Infertility – Serious Public Health Issue of Global Dimension

Infertility is a serious public health issue of global dimension. Medical literature defines infertility based on clinical and demographic approaches. Infertility 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.’ (Zegers-Hochschild et al.,2009). Demographers define infertility as ‘the absence of a live birth in a sexually active non-contracepting woman.’ (Larsen, 2005). It is pertinent to address this public concern owing to its persistent prevalence over decades. According to the Centers of Disease Control and Prevention, approximately 12% of females ranging from age 15-44 years in the United States face infertility issues. (Centers for Disease Control and Prevention, 2018). At a global level, prevalence of infertility varies between 8-12% among reproductive aged couples. In South Asia, sub- Saharan Africa, the Middle East and North Africa, Central and Eastern Europe and Central Asia, the rates of infertility reach upto 30 %. (Sonaliya , 2016).

As evident from the statistical data, millions of families face the inimical effects resulting from infertility. Deprivation of the joy which accompanies parenthood leads to a sense of failure, loss and exclusion. (Aflatoonian, Seyedhassani, &Tabibnejad, 2009). Furthermore, the personal, interpersonal, social and religious expectations to bring forth a child may lead to additional distress. (Aflatoonian, Seyedhassani, &Tabibnejad, 2009).Over the years, infertility and its treatment has caused a serious strain on couple’s interpersonal relationship, as well as their relationships with other people, personal distress, reduced self esteem, and periods of existential crisis. (Aflatoonian, Seyedhassani, &Tabibnejad, 2009). This accompanying psychological distress can be managed through education regarding the factors contributing towards infertility and understanding of various available treatments.

The various risk factors that contribute to infertility include age, polycystic ovarian syndrome, obesity and behaviors (such as alcohol consumption and smoking). Age of both male and female play a key role in fertility, as age increases the rate of fertility decreases. When comparing 30-year-old men to 50-year-old men, there is a decrease in semen volume of 3%–22%, a decrease in sperm motility of 3%–37%, and a decrease in normal sperm of 4%–18% were likely. (Kidd, Eskenazi, &Wyrobek, 2001). Polycystic ovarian syndrome (PCOS) being another leading contributor affects 6%–21% of women. PCOS is the primary cause of anovulatory infertility, due to imbalances in hormone levels. (Joham, Teede, Ranasinha, Zoungas, & Boyle, 2015).Obesity, particularly the abdominal obesity phenotype, may impair fertility in both sexes. This adverse effect is mainly related to disorders of sex hormonesecretion and/or metabolism, leading to a condition of relative hyperandrogenism in obese women and of hypotestosteronemia (and, in some cases, a true hypogonadotropic hypogonadism) in obese men(Pasquali, 2006). Smoking, antioxidants and alcohol also decrease the reproductive health of both sexes. The compounds found in mainstream smoke (from active smoking) and side stream smoke (from secondhand smoke, (SHS)) negatively affect women's reproductive health. Tobacco toxins, for example, interfere with fertility byhaving an effect on folliculogenesis, oogenesis, steroidogenesis, embryonic transport and implantation, endometrial angiogenesis, uterine blood flow and myometrial growth. (Hyland, et al., 2015). In men, alcohol abuse, has been reported to cause impaired testosterone production, and atrophy of testes, which can result in impotence, infertility and reduced male secondary sexual characteristics. (Gaur, Talekar, & Pathak, 2010).

As infertility is more prominent amongst the low to middle income countries, my area of concentration will be Middle East (esp. Iran). A study conducted in Tehran (capital of Iran) reported that 21.9% of married women have experienced primary infertility at some time. (Vahidi, Ardalan, & Mohammad, 2009). Infertility and its outcomes are more serious in societies where women are stereotyped primarily as mothers, and this often leads to marital conflict, violence, stigmatization, and isolation. (Vahidi, Ardalan, & Mohammad, 2009). 

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