• Diabetes mellitus, thyroid disorders,undiagnosed and untreated coeliac

disease adrenal disease

• Hypothalamic-pituitary factors
• Hyperprolactinemia
• Hypopituitarism
• The presence of anti-thyroid antibodies is associated with an increased
risk of unexplained subfertility with an odds ratio of 1.5 and 95%
confidence interval of 1.1–2.0
• Environmental factors
• Toxins such as glues, volatile organic solvents or silicones, physical
agents, chemical dusts, and pesticides Tobacco smokers are 60% more
likely to be infertile than non-smokers.
German scientists have reported that a virus called Adeno-associated
virus might have a role in male infertility, though it is otherwise not
harmful. Other diseases such aschlamydia, and gonorrhea can also
cause infertility, due to internal scarring (fallopian tube obstruction).

Females
The following causes of infertility may only be found in females. For a
woman to conceive, certain things have to happen: intercourse must take
place around the time when an egg is released from her ovary; the
system that produces eggs has to be working at optimum levels; and her
hormones must be balanced.
For women, problems with fertilisation arise mainly from either structural
problems in the Fallopian tube or uterus or problems releasing eggs.
Infertility may be caused by blockage of the Fallopian tube due to
malformations, infections such as Chlamydia and/or scar tissue. For
example, endometriosis can cause infertility with the growth of
endometrial tissue in the Fallopian tubes and/or around the ovaries.
Endometriosis is usually more common in women in their mid-twenties
and older, especially when postponed childbirth has taken place.
Another major cause of infertility in women may be the inability to ovulate.
Malformation of the eggs themselves may complicate conception. For
example, polycystic ovarian syndrome is when the eggs only partially
developed within the ovary and there is an excess of male hormones.
Some women are infertile because their ovaries do not mature and
release eggs. In this case synthetic FSH by injection or Clomid
(Clomiphene citrate) via a pill can be given to stimulate follicles to mature
in the ovaries.
Other factors that can affect a woman's chances of conceiving include
being overweight or underweight, or her age as female fertility declines
after the age of 30.
Sometimes it can be a combination of factors, and sometimes a clear
cause is never established.
Common causes of infertility of females include:
• Ovulation problems (e.g. polycystic ovarian syndrome, PCOS, the
leading reason why women present to fertility clinics due to anovulatory
infertility)
• tubal blockage
• pelvic inflammatory disease caused by infections like tuberculosis
• age-related factors
• uterine problems
• previous tubal ligation
• endometriosis
• advanced maternal age

Male
The main cause of male infertility is low semen quality. In men who have
the necessary reproductive organs to procreate, infertility can be caused
by low sperm count due to endocrine problems, drugs, radiation, or
infection. There may be testicular malformations, hormone imbalance, or
blockage of the man's duct system. Although many of these can be
treated through surgery or hormonal substitutions, some may be
indefinite. Infertility associated with viable, but immotile sperm may be
caused by primary ciliary dyskinesia
Combined infertility
In some cases, both the man and woman may be infertile or sub-fertile,
and the couple's infertility arises from the combination of these conditions.
In other cases, the cause is suspected to be immunological or genetic; it
may be that each partner is independently fertile but the couple cannot
conceive together without assistance.
Unexplained infertility
In the US, up to 20% of infertile couples have unexplained infertility.In
these cases abnormalities are likely to be present but not detected by
current methods. Possible problems could be that the egg is not released
at the optimum time for fertilization, which it may not enter the fallopian
tube, sperm may not be able to reach the egg, fertilization may fail to
occur, transport of the zygote may be disturbed, or implantation fails. It is
increasingly recognized that egg quality is of critical importance and
women of advanced maternal age have eggs of reduced capacity for
normal and successful fertilization. Also, polymorphisms in folate pathway
genes could be one reason for fertility complications in some women with
unexplained infertility.

Treatment
Treatment depends on the cause of infertility, but may include counseling,
fertility treatments, which include in vitro fertilization. According to ESHRE
recommendations, couples with an estimated live birth rate of 40% or
higher per year are encouraged to continue aiming for a spontaneous
pregnancy. Treatment methods for infertility may be grouped as medical
or complementary and alternative treatments. Some methods may be
used in concert with other methods. Drugs used for both women and men
includeclomiphene citrate, human menopausal gonadotropin (hMG),
follicle-stimulating hormone (FSH), human chorionic gonadotropin (hCG),
gonadotropin-releasing hormone (GnRH)analogues, aromatase inhibitors,
and metformin
Medical treatments
Medical treatment of infertility generally involves the use of fertility
medication, medical device, surgery, or a combination of the following. If
the sperm are of good quality and the mechanics of the woman's
reproductive structures are good (patent fallopian tubes, no adhesions or
scarring), a course of ovarian stimulating medication maybe used. The
physician or WHNP may also suggest using a conception cap cervical
cap, which the patient uses at home by placing the sperm inside the cap
and putting the conception device on the cervix, or intrauterine
insemination (IUI), in which the doctor or WHNP introduces sperm into
the uterus during ovulation, via a catheter. In these methods, fertilization
occurs inside the body.
If conservative medical treatments fail to achieve a full term pregnancy,
the physician or WHNP may suggest the patient undergo in vitro
fertilization (IVF). IVF and related techniques (ICSI, ZIFT, and GIFT) are
called assisted reproductive technology (ART) techniques.
ART techniques generally start with stimulating the ovaries to increase
egg production. After stimulation, the physician surgically extracts one or
more eggs from the ovary, and unites them with sperm in a laboratory
setting, with the intent of producing one or more embryos. Fertilization
takes place outside the body, and the fertilized egg is reinserted into the
woman's reproductive tract, in a procedure called embryo transfer
Other medical techniques are e.g. tuboplasty, assisted hatching, and
Preimplantation genetic diagnosis.

Effects on the Population

Perhaps except for infertility in science fiction, films and other fiction
depicting emotional struggles of assisted reproductive technology have
had an upswing first in the latter part of the 2000s decade, although the
techniques have been available for decades. Yet, the number of people
that can relate to it by personal experience in one way or another is ever
growing, and the variety of trials and struggles is huge.
Pixar's Up contains a depiction of infertility in an extended life montage
that lasts the first few minutes of the film.
There are several ethical issues associated with infertility and its
treatment.
• High-cost treatments are out of financial reach for some couples.
• Debate over whether health insurance companies (e.g. in the US)
should be required to cover infertility treatment.
• Allocation of medical resources that could be used elsewhere
• The legal status of embryos fertilized in vitro and not transferred in vivo.
(See also Beginning of pregnancy controversy).
• Pro-life opposition to the destruction of embryos not transferred in vivo.
• IVF and other fertility treatments have resulted in an increase in multiple
births, provoking ethical analysis because of the link between multiple
pregnancies, premature birth, and a host of health problems.
• Religious leaders' opinions on fertility treatments; for example, the
Roman Catholic Church views infertility as a calling to adopt or to use
natural treatments (medication, surgery, and/or cycle charting) and
members must reject assisted reproductive technologies.
• Infertility caused by DNA defects on the Y chromosome is passed on
from father to son. If natural selection is the primary error correction
mechanism that prevents random mutations on the Y chromosome, then
fertility treatments for men with abnormal sperm (in particular ICSI) only
defer the underlying problem to the next male generation.
Many countries have special frameworks for dealing with the ethical and
social issues around fertility treatment.
• One of the best known is the HFEA – The UK's regulator for fertility
treatment and embryo research. This was set up on 1 August 1991
following a detailed commission of enquiry led by Mary Warnock in the
1980s
• A similar model to the HFEA has been adopted by the rest of the
countries in the European Union. Each country has its own body or
bodies responsible for the inspection and licencing of fertility treatment
under the EU Tissues and Cells directive
• Regulatory bodies are also found in Canada and in the state of Victoria
in Australia

CONCLUSIONS
Infertility is often not seen (by the West) as being an issue outside
industrialized countries.This is because of assumptions about
overpopulation problems and hyper fertility in developing countries, and a
perceived need for them to decrease their populations and birth rates.
The lack of health care and high rates of life-threatening illness (such as
HIV/AIDS) in developing countries, such as those in Africa, are supporting
reasons for the inadequate supply of fertility treatment options.Fertility
treatments, even simple ones such as treatment for STIs that cause
infertility, are therefore not usually made available to individuals in these
countries.
Despite this, infertility has profound effects on individuals in developing
countries, as the production of children is often highly socially valued and
is vital for social security and health networks as well as for family income
generation. Infertility in these societies often leads to social stigmatization
and abandonment by spouses.Infertility is, in fact, common in sub-
Saharan Africa. Unlike in the West, secondary infertility is more common
than primary infertility, being most often the result of untreated STIs or
complications from pregnancy/birth.
Due to the assumptions surrounding issues of hyper-fertility in developing
countries, ethical controversy surrounds the idea of whether or not access
to assisted reproductive technologies should comprise a critical aspect of
reproductive health or at least, whether or not the distribution and access
of such technologies should be subject to greater equity. However, as
highlighted by Inhorn the overarching conceptualisation of infertility, to a
great extent, disguises important distinctions that can be made within a
local context, both demographically and epidemiological and moreover,
that these factors are highly significant in the ethics of reproduction.
An important factor, argues Inhorn, is the positioning of men within the
paradigm of reproductive health, whereby because rates of general
infertility mask differences between male and female infertility, men
remain a largely invisible facet within the theorisation and discourse
surrounding infertility, as well as the related treatments and
biotechnologies. This is particularly significant given that male infertility
accounts for more than half of all cases of infertility and moreover, it is
evident that the attitudes and behaviours of men have profound
implications for the reproductive health of both individuals and couples.
For example, Inhorn notes that when couples in Egypt are faced with
seemingly intractable infertility problems - due to a range of family and
societal pressures that centre around the place of children in constituting
the gender identity of men and women - it is often the women who is
forced to seek continued treatment; this continues to occur, even in
known instances of male infertility and that the constant seeking of
treatment frequently becomes iatrogenic for the women.
Inhorn states that infertility often leads to “marital demise, physical
violence, emotional abuse, social exclusion, community exile, ineffective
and iatrogenic therapies, poverty, old age insecurity, increased risk of
HIV/AIDS, and death”Significantly, Inhorn demonstrates that this
phenomenon cannot simply be explained by a lack of knowledge, rather it
occurs in a complex interaction between the centrality of children in the
male gender identity as a symbol of maturity and the relative lack of
power of women in Egyptian society, whereby they effectively become
scapegoats for a culturally accepted narrative as a site of blame for the
lack of childlessness. It should be emphasised that this is not simply an
issue of “women oppressed by men” but rather, that men and women
both share the burden of this narrative, but in different, unequal and
highly complex ways.
Therefore, while the notion that reproductive health is a ‘women’s issue’,
may have powerful social currency, especially within popular discourse
and indigenous systems of meaning, the reality of infertility suggests that
medical and health paradigms have a significant part to play in
challenging the validity of this entrenched belief . Moreover, the
effectiveness of any therapeutic intervention, medical or otherwise will be
contingent on such outcomes and has an important part to play in the
alleviation of gendered suffering, especially the burden imposed on
women, who continue to suffer disproportionately from the effects of
infertility.
High costs may also be a factor and research by the Genk Institute for
Fertility Technology, in Belgium, claimed a much lower cost methodology
(about 90% reduction) with similar efficacy, which may be suitable for
some fertility treatment. At the 1994 United Nations International
Conference on Population and Development (ICPD) in Cairo, the
prevention and treatment of infertility was accepted into the program of
action for reproductive healthcare. Infertility has shown to have a greater
affect on developing nations than on birth rates or population control, but
also on a social level as well.
Reproduction is a large aspect of life for many cultures within developing
nations, and infertility can lead to social and familial problems such as
rejection or abandonment as well as personal psychological issues.
Currently, fertility treatment options and programs are only available
through private health sectors in developing nations and little-to-no
treatment is available through public health sectors. The fertility treatment
options offered through the private sectors are often costly or not easily
accessible. Additionally, counseling is considered an essential aspect of
fertility treatment, and due to lack of education and resources such forms
of therapy remain scarce as well. While quality fertility care is not readily
available in developing nations (such as sub-Saharan African countries),
a standard procedure of care could be easily implemented for a low cost
as a basic intervention. The lack of fertility treatment is problematic, and
high birth and population rates are every reason to implement treatment
options rather than reject them.