The Causes and Consequences of Infertility for Individuals, Families and Wider Society - Essay Example

Discuss the causes and consequences of infertility for individuals, families and wider society. Key Words: Couple, Infertility, STIs, Family Building, Reproductive, Causes, Ovulation, Semen, Pre-implantation genetic diagnosis (PGD), Ovulation dysfunction, Disorders, Introduction Infertility is a very common problem and if people stopped to think about it, they would realize that they each know at least one person who is infertile or a couple that has been trying to have a child but they are not able (Perkins & Jackie, 2011). Infertility is the inability of a couple to produce an offspring despite six months of usual sex devoid of any contraceptive (Reece & Barbieri, 2010). Infertility is the contrast of sterility since it may be reversible in some cases (Reece & Barbieri, 2010). People often correlate Infertility with hormonal imbalance, genetic makeup and infectious diseases in both men and women. In addition, infertility can also entail the inability to carry a pregnancy to full term leading to miscarriages (Perkins & Jackie, 2011, p.1). Infertility does not only affect the couple trying to have children but it also impacts greatly on their families and the wider society, especially in the contemporary western culture (Peters, Jackson & Rudge, 2011, p.130). Nevertheless, this topic remains a taboo issue that people do not want to talk about yet it interferes with the most fundamental human activity of building a family. Infertility is a very serious reproductive health problem that may result from a number of preventable and non-preventable conditions related to both males and females and it may have far-reaching consequences on the individuals trying to conceive, their families and the wider society. Biological perspectives Infertility has numerous causes. Initially, people thought that only women were infertile but the truth is males-factor conditions are responsible for half of all the couples who are infertile. The non-preventable conditions that may cause infertility include various genetic, immunological, hormonal and anatomical problems that are responsible for preventing successful pregnancies (Solinger, 2013, p.100). The prevalence of non-preventable conditions is the same within and across populations and is responsible for causing infertility in five percent of all infertile couples. Most of the times infertility is due to preventable conditions and this is the reason why the variations in infertility rates are significant in any given population due to the preventable conditions being more or less prevalent in a given population. The preventable infertility causes are due to occupational or environmental factors and various infections (Kirch, 2009, p.782). There are some sexually transmitted infections (STIs) related to infertility such as gonorrhea (Fauser & Devroey, 2011). Since these symptoms are asymptomatic, it is hard to detect them until the occurrence of permanent damage. Historically, in Central Africa, there was a high prevalence of STIs, which is the reason behind infertility being very high in that region and since there has been an improvement in the diagnosis and treatment of STIs, the infertility rates is now declining (Fauser & Devroey, 2011, p.209). Other parasitic diseases and infections associated with increasing the risk of infertility include schistosomiasis, tuberculosis, malaria and sickle cell disease (Kirch, 2009, p.782). In a report compiled in the mid 1990s, the causes of infertility in 14, 141 couples were 27 percent ovulation disorder, 25 percent abnormal semen, 22 percent tubal occlusion, 5 percent endometriosis and 17 percent are unexplained (Noll & Wilms, 2010). Other lists of infertility include immunological factor, cervical mucus factor and endometrial factor in between five and fifteen percent of the cases. Results obtained from pre-implantation genetic diagnosis (PGD) and IVF performed due to unexplained infertility revealed that many cases of infertility are due to defective gametes or old age (Noll & Wilms, 2010, p.280). Over 60 percent of the infertile women who received the clomiphene citrate (CC) treatment and the treatment failed had undiagnosed male factor or cervical factor. Thin endometrial linings, endometriosis or unsuspected tubal diseases, hypothyroidism and insulin resistance were some of the other contributing factors (Dickey, Richard, Brinsden & Pyrzak, 2009, p.19). Other causes of infertility are due to individuals’ exposure to substances that are potentially toxic in the environment such as aflatoxins, arsenic or pesticides. Pesticide exposure may cause low sperm quality and count. Individuals ingesting substances that are potentially toxic such as tobacco, caffeine or alcohol may lead to infertility because of abnormal sperm production (Kirch, 2009, p.782). Ovulation disorders are the cause of most infertility in women. The World Health Organization (WHO) classifies ovulation disorders into three categories. The first group is the hypothalamic-pituitary failure. Its characteristics include low estrogen and follicle-stimulating hormones and amenorrhea. Common causes for these are weight loss, stress, anorexia nervosa, exercise, isolated pituitary gonadotropin deficiency and the Kallmann syndrome. The second group is the hypothalamic-pituitary dysfunction. Its characteristics include anovulatory or irregular menses. Common causes include androgen disorders and polycystic ovary syndrome. The third group is ovarian failure whose characteristics include low estrogen and FSH and amenorrhea. Ovulation dysfunction is another ovulation disorder although not classified by WHO. Ovulation dysfunction has four types: anovulation where there is heavy menstruation that is not regular (menometorrhagia), ovulation where the menses is infrequent (oligomenorrhea), ovulation where there is a low level of luteal-phase progesterone (luteal insufficiency) and pseudo-ovulation where there are ovulatory cycles but no oocyte released (luteinized un-ruptured follicle) (Dickey, Richard, Brinsden & Pyrzak, 2009, p.20). The causes of infertility in men range from simple, correctible and reversible to uncorrectable and irreversible ones. Men either acquire or inherit these conditions. The factors that affect male fertility are in four major categories: sperm production disorder, sperm function and sperm transport, which constitute the essential causes of infertility in males. The fourth category includes the infertilities with unknown origins, conditions in which the infertility arises from obscure unknown causes or spontaneously. This category accounts for between 37 and 58 percent of all the cases and is divided into two categories: idiopathic male infertility and unexplained male infertility. Thirty percent of all male infertility is due to the idiopathic male infertility and its characteristics include unexplained reduction in the quality of semen whereby no previous infertility history exists and normal findings upon physical examinations and endocrine laboratory testing (Balen, 2013, p.35). The term ‘unexplained male infertility’ refers to the men who are infertile but with unknown origin and normal semen profile, and female infertility in this case already ruled out. Between 6 and 27 percent of male infertility belong to this category and strongly depends on the exhaustiveness of the patient’s evaluation (Dubey, 2012, p.31). For men seeking evaluation, the most common observed abnormality is the varicocele followed by cryptorchidism and obstruction. Primary testicular disease (primary spermatogenic failure) is a common cause of infertility in males. It might even be most reason for all infertilities. As the name implies, it is a testis primary disorder. Testes work like the brain meaning that they cannot repair themselves easily. Therefore, the primary testicular disease is mostly an untreatable condition. The causes of this condition are varied. Depending on how severe it is, primary testicular disorder presents with either oligozoospermia or azoospermia. Minor degrees for the primary testicular disease may give rise to semen analysis deemed normal. It is quite interesting to note that primary ovarian diseases only make up two percent of all the infertility in women but in men, the situation is exactly the opposite with just two percent of male infertility being related to hypothalamic-pituitary axis disturbances or endocrine lesions (Jequier, 2011, p.88). The modern infertility treatments make it possible to circumvent most of these infertility causes. However, when doctors do not diagnose primary causes and treat them on time, they may not only impair the patient’s fertility only but also the general health (Dickey, Richard, Brinsden & Pyrzak, 2009, p.19). Epidemiological studies show that the chances of any couple achieving conception are between 80 and 90 percent after a whole year of regular well-timed sexual intercourse while the monthly chances for conception are between 20 and 25 percent (Dubey, 2012, p.31). The optimum fertility age for conceiving in both males and females is 24 years. Therefore, the potential of fertility decreases, particularly for females, after 31 years of age. For the infertile couples, their spontaneous pregnancy rate, because of idiopathic reasons, depends on the semen analysis result. For the non-azoospermic men, the rate of pregnancy is between one and three percent per month, with 23 percent within two years and ten percent within another 2 additional years (Dubey, 2012, p.31). However, for the infertile couples whose male partners have normal analysis, their cumulative pregnancy rates range from fifty to eighty percent over a period of three years as a function of female age and from thirty to eighty percent as a function of infertility duration. It is possible to achieve a cumulative pregnancy rate of sixty percent for this category of patients. For infertility periods that are longer than 3 years, they are associated with low pregnancy rate of between one and three percent especially of the female partners are aged 35 years and older (Dubey, 2012, p.31). Nutritional perspective When comparing the fertility rates in sedentary and nomadic populations in Sudan, the results strongly suggest that apart from the biological causes, the relationship between the activities performed and the intake of food is a major determinant of female fertility. The same relationship is present in the western countries where there is a significant difference between the general population and women involved in intense exercises. The menstrual irregularities of the general population were as low as 1.8 percent but in ballerinas, it was as high as 79 percent (Hollins, Van, Martin & Preedy, 2014, p.24). Fertility requires about 22 percent of female body fat and it is possible to restore fertility in athletes who gain around 1-2 kg or decrease their exercise load by 10 percent (Hollins, Van, Martin & Preedy, 2014, p.24). Sociological perspective Inequalities in the access of reproductive services exist globally. This is because most women from developing economies do not have the ease of access as women from the developed economies do. Moreover, some healthcare practices and procedures cause infections capable of causing permanent damages to the reproductive tract. They include unhygienic obstetric practices and some sexual initiation rates that are harmful to the female reproductive organs especially in parts of the developing economies. Poor hygiene may lead to sepsis and postpartum infections, infections caused by insertion of intrauterine devices (IUD) or septic abortions and the subsequent complications (Coward & Wells, 2013, p.139). Mostly due to the quality of healthcare, women from industrialized countries do not have high probabilities like their counterparts in the third world countries of experiencing nosocomial infections, which lead to infertility (Kirch, 2009, p.782). Psychological perspective Infertility is a very serious issue that has severe consequences on women, men and communities. This is because infertility is not only a medical condition but also a social one (Carrell & Peterson, 2010, p.93). Even though infertility is involuntary childlessness, whereby the couples lack a choice over their reproduction status; it leads to reactions comparative to grief responses. Research shows that individuals and couples who do not the ability of governing their reproduction futures go through extensive emotional turmoil due to a feeling of failure over what they have failed to achieve (Schmidt, 2009). In several societies, infertility, may lead to couples divorcing. Even in the cultures where people accept infertility, the infertile couples still suffer with inadequacy feelings, depression, shame and grief. In most cases, women withstand the worst of the blame and they normally carry the heaviest burden of their inability to conceive (Kirch, 2009, p.782). It is not women alone who suffer, but men are also severely affected by the infertility stigma, for example men fearing being considered impotent. However, the fact that men are not blamed more than women are causes women to continuously seek and undergo treatments persistently. The male infertility also has psychological consequences and affects their community relations (Malhotra, Haththotuwa & Tank, 2012, p.26). Nevertheless, the consequences of infertility for individuals vary depending on importance of motherhood to women or depending on how much a couple wants children. This is because some people want children more than others and others do not want children at all (Allan, 2009, p.40). Infertility is often a chronic stressor, which develops slowly as a problematic and continuous state in the social roles and conditions. Infertile people appear to be more distressed than other individuals are generally (Crawshaw & Balen, 2010, p.19). The magnitude of this stress can be compared with cancer. Additionally, the stress brought about by infertility is second to the stress involved in losing a loved one (Van, Heggenhougen, & Quah, 2011, p.141). Other scholars such as Schuiling & Likis, (2013 p.461) suggest that high levels of stress may actually cause infertility and vice versa. Many cultures stigmatize infertile people and it may lead to discrimination, ridicule, exclusion and in extreme instances, abuse. The community may mock the family in which an infertile woman comes from. Additionally, the family in which a woman is married into may treat an infertile woman badly because she is not able to conceive. The infertile couples may end up resorting to ineffective interventions and medications possibly by unqualified practitioners. In addition, they may spend most of their earnings on religious rituals with the belief that it would make them conceive through unseen forces and dispel any evils preventing their conception. These negative consequences are more prevalent in the developing countries. A summary of the consequences in different levels ranges from the psychological consequences such as guilt, fear and self-blame to the most sever, which is lost dignity and death. The first level is a sense of worthlessness; the second is depression, helplessness and marital issues. The third is marital or social violence and the fourth is a total loss of social status and moderate to severe violence. The fifth level is starvation, disease or violence aided suicide while the last level is the loss of dignity or (and) death (Malhotra, Haththotuwa & Tank, 2012, p.26). Conclusion Infertility is a very serious reproductive health problem that may result from a number of preventable and non-preventable conditions related to both males and females and it may have far-reaching consequences on the individuals trying to conceive, their families and the wider society. Therefore, it should be an important public health concern and the government should not treat it as a personal problem. This is because there are numerous causes of infertility for both men and women, most of which are preventable or reversible. Moreover, childlessness affects the couple trying to have a baby so much especially the women and may even lead to suicide. References Top of Form Top of Form Top of Form Bottom of Form Top of Form Bottom of Form Top of Form Top of Form Top of Form Bottom of Form Top of Form Top of Form Bottom of Form Top of Form Top of Form Bottom of Form Bottom of Form Top of Form Bottom of Form Top of Form Bottom of Form Top of Form Top of Form Allan, H. T. 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