Introduction into Infertility

Infertility is a disease of the male or female reproductive system defined by the failure to achieve clinical pregnancy even after 1 year or more of regular unprotected sexual intercourses [1]. Infertility is a global health issue affecting 15% of reproductive-aged couples worldwide and is responsible for psychological burden as well [2]. Primary infertility is the inability to have any pregnancy, while secondary infertility is the inability to have a pregnancy after previously successful conception. 

Infertility may occur due to male factors, female factors, a combination of male and female factors or some unexplained reason. However, according to WHO, environmental and lifestyle factors such as smoking (tobacco or marijuana), excessive alcohol and caffeine consumption, obesity or underweight, and exposure to environmental pollutants (heavy metals, petroleum hydrocarbons, pesticides and excessive heat) have been associated with lower fertility rates for both male and female. Major causes of female infertility are ovulatory such as polycystic ovary syndrome and other endocrine disorders like hypogonadism, acromegaly, Cushing's disease, hyperthyroidism and hypothyroidism [3]. Whereas, in case of infertility in males, low sperm counts (oligozoospermia and azoospermia), poor sperm quality (mobility and abnormality) or both, are the major responsible factors. Other causes include anatomical problems, hormonal imbalances and genetic defects [4]. 

Infertility has significant negative impacts on the social life and psychology of infertile couples. Women in particular are at greater risk of violence, divorce, social stigma, emotional stress, depression, anxiety and low self-esteem. Infertility can also have negative economic impact when households incur catastrophic out-of-pocket expenditure to access treatment.

References
1. Krol, M., Nap, A., Michels, R., Veraart, C., Goossens, L., 2019. Health state utilities for infertility and subfertility. Reprod. Health. 16(1), 47.

2. Cui, W., 2010. Mother or nothing: the agony of infertility. Bull World Health Organ. 88(12), 881-882.

3. Unuane D., Tournaye, H., Velkeniers, B., Poppe, K., 2011. Endocrine disorders & female infertility. Best Pract. Res. Clin. Endocrinol. Metab. 25(6), 861-873.

4. Leave, R.B., 2016. Male infertility: an overview of causes and treatment options. Br. J. Nurs.
25(18), S35-S40.