INFERTILITY

 The essentials of Infertility

• Infertility is a male or female reproductive system disease characterized by the inability to achieve pregnancy after 12 months or more of regular unprotected sexual intercourse.
• Millions of people of reproductive age worldwide are affected by infertility, which has an impact on their families and communities. According to estimates, 48 million couples and 186 million individuals worldwide suffer from infertility.
• Infertility in the male reproductive system is most commonly caused by problems with sperm ejection (1), sperm absence or low levels, or abnormal shape (morphology) and movement (motility) of the sperm.
• Infertility in the female reproductive system can be caused by a variety of abnormalities in the ovaries, uterus, fallopian tubes, and endocrine system, among other things.
• Primary or secondary infertility exists. A person has primary infertility if they have never had a pregnancy, and secondary infertility if they have had at least one prior pregnancy.
• Fertility care encompasses infertility prevention, diagnosis, and treatment. In most countries, especially in low and middle-income countries, equal and equitable access to fertility care remains a challenge. Fertility care is rarely prioritized in benefit packages for national universal health coverage.

What factors contribute to infertility?

Infertility can be caused by a variety of factors in both the male and female reproductive systems. However, explaining the causes of infertility is not always possible.

Infertility in the female reproductive system can be caused by:

Tubal disorders, such as blocked fallopian tubes, are caused by untreated sexually transmitted infections (STIs) or complications of unsafe abortion, postpartum sepsis, or abdominal/pelvic surgery; uterine disorders, which can be inflammatory (such as endometriosis), congenital (such as septate uterus), or benign (such as fibroids); ovarian disorders, such as polycystic ovarian syndrome and other follicular disorders; The hypothalamus and pituitary glands are part of the endocrine system. Pituitary cancers and hypopituitarism are two common disorders affecting this system.

he relative importance of these causes of female infertility may vary by country, for example, due to differences in the background prevalence of STIs or the ages of the populations studied. 

Infertility in men can be caused by:

• Obstruction of the reproductive tract, resulting in dysfunctional sperm ejection. This obstruction can occur in the tubes that carry sperm (such as ejaculatory ducts and seminal vesicles). Blockages are most commonly caused by genital tract injuries or infections.
• Hormonal disorders cause abnormalities in hormones produced by the pituitary gland, hypothalamus, and testicles. Hormones such as testosterone control sperm production. Pituitary or testicular cancers are two examples of disorders that cause hormonal imbalance.
• testicular sperm production failure, such as varicoceles or medical treatments that impair sperm-producing cells (such as chemotherapy).
• Sperm function and quality are abnormal. Conditions or situations that cause abnormal sperm shape (morphology) and movement (motility) have a negative impact on fertility.

Smoking, excessive alcohol consumption, and obesity can all have an impact on fertility. Furthermore, environmental pollutants and toxins can be directly toxic to gametes (eggs and sperm), resulting in decreased numbers and poor quality, leading to infertility.

Why is it important to address infertility?

Every human being has the right to the best physical and mental health that can be obtained. Individuals and couples have the right to choose how many children they want, when they want them, and how far apart they want them. Infertility can make it difficult to realize these basic human rights. Addressing infertility is thus an important part of realizing individuals' and couples' right to start a family.

Infertility management and fertility care services may be required for a wide range of people, including heterosexual couples, same-sex partners, older people, individuals who are not in sexual relationships, and those with certain medical conditions, such as some HIV sero-discordant couples and cancer survivors.

Infertility treatment can also help to reduce gender inequality. Although both men and women can be infertile, women who are in a relationship with a man are frequently perceived to be infertile, whether they are or are not. Infertility has significant negative social consequences for infertile couples, particularly women, who frequently face violence, divorce, social stigma, emotional stress, depression, anxiety, and low self-esteem.

Fear of infertility can deter women and men from using contraception in some settings if they feel socially pressured to prove their fertility at a young age due to the high social value of childbearing. In such cases, education and awareness-raising interventions are critical to addressing understanding of the prevalence and determinants of fertility and infertility.

Overcoming obstacles

Most countries continue to struggle with the availability, accessibility, and quality of infertility interventions. Infertility diagnosis and treatment are frequently overlooked in national population and development policies and reproductive health strategies, and are rarely covered by public health funding. Furthermore, even in countries that are actively addressing the needs of people with infertility, a lack of trained personnel and the necessary equipment and infrastructure, as well as the current high costs of treatment medicines, are major barriers.

While assisted reproduction technologies (ART) have been available for more than three decades, with more than 5 million children born worldwide as a result of ART interventions such as in vitro fertilization (IVF), these technologies remain largely unavailable, inaccessible, and unaffordable in many parts of the world, particularly in low and middle-income countries (LMIC).

Government policies could help to address the many inequities in access to safe and effective fertility care. To effectively address infertility, health policies must recognize that infertility is a disease that can often be prevented, reducing the need for costly and inaccessible treatments. Incorporating fertility awareness into national comprehensive sexuality education programs, promoting healthy lifestyles to reduce behavioral risks, including STI prevention, diagnosis, and early treatment, preventing complications of unsafe abortion, postpartum sepsis, and abdominal/pelvic surgery, and addressing environmental toxins associated with infertility are policy and programmatic interventions that all governments can implement.

Furthermore, enabling laws and policies governing third-party reproduction and ART are required to ensure universal access without discrimination, as well as to protect and promote the human rights of all parties involved. Once fertility policies are in place, it is critical to monitor their implementation and continually improve service quality.

The WHO's response

WHO recognizes that providing high-quality family planning services, including fertility care, is a critical component of reproductive health. Recognizing the significance of infertility and its impact on people's quality of life and well-being, WHO is committed to addressing infertility and fertility care by:

• Collaborating with partners to conduct global epidemiological and etiological infertility research. Engaging and facilitating policy dialogue with countries around the world to frame infertility within a supportive legal and policy framework.

• Supporting the collection of data on the burden of infertility in order to inform resource allocation and service delivery.
• Creating guidelines for the prevention, diagnosis, and treatment of male and female infertility as part of global norms and quality care standards for fertility care.
• Other normative products, such as the WHO laboratory manual for the examination and processing of human sperm, are constantly revised and updated.
• Collaborating with relevant stakeholders such as academic institutions, ministries of health, other UN organizations, non-state actors (NSAs), and other partners to increase political commitment, availability, and health system capacity to provide fertility care globally.
• Providing member states with country-level technical assistance in developing or strengthening national fertility policies and services.