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    What Is Infertility?

    Conception and pregnancy are complicated processes that depend upon a number of factors, including: 1) the production of healthy sperm, 2) healthy eggs; 3) unblocked fallopian tubes that allow the sperm to reach the egg; 4) the sperm's ability to fertilize the egg; 5) the ability of the fertilized egg to get implanted in the woman's uterus; and, 6) sufficient embryo quality. In addition for the pregnancy to progress to full term the embryo must be healthy and the woman's hormonal environment adequate for its development. If one of these factors is impaired, it can result in infertility.

    The failure of a couple to become pregnant after one complete year of regular, unprotected intercourse can be defined by the term infertility. Infertility affects ~10% of the population. Infertility strikes diverse groups-affecting people from all socioeconomic levels and cutting across all racial, ethnic and religious lines. Infertility is a condition that results in the abnormal functioning of the male or female reproductive system which eventually causes inability to conceive after normal intercourse. One should seek the care of a specialist if unable to achieve pregnancy after 12 months of unprotected intercourse and the women is under the age of 35, six months if the women is more than 35 years of age. You should also seek the care of a specialist if you have had more than one miscarriage.

    It is a common assumption that infertility is primarily related to the woman. Female infertility is the reason for only about a third of infertility and another third are due to male infertility. The remaining cases of infertility affect both partners or the cause is unexplained. Fertility reflects the overall health of a man. Men who live a healthy lifestyle are more likely to produce healthy sperm. In spite of the high importance of infertility due to the male partner, infertility evaluations have traditionally focused on women, because women tend to seek gynecological care and men often are reluctant to seek advice.

    There are no signs or symptoms associated with an infertility problem. Understanding your body and getting regular checkups will help to detect a problem. Early detection and treatment of a problem are often critical in achieving successful pregnancy outcomes later.

    Advancement in the field of Medicine offers more answers and treatment options to men and women trying to conceive a child. From hormonal treatments, ovulation induction and intrauterine insemination to more advanced technologies like in vitro fertilization, ICSI to surrogacy, egg/sperm donation and even embryo donation.

    Infertility often involves major personal life issues and decisions and it is often experienced as a private matter and is not ordinarily discussed in public forums. The personal nature of the infertility experience contributes to the failure of the public, politicians, healthcare professionals and the media to recognize infertility as a disease. This causes a lack of sound knowledge and available resources about infertility. Infertility has a strong impact on self-esteem. Suddenly your life, which may have been well-planned and successful, seems out-of-control. Not only is your physical body not responding as expected but it feels as if your entire life is on hold. Facing the disappointment of not becoming pregnant month after month can lead to depression for both you and your spouse.

    Reproductive endocrinologists, consider a couple to be infertile if:
    • The couple has not conceived after 12 months of contraceptive-free intercourse if the female is under the age of 34.
    • The couple has not conceived after 6 months of contraceptive-free intercourse if the female is over the age of 35.
    • The female is incapable of carrying a pregnancy to full term.
    Subfertility: A couple unsuccessfull to have a child for a year or more is believed to be subfertile or less fertile than a typical couple. Many of its causes are the same as those of infertility like endometriosis, or polycystic ovarian syndrome.

    Primary vs. secondary infertility: Couples with primary infertility have never been able to conceive, while, secondary infertility is difficulty conceiving after already having conceived or had a miscarriage. Secondary infertility is not present if there has been a change of partners.

    Combined infertility: In some cases, both the man and woman may be infertile or sub-fertile. In such cases 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 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. Also, polymorphisms in folate pathway genes could be one reason for fertility complications in some women with unexplained infertility.
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