear children. In some African and Asian countries, a husband can deprive an infertile wife of food, shelter, and other basic necessities such as clothing. In Cameroon, a woman may lose access to the land of her husband and go alone in old age.
In many cases, a woman who can not bear children is excluded from social and cultural events including traditional ceremonies. This stigmatization is seen in Mozambique and Nigeria where infertile women have been treated as outcasts to society. It is an embarrassing practice that belittles infertile women in society. In the Macua tradition, pregnancy and birth are regarded as major life events for a woman, with nthaaÃ,Â'ra and nthaÃ,Â'ara no mwana ceremonies, which can only be attended by women who have been pregnant and have babies.
The effects of infertility can cause social embarrassment from the internal and social norms surrounding pregnancy, affecting women around the world. When pregnancy is considered an important event in life, and is considered a "socially unacceptable condition," pregnancy can lead to the search for treatment in the form of traditional healers and expensive Western care. Limited access to treatment in many areas can lead to extreme and sometimes illegal actions to produce children.
Wedding roles
Men in some countries may find another wife when their first wife can not produce children, hoping that by sleeping with more women, she will be able to produce her own child. This can happen in some communities, including Cameroon, Nigeria, Mozambique, Egypt, Botswana, and Bangladesh, among many others where polygamy is more common and more socially acceptable.
In some cultures, including Botswana and Nigeria, women can choose the woman with whom she allows her husband to sleep in the hope of conceiving a child. Women who are desperate for children can compromise with their husbands to choose a woman and accept the task of taking care of the children to feel welcome and useful in society.
Women can also sleep with other men in the hope of getting pregnant. This can be done for various reasons including advice from traditional healers, or find out if other men are "more suitable". In many cases, the husband is unaware of the extra sexual relationship and will not be told if a woman is pregnant by another man. This is unacceptable culturally, and can contribute to the gender suffering of women who have fewer options for conceiving alone than men.
Men and women can also turn to divorce in an attempt to find a new partner with whom to give birth to a child. Infertility in many cultures is the reason for divorce, and a way for men or women to increase their chances of producing an heir. When a woman gets divorced, she can lose her security that often comes with land, wealth, and family. This can ruin a marriage and may cause distrust in marriage. Increased sexual partners potentially lead to the spread of the disease including HIV/AIDS, and can actually contribute to the infertility of future generations.
Domestic harassment
The stress and emotional stress that comes with infertility in the home can lead to mistreatment and domestic violence of a woman. Devaluation of a wife because of her inability to conceive can lead to domestic abuse and emotional trauma such as blaming victims. Women are sometimes or often blamed for causing partner infertility, which can lead to emotional abuse, anxiety, and embarrassment. In addition, being blamed for not being able to get pregnant is often imposed on women, even if it is a man who is infertile. Women who are unable to conceive can starve, be beaten, and may be neglected financially by her husband as if she does not have children who use them for her. Physical abuse associated with infertility may result from this and the emotional distress that comes with it. In some countries, emotional and physical violations that come with infertility can potentially lead to attacks, killing, and suicide.
Mental and psychological impact
Many infertile women tend to cope with enormous stress and social stigma behind their condition, which can cause considerable mental stress. The long-term stress involved in attempting to conceive a child and the social pressure behind childbirth can cause emotional distress that can manifest as a mental illness. Women who suffer from infertility may face psychological pressure such as rejection, anger, sadness, guilt, and depression. There are many social insults that can lead to strong feelings of sadness and frustration that potentially contribute to depression and suicide. The implications behind infertility bear the great consequences for the mental health of an infertile woman because of the social pressures and personal grief behind being unable to bear children.
See also
- Infertility
- Male infertility
- Meiosis
- Oncofertility
- Primary infertility
- Secondary infertility
- Fertility
References
Source of the article : Wikipedia
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