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Female infertility

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Title: Female infertility  
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Subject: Zygote intrafallopian transfer, Vulvitis, Theca lutein cyst, Kraurosis vulvae, Parametritis
Collection: Fertility, Fertility Medicine, Infertility, Noninflammatory Disorders of Female Genital Tract
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Female infertility

Female infertility
Classification and external resources
ICD-10 N97.0
ICD-9-CM 628
DiseasesDB 4786
MedlinePlus 001191
eMedicine med/3535
MeSH D007247

Female infertility refers to infertility in female humans. It affects an estimated 48 million women[1] with the highest prevalence of infertility affecting people in South Asia, Sub-Saharan Africa, North Africa/Middle East, and Central/Eastern Europe and Central Asia.[1] Infertility is caused by many sources, including nutrition, diseases, and other malformations of the uterus. Infertility affects women from around the world, and the cultural and social stigma surrounding it varies.

Contents

  • Definition 1
  • Prevalence 2
    • Africa 2.1
    • Asia 2.2
    • Latin America and Caribbean 2.3
  • Causes and factors 3
    • Acquired 3.1
      • Age 3.1.1
      • Tobacco smoking 3.1.2
      • Sexually transmitted infections 3.1.3
      • Body weight and eating disorders 3.1.4
      • Chemotherapy 3.1.5
      • Other acquired factors 3.1.6
    • Genetic factors 3.2
    • By location 3.3
      • Hypothalamic-pituitary factors 3.3.1
      • Ovarian factors 3.3.2
      • Tubal (ectopic)/peritoneal factors 3.3.3
      • Uterine factors 3.3.4
      • Cervical factors 3.3.5
      • Vaginal factors 3.3.6
  • Diagnosis 4
  • Prevention 5
  • Society and culture 6
    • Social stigma 6.1
    • Marital role 6.2
    • Domestic abuse 6.3
    • Mental and psychological impact 6.4
  • See also 7
  • References 8

Definition

There is no unanimous definition of female infertility, because the definition depends on social and physical characteristics which may vary by culture and situation.

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  2. ^ a b c Fertility: assessment and treatment for people with fertility problems. NICE clinical guideline CG156 - Issued: February 2013
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  5. ^ World Health Organization 2013."Sexual and reproductive health: Infertility definitions and terminology". Available http://www.who.int/reproductivehealth/topics/infertility/definitions/en/.Retrieved November 5, 2013.
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  24. ^ a b Rosendahl, M.; Andersen, C.; La Cour Freiesleben, N.; Juul, A.; Løssl, K.; Andersen, A. (2010). "Dynamics and mechanisms of chemotherapy-induced ovarian follicular depletion in women of fertile age". Fertility and Sterility 94 (1): 156–166.  
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  27. ^ a b Codner, E.; Merino, P. M.; Tena-Sempere, M. (2012). "Female reproduction and type 1 diabetes: From mechanisms to clinical findings". Human Reproduction Update 18 (5): 568.  
  28. ^ Tersigni C, Castellani R, de Waure C, Fattorossi A, De Spirito M, Gasbarrini A, Scambia G, Di Simone N (2014). "Celiac disease and reproductive disorders: meta-analysis of epidemiologic associations and potential pathogenic mechanisms". Hum Reprod Update 20 (4): 582–93.  
  29. ^ Lasa, JS; Zubiaurre, I; Soifer, LO (2014). "Risk of infertility in patients with celiac disease: a meta-analysis of observational studies". Arq Gastroenterol 51 (2): 144–50.  
  30. ^ Middeldorp S (2007). "Pregnancy failure and heritable thrombophilia". Semin. Hematol. 44 (2): 93–7.  
  31. ^ Qublan HS, Eid SS, Ababneh HA, et al. (2006). "Acquired and inherited thrombophilia: implication in recurrent IVF and embryo transfer failure". Hum. Reprod. 21 (10): 2694–8.  
  32. ^ Karasu, T.; Marczylo, T. H.; MacCarrone, M.; Konje, J. C. (2011). "The role of sex steroid hormones, cytokines and the endocannabinoid system in female fertility". Human Reproduction Update 17 (3): 347–361.  
  33. ^ Tichelli André, Rovó Alicia (2013). "Fertility Issues Following Hematopoietic Stem Cell Transplantation". Expert Rev Hematol 6 (4): 375–388.  
    In turn citing: Wallace WH, Thomson AB, Saran F, Kelsey TW (2005). "Predicting age of ovarian failure after radiation to a field that includes the ovaries". Int. J. Radiat. Oncol. Biol. Phys. 62 (3): 738–744. 
  34. ^ Tichelli André, Rovó Alicia (2013). "Fertility Issues Following Hematopoietic Stem Cell Transplantation". Expert Rev Hematol 6 (4): 375–388.  
  35. ^
    In turn citing: Salooja N, Szydlo RM, Socie G, et al. "Pregnancy outcomes after peripheral blood or bone marrow transplantation: a retrospective survey". Lancet 358 (9278): 271–276.  
  36. ^ Sultan C, Biason-Lauber A, Philibert P (January 2009). "Mayer-Rokitansky-Kuster-Hauser syndrome: recent clinical and genetic findings". Gynecol Endocrinol 25 (1): 8–11.  
  37. ^ Bodri D, Vernaeve V, Figueras F, Vidal R, Guillén JJ, Coll O (March 2006). "Oocyte donation in patients with Turner's syndrome: a successful technique but with an accompanying high risk of hypertensive disorders during pregnancy". Hum Reprod. 2006 Mar;21(3): 829–832. 
  38. ^ a b Unless otherwise specified in boxes, then reference is: The Evian Annual Reproduction (EVAR) Workshop Group 2010; Fauser, B. C. J. M.; Diedrich, K.; Bouchard, P.; Domínguez, F.; Matzuk, M.; Franks, S.; Hamamah, S.; Simón, C.; Devroey, P.; Ezcurra, D.; Howles, C. M. (2011). "Contemporary genetic technologies and female reproduction". Human Reproduction Update 17 (6): 829–847.  
  39. ^ Wang, Jian; Zhang, Wenxiang; Jiang, Hong; Wu, Bai-Lin (2014). "Mutations inHFM1in Recessive Primary Ovarian Insufficiency". New England Journal of Medicine 370 (10): 972–974.  
  40. ^ Caburet, Sandrine; Arboleda, Valerie A.; Llano, Elena; Overbeek, Paul A.; Barbero, Jose Luis; Oka, Kazuhiro; Harrison, Wilbur; Vaiman, Daniel; Ben-Neriah, Ziva; García-Tuñón, Ignacio; Fellous, Marc; Pendás, Alberto M.; Veitia, Reiner A.; Vilain, Eric (2014). "Mutant Cohesin in Premature Ovarian Failure". New England Journal of Medicine 370 (10): 943–949.  
  41. ^ Huang, Hua-Lin; Lv, Chao; Zhao, Ying-Chun; Li, Wen; He, Xue-Mei; Li, Ping; Sha, Ai-Guo; Tian, Xiao; Papasian, Christopher J.; Deng, Hong-Wen; Lu, Guang-Xiu; Xiao, Hong-Mei (2014). "Mutant ZP1 in Familial Infertility". New England Journal of Medicine 370 (13): 1220–1226.  
  42. ^ Female Infertility
  43. ^ Hull MG, Savage PE, Bromham DR (June 1982). "Anovulatory and ovulatory infertility: results with simplified management". Br Med J (Clin Res Ed) 284 (6330): 1681–5.  
  44. ^ Luteal Phase Dysfunction at eMedicine
  45. ^ Guven MA, Dilek U, Pata O, Dilek S, Ciragil P (2007). "Prevalence of Chlamydia trochomatis, Ureaplasma urealyticum and Mycoplasma hominis infections in the unexplained infertile women". Arch. Gynecol. Obstet. 276 (3): 219–23.  
  46. ^ García-Ulloa AC, Arrieta O (2005). "Tubal occlusion causing infertility due to an excessive inflammatory response in patients with predisposition for keloid formation". Med. Hypotheses 65 (5): 908–14.  
  47. ^ Fernandez, H.; Capmas, P.; Lucot, J. P.; Resch, B.; Panel, P.; Bouyer, J. (2013). "Fertility after ectopic pregnancy: The DEMETER randomized trial". Human Reproduction 28 (5): 1247–1253.  
  48. ^ Raga F, Bauset C, Remohi J, Bonilla-Musoles F, Simón C, Pellicer A (1997). "Reproductive impact of congenital Müllerian anomalies". Hum. Reprod. 12 (10): 2277–81.  
  49. ^ Magos A (2002). "Hysteroscopic treatment of Asherman's syndrome". Reprod. Biomed. Online 4 (Suppl 3): 46–51.  
  50. ^ Shuiqing M, Xuming B, Jinghe L (2002). "Pregnancy and its outcome in women with malformed uterus". Chin. Med. Sci. J. 17 (4): 242–5.  
  51. ^ Proctor JA, Haney AF (2003). "Recurrent first trimester pregnancy loss is associated with uterine septum but not with bicornuate uterus". Fertil. Steril. 80 (5): 1212–5.  
  52. ^ Tan Y, Bennett MJ (2007). "Urinary catheter stent placement for treatment of cervical stenosis". The Australian & New Zealand journal of obstetrics & gynaecology 47 (5): 406–9.  
  53. ^ Francavilla F, Santucci R, Barbonetti A, Francavilla S (2007). "Naturally-occurring antisperm antibodies in men: interference with fertility and clinical implications. An update". Front. Biosci. 12 (8–12): 2890–911.  
  54. ^ Farhi J, Valentine A, Bahadur G, Shenfield F, Steele SJ, Jacobs HS (1995). "In-vitro cervical mucus-sperm penetration tests and outcome of infertility treatments in couples with repeatedly negative post-coital tests". Hum. Reprod. 10 (1): 85–90.  
  55. ^ Wartofsky L, Van Nostrand D, Burman KD (2006). "Overt and 'subclinical' hypothyroidism in women". Obstetrical & gynecological survey 61 (8): 535–42.  
  56. ^ Broer, S. L.; Broekmans, F. J. M.; Laven, J. S. E.; Fauser, B. C. J. M. (2014). "Anti-Mullerian hormone: ovarian reserve testing and its potential clinical implications". Human Reproduction Update 20 (5): 688–701.  
  57. ^ Hall, Carl T. (April 30, 2002). "Study speeds up biological clocks / Fertility rates dip after women hit 27". The San Francisco Chronicle. Retrieved 2007-11-21. 
  58. ^ "Information on Egg Freezing". Egg Freezing. Retrieved 6 March 2015. 
  59. ^ Egg Vitrification Process Retrieved 28. June 2015
  60. ^ a b c d e WHO (2010). "Mother or nothing: the agony of infertility." Bulletin World Health Organization, 2010(88) 881–882 doi:10.2471/BLT.10.011210
  61. ^ a b c d e f g h i j k l m Araoye, M. O. (2003). "Epidemiology of infertility: social problems of the infertile couples." West African journal of medicine (22;2): 190-196.
  62. ^ Robert J. Leke, Jemimah A. Oduma, Susana Bassol-Mayagoitia, Angela Maria Bacha, and Kenneth M. Grigor. "Regional and Geographical Variations in Infertility: Effects of Environmental, Cultural, and Socioeconomic Factors" Environmental Health Perspectives Supplements (101) (Suppl. 2): 73-80 (1993).
  63. ^ a b c d e f g Inhorn, M. C. (2003). "Global infertility and the globalization of new reproductive technologies: illustrations from Egypt." Social Science & Medicine (56): 1837 - 1851.
  64. ^ a b c d e f g h Dyer, S. J. (2012). "The economic impact of infertility on women in developing countries – a systematic review." FVV in ObGyn: 38-45.
  65. ^ a b c d e f Gerrits, T. (1997). "Social and cultural aspects of infertility in Mozambique." Patient Education and Counseling (31): 39-48.
  66. ^ a b Whiteford, L. M. (1995). "STIGMA: THE HIDDEN BURDEN OF INFERTILITY." Sot. Sci. Med. (40;1): 27-36.
  67. ^ a b c d e f g Mogobe, D. K. (2005). "Denying and Preserving Self: Batswana Women's Experiences of Infertility." African Journal of Reproductive Health (9;2): 26-37.
  68. ^ Omberlet, W. (2012). "Global access to infertility care in developing countries: a case of human rights, equity and social justice " FVV in ObGyn: 7-16.
  69. ^ McQuillian, J., Greil, A.L., White, L., Jacob, M.C. (2003). "Frustrated Fertility: Infertility and Psychological Distress among Women." Journal of Marriage and Family (65;4): 1007-1018.
  70. ^ Reproductive Health Outlook (2002). "Infertility: Overview and lessons learned."
  71. ^ Matthews A. M., Matthews R. (1986). "Beyond the Mechanics of Infertility: Perspectives on the Social Psychology of Infertility and Involuntary Childlessness". Family Relations 35 (4): 479–487.  

References

See also

Many infertile women tend to cope with immense stress and social stigma behind their condition, which can lead to considerable mental distress.[69] The long-term stress involved in attempting to conceive a child and the social pressures behind giving birth can lead to emotional distress that may manifest as mental disease.[70] Women who suffer from infertility might deal with psychological stressors such as denial, anger, grief, guilt, and depression.[71] There can be considerable social shaming that can lead to intense feelings of sadness and frustration that potentially contribute to depression and suicide.[67] The implications behind infertility bear huge consequences for the mental health of an infertile woman because of the social pressures and personal grief behind being unable to bear children.

Mental and psychological impact

The emotional strain and stress that comes with infertility in the household can lead to the mistreatment and domestic abuse of a woman. The devaluation of a wife due to her inability to conceive can lead to domestic abuse and emotional trauma such as victim blaming. Women are sometimes or often blamed as the cause of a couples' infertility, which can lead to emotional abuse, anxiety, and shame.[61] In addition, blame for not being able to conceive is often put on the female, even if it is the man who is infertile.[60] Women who are not able to conceive can be starved, beaten, and may be neglected financially by her husband as if she had no child bearing use to him.[64] The physical abuse related to infertility may result from this and the emotional stress that comes with it. In some countries, the emotional and physical abuses that come with infertility can potentially lead to assault, murder, and suicide.[68]

Domestic abuse

Men and women can also turn to divorce in attempt to find a new partner with whom to bear a child. Infertility in many cultures is a reason for divorce, and a way for a man or woman to increase his/her chances of producing an heir.[61][63][65][67] When a woman is divorced, she can lose her security that often comes with land, wealth, and a family.[67] This can ruin marriages and can lead to distrust in the marriage. The increase of sexual partners can potentially result with the spread of disease including HIV/AIDS, and can actually contribute to future generations of infertility.[67]

Women may also sleep with other men in hopes of becoming pregnant.[65] This can be done for many reasons including advice from a traditional healer, or finding if another man was "more compatible". In many cases, the husband was not aware of the extra sexual relations and would not be informed if a woman became pregnant by another man.[65] This is not as culturally acceptable however, and can contribute to the gendered suffering of women who have fewer options to become pregnant on their own as opposed to men.[63]

In some cultures, including Botswana [67] and Nigeria,[61] women can select a woman with whom she allows her husband to sleep with in hopes of conceiving a child.[61] Women who are desperate for children may compromise with her husband to select a woman and accept duties of taking care of the children to feel accepted and useful in society.[67]

Men in some countries may find another wife when their first cannot produce a child, hoping that by sleeping with more women he will be able to produce his own child.[61][63][64] This can be prevalent in some societies, including Cameroon,[61][64] Nigeria,[61] Mozambique,[65] Egypt,[63] Botswana,[67] and Bangladesh,[64] among many more where polygamy is more common and more socially acceptable.

Marital role

The effect of infertility can lead to social shaming from internal and social norms surrounding pregnancy, which affects women around the world.[66] When pregnancy is considered such an important event in life, and considered a “socially unacceptable condition”, it can lead to a search for treatment in the form of traditional healers and expensive Western treatments.[63] The limited access to treatment in many areas can lead to extreme and sometimes illegal acts in order to produce a child.[61][63]

In many cases, a woman who cannot bear children is excluded from social and cultural events including traditional ceremonies. This stigmatization is seen in Mozambique and Nigeria where infertile women have been treated as outcasts to society.[61] This is a humiliating practice which devalues infertile women in society.[65][66] In the Macua tradition, pregnancy and birth are considered major life events for a woman, with the ceremonies of nthaa´ra and ntha´ara no mwana, which can only be attended by women who have been pregnant and have had a baby.[65]

Wealth is sometimes measured by the number of children a woman has, as well as inheritance of property.[61][64] Children can influence financial security in many ways. In Nigeria and Cameroon, land claims are decided by the number of children. Also, in some Sub-Saharan countries women may be deniedinheritance if she did not bear any children [64] In some African and Asian countries a husband can deprive his infertile wife of food, shelter and other basic necessities like clothing.[64] In Cameroon, a woman may lose access to land from her husband and left on her own in old age.[61]

Social stigma due to infertility is seen in many cultures throughout the world in varying forms. Often, when women cannot conceive, the blame is put on them, even when approximately 50% of infertility issues come from the man .[60] In addition, many societies only tend to value a woman if she is able to produce at least one child, and a marriage can be considered a failure when the couple cannot conceive.[60] The act of conceiving a child can be linked to the couple’s consummation of marriage, and reflect their social role in society.[61] This is seen in the "African infertility belt", where infertility is prevalent in Africa which includes countries spanning from Tanzania in the east to Gabon in the west.[60] In this region, infertility is highly stigmatized and can be considered a failure of the couple to their societies.[60][62] This is demonstrated in Uganda and Nigeria where there is a great pressure put on childbearing and its social implications.[61] This is also seen in some Middle Eastern societies including Egypt [63] and Pakistan.[64]

Social stigma

Society and culture

  • Maintaining a healthy lifestyle. Excessive exercise, consumption of caffeine and alcohol, and smoking have all been associated with decreased fertility. Eating a well-balanced, nutritious diet, with plenty of fresh fruits and vegetables, and maintaining a normal weight, on the other hand, have been associated with better fertility prospects.
  • Treating or preventing existing diseases. Identifying and controlling chronic diseases such as diabetes and hypothyroidism increases fertility prospects. Lifelong practice of safer sex reduces the likelihood that sexually transmitted diseases will impair fertility; obtaining prompt treatment for sexually transmitted diseases reduces the likelihood that such infections will do significant damage. Regular physical examinations (including pap smears) help detect early signs of infections or abnormalities.
  • Not delaying parenthood. Fertility does not ultimately cease before menopause, but it starts declining after age 27 and drops at a somewhat greater rate after age 35.[57] Women whose biological mothers had unusual or abnormal issues related to conceiving may be at particular risk for some conditions, such as premature menopause, that can be mitigated by not delaying parenthood.
  • Egg freezing. A woman can freeze her eggs preserve her fertility. By using egg freezing while in the peak reproductive years, a woman's oocytes are cryogenically frozen and ready for her use later in life, reducing her chances of female infertility. [58] Vitrification is the technique which preserves a determinate number of a woman's mature eggs. We use the ultra-rapid freezing method, which keeps these cells in an unaltered state over an indefinite period of time.[59]

Acquired female infertility may be prevented through identified interventions:

Prevention

Usually reproductive endocrinology & infertility medical practices do not see women for general maternity care. The practice is primarily focused on helping their women to conceive and to correct any issues related to recurring pregnancy loss.

Initial diagnosis and treatment of infertility is usually made by obstetrician/gynecologists or women's health nurse practitioners. If initial treatments are unsuccessful, referral is usually made to physicians who are fellowship trained as reproductive endocrinologists. Reproductive endocrinologists are usually obstetrician/gynecologists with advanced training in reproductive endocrinology and infertility (in North America). These physicians treat reproductive disorders affecting not only women but also men, children, and teens.

There are genetic testing techniques under development to detect any mutation in genes associated with female infertility.[38]

Diagnosis of infertility begins with a medical history and physical exam. The healthcare provider may order tests, including the following:

Diagnosis

Vaginal factors

  • Non-receptive cervical mucus[54]
  • Antisperm antibodies[53]

Cervical factors

Previously, a bicornuate uterus was thought to be associated with infertility,[50] but recent studies have not confirmed such an association.[51]

Uterine factors

  • Previous ectopic pregnancy. A randomized study in 2013 came to the result that the rates of intrauterine pregnancy 2 years after treatment of ectopic pregnancy are approximately 64% with radical surgery, 67% with medication, and 70% with conservative surgery.[47] In comparison, the cumulative pregnancy rate of women under 40 years of age in the general population over 2 years is over 90%.[2]
  • Tubal dysfunction

Tubal (ectopic)/peritoneal factors

  • Luteal dysfunction[44]
  • Anovulation. Female infertility caused by anovulation is called "anovulatory infertility", as opposed to "ovulatory infertility" in which ovulation is present.[43]
  • Many genetic defects (as also detailed previously) also disturb ovarian function.
  • Chemotherapy (as detailed previously) with certain agents have a high risk of toxicity on the ovaries.

Ovarian factors

Hypothalamic-pituitary factors

By location

Genes wherein mutation causes female infertility[38]
Gene Encoded protein Effect of deficiency
BMP15 Bone morphogenetic protein 15 Hypergonadotrophic ovarian failure (POF4)
BMPR1B Bone morphogenetic protein receptor 1B Ovarian dysfunction, hypergonadotrophic hypogonadism and acromesomelic chondrodysplasia
CBX2; M33 Chromobox protein homolog 2 ; Drosophila polycomb class Autosomal 46,XY, male-to-female sex reversal (phenotypically perfect females)
CHD7 Chromodomain-helicase-DNA-binding protein 7 CHARGE syndrome and Kallmann syndrome (KAL5)
DIAPH2 Diaphanous homolog 2 Hypergonadotrophic, premature ovarian failure (POF2A)
FGF8 Fibroblast growth factor 8 Normosmic hypogonadotrophic hypogonadism and Kallmann syndrome (KAL6)
FGFR1 Fibroblast growth factor receptor 1 Kallmann syndrome (KAL2)
HFM1 Primary ovarian failure[39]
FSHR FSH receptor Hypergonadotrophic hypogonadism and ovarian hyperstimulation syndrome
FSHB Follitropin subunit beta Deficiency of follicle-stimulating hormone, primary amenorrhoea and infertility
FOXL2 Forkhead box L2 Isolated premature ovarian failure (POF3) associated with BPES type I; FOXL2 402C --> G mutations associated with human granulosa cell tumours
FMR1 Fragile X mental retardation Premature ovarian failure (POF1) associated with premutations
GNRH1 Gonadotropin releasing hormone Normosmic hypogonadotrophic hypogonadism
GNRHR GnRH receptor Hypogonadotrophic hypogonadism
KAL1 Kallmann syndrome Hypogonadotrophic hypogonadism and insomnia, X-linked Kallmann syndrome (KAL1)
KISS1R ; GPR54 KISS1 receptor Hypogonadotrophic hypogonadism
LHB Luteinizing hormone beta polypeptide Hypogonadism and pseudohermaphroditism
LHCGR LH/choriogonadotrophin receptor Hypergonadotrophic hypogonadism (luteinizing hormone resistance)
DAX1 Dosage-sensitive sex reversal, adrenal hypoplasia critical region, on chromosome X, gene 1 X-linked congenital adrenal hypoplasia with hypogonadotrophic hypogonadism; dosage-sensitive male-to-female sex reversal
NR5A1; SF1 Steroidogenic factor 1 46,XY male-to-female sex reversal and streak gonads and congenital lipoid adrenal hyperplasia; 46,XX gonadal dysgenesis and 46,XX primary ovarian insufficiency
POF1B Premature ovarian failure 1B Hypergonadotrophic, primary amenorrhea (POF2B)
PROK2 Prokineticin Normosmic hypogonadotrophic hypogonadism and Kallmann syndrome (KAL4)
PROKR2 Prokineticin receptor 2 Kallmann syndrome (KAL3)
RSPO1 R-spondin family, member 1 46,XX, female-to-male sex reversal (individuals contain testes)
SRY Sex-determining region Y Mutations lead to 46,XY females; translocations lead to 46,XX males
SOX9 SRY-related HMB-box gene 9 Autosomal 46,XY male-to-female sex reversal (campomelic dysplasia)
STAG3 Stromal antigen 3 Premature ovarian failure[40]
TAC3 Tachykinin 3 Normosmic hypogonadotrophic hypogonadism
TACR3 Tachykinin receptor 3 Normosmic hypogonadotrophic hypogonadism
ZP1 zona pellucida glycoprotein 1 Dysfunctional zona pellucida formation[41]

Some of these gene or chromosome abnormalities cause intersexed conditions, such as androgen insensitivity syndrome.

Chromosomal abnormalities causing female infertility include Turner syndrome. Oocyte donation is an alternative for patients with Turner syndrome.[37]

There are many genes wherein mutation causes female infertility, as shown in table below. Also, there are additional conditions involving female infertility which are believed to be genetic but where no single gene has been found to be responsible, notably Mayer-Rokitansky-Küstner-Hauser Syndrome (MRKH).[36] Finally, an unknown number of genetic mutations cause a state of subfertility, which in addition to other factors such as environmental ones may manifest as frank infertility.

Genetic factors

Other acquired factors

Women may choose between several methods of fertility preservation prior to chemotherapy, including cryopreservation of ovarian tissue, oocytes or embryos.[25]

Female infertility by chemotherapy appears to be secondary to [23] Antral follicle count decreases after three series of chemotherapy, whereas follicle stimulating hormone (FSH) reaches menopausal levels after four series.[24] Other hormonal changes in chemotherapy include decrease in inhibin B and anti-Müllerian hormone levels.[24]

Chemotherapy poses a high risk of infertility. Chemotherapies with high risk of infertility include procarbazine and other alkylating drugs such as cyclophosphamide, ifosfamide, busulfan, melphalan, chlorambucil and chlormethine.[22] Drugs with medium risk include doxorubicin and platinum analogs such as cisplatin and carboplatin.[22] On the other hand, therapies with low risk of gonadotoxicity include plant derivatives such as vincristine and vinblastine, antibiotics such as bleomycin and dactinomycin and antimetabolites such as methotrexate, mercaptopurine and 5-fluorouracil.[22]

Chemotherapy

A review from 2010 concluded that overweight and obese subfertile women have a reduced probability of successful fertility treatment and their pregnancies are associated with more complications and higher costs. In hypothetical groups of 1000 women undergoing fertility care, the study counted approximately 800 live births for normal weight and 690 live births for overweight and obese anovulatory women. For ovulatory women, the study counted approximately 700 live births for normal weight, 550 live births for overweight and 530 live births for obese women. The increase in cost per live birth in anovulatory overweight and obese women were, respectively, 54 and 100% higher than their normal weight counterparts, for ovulatory women they were 44 and 70% higher, respectively.[21]

A study in the US indicated that approximately 20% of infertile women had a past or current eating disorder, which is five times higher than the general lifetime prevalence rate.[20]

[19] Proper nutrition in early life is also a major factor for later fertility.[14] Both under and overweight women have irregular cycles in which ovulation does not occur or is inadequate.[14].menstrual cycle Too little body fat causes insufficient production of estrogen and disruption of the [14] Twelve percent of all infertility cases are a result of a woman either being

Body weight and eating disorders

Sexually transmitted infections are a leading cause of infertility. They often display few, if any visible symptoms, with the risk of failing to seek proper treatment in time to prevent decreased fertility.[14]

Sexually transmitted infections

Tobacco smoking is harmful to the ovaries, and the degree of damage is dependent upon the amount and length of time a woman smokes or is exposed to a smoke-filled environment. Nicotine and other harmful chemicals in cigarettes interfere with the body’s ability to create estrogen, a hormone that regulates folliculogenesis and ovulation. Also, cigarette smoking interferes with folliculogenesis, embryo transport, endometrial receptivity, endometrial angiogenesis, uterine blood flow and the uterine myometrium.[13] Some damage is irreversible, but stopping smoking can prevent further damage.[14][15] Smokers are 60% more likely to be infertile than non-smokers.[16] Smoking reduces the chances of IVF producing a live birth by 34% and increases the risk of an IVF pregnancy miscarrying by 30%.[16] Also, female smokers have an earlier onset of menopause by approximately 1–4 years.[17]

Tobacco smoking

A woman's fertility is affected by her age. The average age of a girl's first period (menarche) is 12-13 (12.5 years in the United States,[9] 12.72 in Canada,[10] 12.9 in the UK[11]), but, in postmenarchal girls, about 80% of the cycles are anovulatory in the first year after menarche, 50% in the third and 10% in the sixth year.[12] A woman's fertility peaks in the early and mid 20s, after which it starts to decline, with this decline being accelerated after age 35. However, the exact estimates of the chances of a woman to conceive after a certain age are not clear, with research giving differing results. The chances of a couple to successfully conceive at an advanced age depend on many factors, including the general health of a woman and the fertility of the male partner.

Age

In broad sense, acquired factors practically include any factor that is not based on a genetic mutation, including any intrauterine exposure to toxins during fetal development, which may present as infertility many years later as an adult.

According to the American Society for Reproductive Medicine (ASRM), Age, Smoking, Sexually Transmitted Infections, and Being Overweight or Underweight can all affect fertility.[8]

Acquired

Although factors of female infertility can be classified as either acquired or genetic, female infertility is usually more or less a combination of nature and nurture. Also, the presence of any single risk factor of female infertility (such as smoking, mentioned further below) does not necessarily cause infertility, and even if a woman is definitely infertile, the infertility cannot definitely be blamed on any single risk factor even if the risk factor is (or has been) present.

Causes or factors of female infertility can basically be classified regarding whether they are acquired or genetic, or strictly by location.

Causes and factors

The prevalence of female infertility in the Latin America/Caribbean region is typically lower than the global prevalence. However, the greatest rates occurred in Jamaica, Suriname, Haiti, and Trinidad and Tobago. Central and Western Latin America has some of the lowest rates of prevalence.[1] The highest regions in Latin America and the Caribbean was in the Caribbean Islands and in less developed countries.[6]

Latin America and Caribbean

In Asia, the highest rates of combined secondary and primary infertility was in the South Central region, and then in the Southeast region, with the lowest rates in the Western areas.[6]

Asia

Sub-Saharan Africa has had decreasing levels of primary infertility from 1990 to 2010. Within the Sub-Saharan region, rates were lowest in Kenya, Zimbabwe, and Rwanda, while the highest rates were in Guinea, Mozambique, Angola, Gabon, and Cameroon along with Northern Africa near the Middle East.[1] According to a 2004 DHS report, rates in Africa were highest in Middle and Sub-Saharan Africa, with East Africa’s rates close behind.[6]

Africa

Female infertility varies widely by geographic location around the world. In 2010, there was an estimated 48.5 million infertile couples worldwide, and from 1990 to 2010 there was little change in levels of infertility in most of the world.[1] In 2010, the countries with the lowest rates of female infertility included the South American countries of Peru, Ecuador and Bolivia, as well as in Poland, Kenya, and Republic of Korea.[1] The highest rate regions included Eastern Europe, North Africa, the Middle East, Oceania, and Sub-Saharan Africa.[1] The prevalence of primary infertility has increased since 1990, but secondary infertility has decreased overall. Rates decreased (although not prevalence) of female infertility in high-income, Central/Eastern Europe, and Central Asia regions.[1]

Prevalence

[7][6] refers to the inability to conceive or give birth when there was a previous pregnancy or live birth.Secondary infertility [6][5] refers to the inability to give birth either because of not being able to become pregnant, or carry a child to live birth, which may include miscarriage or a stillborn child. Primary infertility Infertility can further be broken down into primary and secondary infertility. [4] and ICMART is “a disease of the reproductive system defined by the failure to achieve a clinical pregnancy after 12 months or more of regular unprotected sexual intercourse.” WHO A clinical definition of infertility by the [3]

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