1.2. Infertility

The World Health Organization defines infertility as follows:

“ 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 (and there is no other reason, such as breastfeeding or postpartum amenorrhoea). Primary infertility is infertility in a couple who have never had a child. Secondary infertility is failure to conceive following a previous pregnancy. Infertility may be caused by infection in the man or woman, but often there is no obvious underlying cause [10]. ”

1.3. Causes of infertility

To become pregnant, the complex processes of ovulation and fertilization need to work just right. For some couples, infertility problems can be present from birth (congenital) or something can go wrong along the way that results in infertility [10].

The reasons for infertility can involve one or both partners. In general:

• In about one-third of cases, the cause of infertility involves only the male.

• In about one-third of cases, the cause of infertility involves only the female.

• In the remaining cases, the cause of infertility involves both the male and female, or no cause can be identified [6].

1.4 Infertility in women

Conditions affecting a woman’s fertility can include:

• Damage to the fallopian tubes

• Ovulatory problems

• Endometriosis

• Conditions affecting the uterus

• A combination of factors

• No identifiable reason.

Other factors that may play a part include:

• Age — female fertility declines sharply after the age of 35

• Polycystic Ovary Syndrome (PCOS)

• Gynaecological problems such as previous ectopic pregnancy or having had more than one miscarriage

• Medical conditions such as diabetes, epilepsy, and thyroid and bowel diseases

• Lifestyle factors such as stress, being overweight or underweight, and smoking.

1.5 Infertility in men

Conditions that may result in infertility include:

• Low sperm count or quality

• Problems with the tubes carrying sperm

• Problems getting an erection

• Problems ejaculating.

Other factors that may play a part in infertility include:

• Having had inflamed testes (orchitis)

• A past bacterial infection that caused scarring and blocked tubes within the epididymis as it joins the vas

• Having received medical treatment such as drug treatment, radiotherapy or surgery — for example to correct a hernia, undescended testes or twisted testicles

• Genetic problems

• Diabetes

• Lifestyle factors such as being overweight or having a job that involves contact with chemicals or radiation.

Male fertility is also thought to decline with age, although to what extent is unclear [11].

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