Infertility

"Demographers tend to define infertility as childlessness in a population of women of reproductive age." The epidemiological definition refers to "trying for" or "time to" a pregnancy, generally in a population of women exposed to a probability of conception. Currently, female fertility normally peaks in young adulthood. It diminishes after age 35, with pregnancy occurring rarely after age 50. A female is most fertile within 24 hours of ovulation. Male fertility peaks usually in young adulthood and declines after age 40. The time needed to pass (during which the couple tries to conceive) for that couple to be diagnosed with infertility differs between different organizations. Existing definitions of infertility lack uniformity, rendering comparisons in prevalence between countries or over time problematic. Therefore, data estimating the prevalence of infertility cited by various sources differ significantly. World Health Organization The World Health Organization defines infertility as follows: United States One definition of infertility that is frequently used in the United States by reproductive endocrinologists, doctors who specialize in infertility, to consider a couple eligible for treatment is: • A woman under 35 has not conceived after 12 months of contraceptive-free intercourse. • A woman over 35 has not conceived after six months of contraceptive-free sexual intercourse. United Kingdom In the UK, previous NICE guidelines defined infertility as failure to conceive after regular unprotected sexual intercourse for two years in the absence of known reproductive pathology. Updated NICE guidelines do not include a specific definition, but recommend that "A woman of reproductive age who has not conceived after 1 year of unprotected vaginal sexual intercourse, in the absence of any known cause of infertility, should be offered further clinical assessment and investigation along with her partner, with earlier referral to a specialist if the woman is over 36 years of age." Other definitions Researchers commonly base demographic studies on infertility prevalence over five years. Primary vs. secondary infertility Primary infertility is defined as the absence of a live birth for women who desire a child and have been in a union for at least 12 months, during which they have not used any contraceptives. Secondary infertility is defined as the difficulty in conceiving a live birth in couples who previously had a child. ==Effects==

Psychological The consequences of infertility are manifold and can include societal repercussions and personal suffering. Advances in assisted reproductive technologies, such as IVF, can offer hope to many couples where treatment is available. Medical coverage and affordability barriers exist. The medicalization of infertility has unwittingly led to a disregard for the emotional responses that couples experience, which include distress, loss of control, stigmatization, and a disruption in the developmental trajectory of adulthood. One of the main challenges in assessing the distress levels in women with infertility is the accuracy of self-report measures. It is possible that women "fake good" to appear mentally healthier than they are. It is also possible that women feel a sense of hopefulness/increased optimism before initiating infertility treatment, which is when most assessments of distress are collected. Some early studies concluded that infertile women did not report any significant differences in symptoms of anxiety and depression compared to fertile women. The further into treatment a patient goes, the more often they display symptoms of depression and anxiety. Patients with one treatment failure had significantly higher levels of anxiety, and patients with two failures experienced more depression when compared with those without a history of treatment. However, it has also been shown that the more depressed the infertile woman, the less likely she is to start infertility treatment and the more likely she is to drop out after only one cycle. Researchers have also shown that, despite a good prognosis and having the finances available to pay for treatment, discontinuation is most often due to psychological reasons. Fertility does not seem to increase when the women takes antioxidants to reduce the oxidative stress brought by the situation. Infertility may have psychological effects. Parenthood is one of the major transitions in adult life for both men and women. The stress of the non-fulfilment of a wish for a child has been associated with emotional consequences such as anger, depression, anxiety, marital problems, and feelings of worthlessness. Partners may become more anxious to conceive, increasing sexual dysfunction. Marital discord often develops, especially when they are under pressure to make medical decisions. Women trying to conceive often have depression rates similar to those of women who have heart disease or cancer. Emotional stress and marital difficulties are greater in couples where the infertility lies with the man. Male and female partners respond differently to infertility problems. In general, women show higher depression levels than their male partners when dealing with infertility. A possible explanation may be that women feel more responsible and guilty than men during the process of trying to conceive. On the other hand, infertile men experience psychosomatic distress. Societal pressures may affect a couple's decision to approach, avoid, or experience an infertility treatment. Moreover, the socioeconomic status influences the psychology of infertile couples: low socioeconomic status is associated with increased chances of developing depression. In the United States, some treatments for infertility, including diagnostic tests, surgery, and therapy for depression, can qualify one for Family and Medical Leave Act leave. It has been suggested that infertility be classified as a form of disability. Sexual Couples that suffer from infertility have a higher risk than other couples of developing sexual dysfunctions. The most common sexual issue facing couples is a decline in sexual desire and erectile dysfunction. ==Causes==

Male infertility is responsible for 20–30% of infertility cases, while 20–35% are due to female infertility, and 25–40% are due to combined problems in both partners. In 10–20% of cases, no cause is found. Natural infertility Before puberty, humans are naturally infertile; their gonads have not yet developed the gametes required to reproduce: boys' testicles have not developed the sperm cells required to impregnate a female; girls have not begun the process of ovulation which activates the fertility of their egg cells (ovulation is confirmed by the first menstrual cycle, known as menarche, which signals the biological possibility of pregnancy). Infertility in children is commonly referred to as prepubescence (or being prepubescent, an adjective used to also refer to humans without secondary sex characteristics). The absence of fertility in children is considered a natural part of human growth and child development, as the hypothalamus in their brain is still underdeveloped and cannot release the hormones required to activate the gonads' gametes. Fertility in children before the ages of eight or nine is considered a disease known as precocious puberty. This disease is usually triggered by a brain tumor or other related injury. Delayed puberty Delayed puberty, puberty absent past or occurring later than the average onset (between the ages of ten and fourteen), may be a cause of infertility. In the United States, girls are considered to have delayed puberty if they have not started menstruating by age 16 (alongside lacking breast development by age 13).