Category: Infertility

Fertility Issues Are Not Resolved Through Sexual Positions

One of the more prevalent articles seen in magazine oriented towards a female readership are articles specifically dealing with the topic of fertility and pregnancy. It is often the case that these articles give recommendations related to proper sexual positions as a means of addressing fertility issues or to bring about a greater likelihood of getting pregnant. The problem with this perspective is that fertility issues are not resolved through sexual positions.

Biology versus Positioning

People seem to assume that sexual intercourse is all that is needed when it comes to getting pregnant and that difficulties experienced in conceiving are likely due to a lack of sufficient sexual interaction or improper positioning to ensure that sperm reaches the ovum. The problem with this way of thinking is that it neglects to take into consideration the biological factors that can cause issues when it comes to conception (Peng 175).

For instance, vaginal acidity levels are something that most people do not even consider or even know about, yet it plays a crucial role in determining how likely a person is in getting pregnant. The higher the levels of acidity in the vaginal canal, the lower the likelihood someone has in getting pregnant (Glover, McLellan, and Weaver 402). This is due to sperm not being able to survive in a highly acidic environment.

There are also issues with a womans hormones to take into consideration. Even if a woman is menstruating, which is indicative of their potential to get pregnant, abnormal hormone levels within a womans body can cause issues when it comes to the density of the uterine wall or even the viability of the eggs that are released (Brown and Guinnane 513). Aside from this, there also potential issues when it comes to a mans fertility that need to be taken into consideration (Barry 606).

There is always the possibility that the sperm a man produces is abnormal (i.e. slow swimmers) which causes them to not reach the female ovum at all. Male infertility is often one of the primary reasons why some couples cannot get pregnant (Kemnitz and Thum 225). These are only a few of the plethora of biological factors that can influence the potential for pregnancy and, as such, shows that proper sexual positioning cannot help someone if biological factors are the primary cause behind their fertility issues.

Potential Harm Caused by these Articles

The problem with these articles is that they are written from a woefully unscientific perspective. They imply that proper positioning, the regularity of intercourse, and the performance of the parties involved are all that is needed to get pregnant. A lot of the articles fail even to mention the potential for biological irregularities being the primary source of the problem. This can be the origin of a considerable amount of conflict between couples who are trying the recommended positions of the articles and are getting nothing out of it (Kjaer 271). As such, this shows the need for proper article investigation.

Works Cited

Barry, Jane. Prolactin And Aggression In Women With Fertility Problems. Journal Of Obstetrics & Gynaecology 34.7 (2014): 605-610. Print.

Brown, John C., and Timothy W. Guinnane. Regions And Time In The European Fertility Transition: Problems In The Princeton ProjectS Statistical Methodology. Economic History Review 60.3 (2007): 513-544. Print.

Glover, Lesley, Ashleigh McLellan, and Susan M. Weaver. What Does Having A Fertility Problem Mean To Couples?. Journal Of Reproductive & Infant Psychology 27.4 (2009): 401-418. Print.

Kemnitz, Alexander, and Marcel Thum. Gender Power, Fertility, And Family Policy. Scandinavian Journal Of Economics 117.1 (2015): 220-247. Print.

Kjaer, Trille. Divorce Or End Of Cohabitation Among Danish Women Evaluated For Fertility Problems. Acta Obstetricia Et Gynecologica Scandinavica 93.3 (2014): 269-276. Print.

Peng, Tao. Testing The Psychometric Properties Of Mandarin Version Of The Fertility Problem Inventory (M-FPI) In An Infertile Chinese Sample. Journal Of Psychosomatic Obstetrics & Gynecology 32.4 (2011): 173-181. Print.

In vitro fertilization (IVF) is a form of fertilization that occurs outside the body in which egg cells are fertilized by sperm cells in a specially prepared fluid medium. Following the fertilization of the egg outside the body, the zygote is implanted into the womb of the mother. If both the fertilization and implantation take place successfully, the probability of establishing a successful pregnancy is also high. The process has served as a treatment for many cases of infertility since it started being applied in humans.

This procedure has been particularly useful in countries where the rates of infertility are high such as in the United States where an estimated 500,000 couples struggle with infertility every year (Human fertilization-embryo authority 1). The history of IVF was marked by major scientific breakthroughs and the significance of this procedure today can be most appreciated and understood by tracing the scientific developments associated with it. The goal of this paper is to trace the history of IVF highlighting the significance of various milestones in this history.

Long before IVF started being applied in human fertility, there were various experiments involving the transfer of embryos that were being conducted in animals. The major success among these experiments came after Walter Heap successfully performed embryo transfer between rabbits in the early 1890s (In vitro fertilization 3). Following this successful experiment, several publications were made in relation to the IVF technique. One of the renowned published works was Brave New World, a fiction work written by Aldous Huxley.

The basis for this novel was science fiction and gave a concrete description of IVF as it is currently known. However, the success of the journey towards assisted procreation was still to gain some assurance and momentum until MC Chang successfully applied IVF to obtain births in rabbits. In this procedure, Chang used capacitated sperm to fertilize eggs that had been newly ovulated by incubating them for a period of four hours in a Carrel flask.

It is worth noting that without immense contribution by expertise from other fields like embryology, anatomy as well as microscopy this technique would not have been practically undertaken (World in Vitro fertilization units 1) The progressive application of IVF in humans as evident today has been enhanced by important modifications in the development of the technique including modifications relating to culture media in which fertilization takes place, the duration within which embryos are transferred after fertilization, equipment are utilized to ensure successful procedures, embryo biopsy and the reduction of the number of sperm cells that can be used in the fertilization dish.

There are a number of personalities who have immensely contributed to these new developments in the technique including the initiation of new treatment protocols. The first successful attempt to obtain oocytes through laparoscopy was accomplished by Palmer in 1961 which paved way for the first attempt to use Invitro Fertilization on human oocytes in 1965 by Robert Edwards, Howard Jones, and Georgeanna who performed this procedure in the United States at Johns Hopkins Hospital (World in Vitro fertilization units 2) This milestone was followed by another sign of successful progress when reports of the first pregnancy from IVF were submitted in 1973 by a research team working hand in hand with Professors John Leeton and Carl Wood in Melbourne, Australia (World in Vitro fertilization units 4). However, a setback in this achievement came after an early miscarriage resulting from the pregnancy (IVF In Vitro Fertilization 3).

Three years after this unfortunate setback, the first preparation of the B2 culture medium was successfully accomplished by Y. Menezo who used formulations that reflected the uterine, follicular, and tubal environments of rabbits, humans, and sheep (World in Vitro fertilization units 4). In the same year that is 1976; two scientists, Edwards and Steptoe working in collaboration published a report relating to their discovery of ectopic pregnancy after transferring human embryos at the early blastocyst stage (Nationa institute of health 1). Their further work bore much success when the first IVF birth occurred in England in 1978. This IVF baby called Louise Brown at the time of birth weighed 5lb 12oz and his birth pave way for many more successful births through IVF not only in England but also worldwide (Human fertilization-embryo authority 3)

The subsequent periods were chatacterized by more developments which gave a new picture as to where the technique of IVF was headed. In 1979 for instance, the first report on the use of ultrasound for tracking the development of follicles during the menstrual cycle was published after great work done by Pez and his team. The better part of the following decade was dominated by reports of successful IVF births in different parts of the world such as the US, Australia, and France after immense work done by scientists.

The year 1983 saw more advancement in the technique of IVF when the first pregnancy in a woman without ovaries was achieved by transferring donor ovaries into the woman to initiate an artificial menstrual cycle. This menstrual cycle together with a specially prepared hormonal formula was able to support the pregnancy for a period of 10 weeks. A successful delivery from this kind of pregnancy was also reported in the same year (Nationa institute of health 1).

In the same year, Christopher Chen reported the birth of the first triplets conceived through IVF. The IVF research was until 1984 largely unregulated through legislation but following the passage of the Infertility Act by the Government of Victoria, regulation of IVF research and the whole area involving research on human embryos was entrenched in the law. The year 1984 also saw developments that hardly occurred in the preceding years with the most fascinating being the discovery that healthy babies could be born after the enrichment of abnormal spermatozoa. Scientists accomplished this possibility when the first case of male infertility was treated by employing IVF (Nationa institute of health 2).

The first quadruplets ever born in the world through IVF were also reported in 1984. The rate of survival of human pregnancy was a challenge until 1985 when a formulation of media that mimics the natural uterine environment was developed and used on humans. The first report of successful pregnancy from oocytes that had been fertilized in vitro and then donated to a patient whose ovaries were healthy was published in 1986. Up to this point in time, there were no reports of human oocyte fertilization by using a single spermatozoon until 1987 when this was accomplished successfully. Newer methods of enhancing the outcome of IVF continued to be invented and practically applied. One such method was called zona drilling which researchers used to manipulate the zona pellucida of oocytes to promote better penetration of sperms.

In addition, laser techniques and those used for DNA amplification as well as Testicular Sperm Extraction (TESE) began being used in IVF from the late 1990s (Nationa institute of health 1). Despite these developments in IVF, the current situation in terms of atones of this technique in many countries such as the United States is not encouraging. This has been contributed by economic factors such as the high cost of infertility treatment. In addition, many insurance companies are not willing to commit themselves to infertility benefits for the large population facing infertility problems dthe ue to economic and social implications of Assisted Reproductive Technologies including IVF (Human fertilization embryo authority 1).

The history of IVF can be traced back in the early 1890s when embryo transfer in rabbits was successfully done by Walter (World in Vitro fertilization units 5). Its application in humans resulted from great contributions from different professionals in the disciplines of microbiology, embryology and anatomy. The gradual developments over time paved way for the first birth from IVF in humans in 1978 when Louise Brown was born in England. Further developments resulted in widespread research which culminated in the invention of new techniques with tangible scientific outcomes being reported across the globe. Current challenges in the midst of increased cases of infertility relates to access to Assisted Reproductive Technologies such as IVF due to economic and social factors.

References

Human fertilization embryo authority. History of IVF. 2009. Web.

In vitro fertilization. History. n.d. Web.

Nationa institute of health. ivf In Vitro Fertilization. 2010. Web.

World in Vitro fertilization units. A History of IVF. 2004. Web.

Introduction

The current presentation is dedicated to the research conducted by Zhu, et al. (2018) and reflected in a peer-reviewed article Acupuncture Treatment for Fertility. In it, the authors aim to evaluate the ability of acupuncture as a well-known practice of Traditional Chinese Medicine (TCM) to treat infertility in both women and men. The significance of this study is determined by the disturbing trends of this issue in the present day. While in the present day, approximately 8-12% of couples face infertility worldwide, these numbers are expected to grow in the future (Zhu et al., 2018).

Infertility

In general, infertility is traditionally regarded as the inability to conceive in a sexually active couple who are trying to get pregnant for one year (Zhu et al., 2018, p. 1685). The factors of this condition are numerous, however, the most common ones include low sperm count and low sperm motility in men, polycystic ovarian syndrome, poor egg quality, hormonal imbalance, hyperprolactinemia in women, various comorbidities, age, stress, obesity, unhealthy habits, and genetics.

Infertility in Traditional Chinese Medicine (TCM)

According to TCM, the main causes of infertility are the disruption of vital balance and blockages in blood circulation flow and Qi energy. Thus, when energy and blood flow are blocked, deficiency, stagnancy, and heat syndromes may occur. The deficiency syndrome leads to the disorder in the sexual and reproductive functions of men and women. The stagnancy syndrome presupposes the restriction of blood and energy circulation in the reproductive organs. Finally, heat syndrome refers to inflammation processes that contribute to gynecological infections and impact semen quality. In turn, acupuncture has been successfully used in TCM for the treatment of infertility for more than 5000 years (Zhu et al., 2018). It implies the insertion of highly thin sterile needles into the bodys specific points called acupoints for the regulation of its functionality. In particular, acupuncture regulates the flow of blood and energy, balances the hormones, removes phlegm and stasis, and stimulates the nervous system.

Methods

The research implies the description of the case of a young couple who faced infertility and underwent acupuncture treatment in a clinic for TCM and acupuncture in Skopje, Macedonia (Zhu et al., 2018). Both men and women are 28 years old, and treatment was organized simultaneously to improve its outcomes. In particular, the acupuncture treatment for a man was made to improve his sperm quality while for a woman, it aimed to balance the hormones and remove ovarian endometriotic cysts on both ovaries (Zhu et al., 2018). Treatments were done with sterile disposable needles 0.25 x 25mm manufactured in China on the bodys sides for approximately 35-40 minutes once a week for three months.

Data and Results

According to the results, the acupuncture treatment led to successful outcomes. In particular, the quality of a mans sperm substantially improved  the percentage of progressively moving sperm cells increased from 5% to 40% (Zhu et al., 2018). In turn, a womans ovarian endometriotic cysts disappeared after seven sessions  as a result, got pregnant spontaneously and successfully. In general, acupoints chosen for the treatment contributed to the improvement of blood flow and the circulation of fluids in the lower abdomen, the liver, and the kidneys. The blockages in this area led to excessive dampness, blood stagnation, and the formation of ovarian cysts in a woman and poor sperm quality in a man. In turn, acupuncture helped prevent further accumulation of fluids, restore the normal circulation of blood, and resolve the phlegm masses.

Conclusion

In TCM, acupuncture has been used for the treatment of infertility for thousands of years. The insertion of tiny sterile needs in specific points contributes to the improvement of body functionality and the normalization of blood and fluid flows essential for sexual activity and pregnancy. Using the example of the couples successful treatment, the authors demonstrate the efficiency of acupuncture for the restoration of fertility in both men and women. In general, this case may be used in a full-scale literature review dedicated to the issue of infertility in order to collect and generate data for reliable and unbiased results.

References

Zhu, J., Arsovska, B., & Kozovska, K. (2018). Acupuncture treatment for fertility. Open Access Macedonian Journal of Medical Sciences, 6(9), 1685-1687. Web.

Infertility may be a couples’ helplessness to conceive a baby despite trying. About one third of each couple having unprotected sexual activity faces this problem. When the matter lies with the male because of insufficiency in semen, it’s referred to as male infertility. The probabilities of infertility affecting men are 33% whereas women are at almost 66% risk of affected by one.

In a healthy male and feminine couple, a human body ejaculates sperm during sexual activity during a female’s body that initiate to fertilization of egg (cell produced by woman body) and pregnancy. But this doesn’t happen every time! There are certain environmental and health factors that highly affect sperm production. Let’s first explore the symptoms that indicates infertility in men.

Infertility Symptoms in Men

The most obvious symptom of barrenness is no pregnancy despite having unprotected sexual activity for over a year. As compared to men, the symptoms of infertility are easily noticeable in women like irregular menstrual cycle, heavy or light bleeding, weight gain or loss etc. But in man the symptoms are observed on paying close attention as they depend upon the cause. Below are a number of the common symptoms of an arid man as suggested by andrologists:

• Erectile dysfunction may be a problem on its own for male reproductive system but it also can be an indicator of barrenness because men who are infertile may find it difficult to urge erection or maybe sustain it for long.
• Unusual pain during sexual intercourse and variations within the amount of semen points towards problems in male reproductive system.
• Low libido also can mean low levels of testosterone and hence are often an indicator of male infertility.
• Any unusual inflammation or uneven mass in testicles should not be ignored because they also point towards something grave.
• Hair growth pattern is additionally affected in an unproductive man as many patients report less than usual hair growth on face and other body parts to andrologists.
• Any different changes within the appearance of testicles is additionally one symptom.
• Men affected by respiratory infections frequently also can be unproductive.
• A low sperm count (< 15million per milliliter) is additionally a red signal.

Having discussed the symptoms related to male infertility, allow us to have a glance at what are the causes that initiate thereto. A person should have a healthy semen with a minimum of 15 million sperms per milliliter so as to make his partner conceive. Also the sperms must be in good physical shape and energetic since the fertilization of the egg within the women’s body highly depends on the power of the sperm to maneuver and reach the fallopian tubes (women’s reproductive system). Hence if there’s a problem with sperm production or the quality of sperms being produced, then conception is very impossible. Consistent with andrologists, there are certain medical reasons that are accountable for infertility disorder in men.

• One source is infections that interfere with sperm production or sperm quality. These infections can cause inflammation of the testicles and henceforth cause blockage in sperm production. Although most of the infections are treatable but some can cause permanent testicle damage. As seen from the above statistic, idiopathic accounts for nearly 25% of all infertility disorders.
• The leading reason behind infertility in men is basically a lump formation within the veins that carry semen from the testicles. The swelling might be because of irregulation of temperature within the testicles as that’s very crucial not just for sperms but also for a male reproductive system’s anatomy. This condition leads to poor quality of sperms. It accounts for 37% of infertility disorder in men.
• The 3rd leading explanation for male infertility is ailment in semen whereby the semen isn’t healthy enough to permit sperms to survive and hence sperms either don’t survive or don’t seem to be of fine quality. It can be because of a number of factors like medicine side effects, diabetes, groin area injuries, substance abuse, alcohol, smoking etc.
• Another reason is when the testicles cannot produce male hormone testosterone and sperm. It affects about 9% of infertile males.
• In some males testicles do not descend from the abdomen into the scrotum during fetal development and hence it’s one among the explanations of decreased fertility in men.
• Obstruction can also cause infertility. It occurs when the tubes that carry sperm are blocked due to many causes like surgery, accident, infections or abnormal development.
• There are often many other causes of unfruitfulness like genetic disorders, hormonal fluctuations, instabilities in chromosomes and certain drugs etc. Several times environmental factors like chemical and radiation exposure, overheating of testicles can also effect fertility in men. Emotional stress, tobacco smoking and chronic depression can also be one of the reasons of infertility.

When the Red light blinks?

A couple should consult a doctor if they experience any one or more of the above mentioned warning signs and are unable to bear children despite trying for more than a year. One can find best andrologists in Dubai (doctors that deal with male health especially male reproductive system and urological systems). An andrologist will run a few basic diagnostic tests on the patient to determine the cause of aridity in order to prescribe medications depending on the finding. The doctor will first inspect the testicles, penis and prostate physically to look for any unusual bulge and then take a small penis secretion and test it for infections. Followed by the culture will be a semen examination to determine the number and quality of sperm. A blood test is also done for determining hormone levels and any bacteria or virus in the system.

Male Infertility Diagnosis

On analyzing the semen, the healthcare provider will access fertility grounded on the semen volume produced, sperm count, size and shape and also the movement. The semen volume less than 2 milliliters, sperm count fewer than 15 million per milliliter and abnormal sperm size is suggestive of an underlying problem

Next follows the cures necessary to treat the condition based on the diagnosis. The encouraging part is that male infertility is curable provided that you’re lucky enough to seek out a renowned andrologist and fortunately there are many expert andrologists in Dubai.

How can Male Infertility be cured?

A good news for all suffering from male infertility is that it can be cured. Yes you read it right! It can easily be treated by one or more of the following methods depending on the cause:

• In case of an infection, antibiotics is recommended for treatment.
• If a male suffers from discrepancy of hormones, then medicines treating such will be given.
• For low sperm count, supplements are easily available that can increase not only the sperm count but also the sperm quality.
• Some food items are also healthy for increasing the sperm count like oysters, dark chocolate, salmon, citrus fruits, almonds, walnuts and many more.
• When the sperm is insufficient one other method is to accumulate sperm manually and place it in a women’s’ uterus that can lead up to fertilization.
• Then there is the method of In Vitro Fertilization (IVF) when the sperm quantity is not increasing, whereby sperm and egg are fertilized in laboratory and then the fertilized egg is implanted in female’s uterus.

Hence the call to actions vary depending on the requirements of the patient but the key lies in choosing the best doctor for oneself. Lucky for the people living in United Arab Emirates that there are many good andrologists to choose from and excellent hospital care available. It is just about making the right choice.

There are certain measures that can also be taken to avoid male infertility like avoiding exposure to lethal chemicals and radiation, wearing loose clothing, quit smoking and alcohol consumption and avoiding- warm showers. Though these precautions does not guarantee that male infertility will not occur but at least they can prevent it to some extent.

“Never let the odds keep you from doing what you know in your heart you were meant to do.” Not everyone has a goal of becoming a parent, but for those who do, being unable to conceive a child is a very painful reality, women are often identified with the ability to give birth. But, having difficulties in creating a child may come from both sides. Keep in mind, infertility is defined as not being able to get pregnant, infertility may result from an issue with either you or your partner or a combination of factors that prevent pregnancy. What causes infertility in both males and females? How can technology solve infertility?

There are many elements that play a position to a girl on the subject of infertility. For instance, aging, a lady’s age A girl’s age is the most widespread issue influencing her fertility. Women are born with a hard and fast wide variety of eggs and in order, they age so do their eggs. A female’s fertility starts to say no in her early 30s and by means of age 35, it has dropped by approximately 40%. By age 40 a lady’s fertility has declined even further. In addition, as ladies age conditions like endometriosis can also progress to a level where they may affect fertility as well (see endometriosis below). Unfortunately, there appears to be a scarcity of recognition of the effect that age has on fertility. Celebrities having infants in their 40s, for example, has given many girls the impression they are able to depart their childbearing to later in life. Similarly, many ladies falsely believe that infertility treatments like IVF can overcome any fertility issues. The modern figures on assisted reproductive technology in Australia and New Zealand display that for ladies elderly 30-34 years the chance of a stay delivery per treatment cycle become 25.3%. For girls aged 35-39, this percentage dropped to 16.9% and for girls, 40-forty four years it was most effective 6.6%. In addition, Polycystic ovarian syndrome, PCOS is a hormone imbalance that leads to disrupted menstrual and ovulation cycles. It is the most not unusual purpose of infertility due to anovulation (no ovulation or egg is released). The name of the situation comes from the presence of tiny cysts on the outdoor ovaries. While many women have polycystic ovaries, now not all ladies have the polycystic ovarian syndrome. Women with PCOS have additional symptoms including abnormal periods, extra weight (particularly within the tummy area), extra hair on the face and frame, pimples, and male pattern baldness. It is anticipated that 30% of infertile women be afflicted by PCOS. Also, Endometriosis, Endometriosis is a circumstance wherein the tissue that strains the uterus (endometrial tissue) grows in other components of the body, commonly within the pelvis. This stray endometrial tissue bleeds in the same manner because the lining of the uterus, besides the blood/tissue is trapped causing inflammation and irritation. Scar tissue can shape resulting in adhesions that can stick pelvic systems together. The most not unusual signs of endometriosis are period ache and/or pelvic and abdominal ache. Endometriosis can have an effect on fertility by way of destroying the ovaries so that ovulation can not occur. Similarly, harm and/or blockages to the internal fallopian tubes can impede the journey of the egg to the uterus. It is additionally notion that endometriosis could have an effect on the lining of the uterus, affecting the implantation of a fertilized egg. If ladies revel in pain during sex from endometriosis they could also be reluctant to have intercourse, decreasing their probability of getting pregnant. Keep in mind, weight can play a function in infertility in ladies, wherein a woman’s weight is a crucial consideration in her fertility. Women who are underweight and/or have a low percentage of frame fat (ie., athletes) can experience abnormal menstrual cycles and troubles with ovulation. Being obese or obese also can intrude with regular menstruation and ovulation. In addition, overweight and obese girls additionally have a higher risk of miscarriage and other pregnancy headaches and a lower achievement rate with infertility remedies which include IVF. Women who locate it hard to lose weight need to be assessed to see in the event that they have PCOS (see above) as this is a not unusual symptom. Women can regularly improve their possibilities of being pregnant by means of rather small adjustments to their weight. For example, in girls who are obese, a 5% weight loss can be sufficient to repair a normal menstrual cycle and ovulation. Finally, Sexually transmitted infections (STIs), If an STI which includes chlamydia or gonorrhea is going untreated it could result in pelvic inflammatory disease (PID). PID is the infection or irritation of the organs and tissues in the pelvis. Unfortunately, ladies infected with an STI, in particular chlamydia, do not always enjoy any symptoms or the signs and symptoms are vague so they do now not seek treatment. If PID is left untreated it is able to purpose scarring within the fallopian tubes that could narrow them, blocking the course of the egg. If a fertilized egg will become trapped in a blocked fallopian tube an ectopic being pregnant can occur. After two or greater episodes of PID, a lady’s threat of becoming infertile is about 50%.

In addition, there are many reasons why male infertility may happen. For example, obesity, A BMI above 30 can have an impact on sperm first-class, because fat deposits can overload and impact the metabolism of androgens (hormones that play a position in male development and reproductive activity), especially testosterone. This causes massive alterations in sperm development and sperm DNA inside the nucleus. Smoking and addictive materials, inhaled and addictive materials have a huge, negative effect on sperm because of nicotine and cannabinoid receptors in testicular tissue. Nicotine causes an imbalance in the frame which is known as oxidative stress; this impacts sperm fine and fertilization potential. Cocaine also distorts sperm improvement and motility. Stopping smoking and drug use causes reversal of most of the spermatic damages handiest after numerous months of discontinuation. Radiation, Although there is extensive debate within the medical literature on the impact of cell telephone irradiation on male infertility it’s far highly endorsed that men do not hold mobile phones near the scrotum and testicles to reduce risk. A less avoidable purpose of radiation publicity is cancer remedy along with chemotherapy. In this case, the fertility preservation protocol consists of sperm freezing and other advanced techniques like testicular biopsy or spermatogonial stem mobile extraction and freezing. High testicles temperature, Male genital organs hang out of doors the frame, in a scrotal sac with a decrease temperature in comparison to intra-abdominal organs. Raising the testicular temperature even 2 or 3 ranges centigrade can compromise sperm quality and functionality. Risk elements may encompass work in excessive temperature professions; professions with long hours in a seating position; tight underclothes and use of laptops assist at the lap for a long duration of time. Age, The assumption that men can reproduce into superior age is completely untrue. After 35, the reproductive potential of men drops sharply, as DNA in the nucleus fragments. After the age of 40, the likelihood of men fathering a toddler without genetic mutations declines eleven percent every year. Children with fathers older than 50 are significantly much more likely to go through conditions that include Down Syndrome, Neurofibromatosis, Autism, and Klinefelter Syndrome.

Fertilisation

The first phase in an organism’s sexual reproduction is gametogenesis, a process called meiosis allows haploid cells to be created from diploid parent cells. Gametogenesis is the formation of gametes which occurs from the germ cells in the testes and ovaries (Joseph, 2017). In a male, this process is termed spermatogenesis and oogenesis in a female. In a male, each primary cell or spermatocyte divides meiotically and produces four spermatids and then eventually become functional sperm cells (Abdullah, 2008). Comparably, of the four cells produced only one ultimately becomes a functional oocyte (Abdullah, 2008). This is illustrated in figure 1 displaying gametogenesis in humans.

Although about 300 million sperm enter the vagina, millions fall out or die from the acidic environment. However, many survive, and they move up through the cervix, into the uterus, and then to the end of the fallopian tube. If a single sperm can penetrate the egg, the egg will close off and Fertilisation occurs (Brown, 2013). Within the egg, the tightly packed male genetic material spreads out, a new membrane is created around the genetic material creating the pronucleus. Inside the membrane, the genes reform into the 23 chromosomes. The female genetic materials become activated by the fusion of the sperm with the egg resulting in the creation of the female pronucleus containing 23 chromosomes. Then microtubules pull the two of them together completing the process of fertilisation, at this moment a unique genetic code is created which instantly determines the baby’s features including its gender (Boyd, 2013). After the single-cell zygote is formed it begins to divide into a solid ball of cells, then, it becomes a hollow ball of cells called a blastocyst, attached to the lining of the uterus (Cherry, 2019). After the blastocyst stage, the major internal organs and external features begin to emerge, forming an embryo. In this stage the heart, spinal cord, and brain start to become visible (Khan academy, 2019). Once the formed features of the embryo begin to develop and grow it’s now considered a fetus. During this time specialization and differentiation of structures occur (Khan academy, 2019). Lastly, the baby is born after 9 months of pregnancy, this is shown in figure 2.

INFERTILITY

Infertility is a diminished or an absent ability to conceive and bear offspring naturally. Approximately, 10% of females are infertile and 7% male (Shiel, N.D.). Infertility is defined as not being able to conceive after 12 months of having unprotected sex. Infertility can have a wide variety of causes which are related to male and female or both. Treatment for infertility can include medications and assisted reproductive technologies (Shiel, N.D.). The most common forms of treatment are intrauterine insemination (IUI) and in vitro fertilisation (IVF) which are the most effective (Mayo Clinic, 2019).

Reason for Infertility (Males)

One reason for infertility in males is a varicocele. Most often, these occur after puberty and typically on the left side of the scrotum (Michigan Urology, 2019). Figure 3 depicts that a varicocele is an enlargement of the veins within the scrotum. As a result of a varicocele, it’s common to have low sperm production and decreased quality of the sperm. However, it can also lead to the testicle to fail to develop and shrink (Mayo clinic, 2016). The most common procedure to treat this problem is to undergo surgery to get it repaired.

Reason for Infertility (Females)

A common reason for infertility in females is having structural problems in the reproductive system which is present in almost 8% of all women with infertility issues (Liu, 2014). Structural problems typically involve the presence of abnormal tissue in the fallopian tubes or uterus. If the fallopian tubes are blocked, the ovum are not able to move from the ovaries to the uterus and therefore the sperm won’t reach it resulting in no fertilisation (Boyden, 2017). Additionally, structural problems with the uterus, can interfere with implantation and cause infertility. Figure 5 shows a diagram of blockages in the female reproductive system.

IVF

In vitro fertilisation (IVF) is a procedure, used to overcome a range of fertility issues, by which the sperm and the egg are fused together outside of the body, in a specialized laboratory. The newly fertilised egg is grown in a protected environment for several days until being transferred into the uterus of the women during the blastocyst stage, therefore significantly increasing the chance of pregnancy (IVF Australia, 2019).

It has been suggested the Jan and Brian undergo the procedure of IVF using donor oocytes. This is because they are unable to naturally conceive, and they have had no eggs or sperm frozen.

ADVANTAGES OF USING IVF

• The biggest advantage of using IVF is the ability to have a successful and healthy baby. This applies to all couples with an infertility issue such as the women having blocked or damaged fallopian tubes, Ovarian failure, varicocele etc.
• Older patients with low ovarian reserve use IVF because it maximizes the chance of conceiving and focuses on the quality of the eggs.
• It can help single women or same sex couples if they wish to have a child.
• The embryos in the laboratory can be screened for inherited diseases. For individuals who are known carries of genetic diseases such as Huntington’s disease, cystic fibrosis and muscular dystrophy, IVF is the most reliable way to ensure that the child that is conceived will not suffer from a disorder.

DISADVANTAGES OF USING IVF

• There is a chance of developing multiple pregnancies. During IVF treatments there is usually more than one embryo being put back into the uterus. Around 25-30% of IVF pregnancies result in multiple pregnancies which increases the risk of miscarriages and infant problems (Create fertility, 2018).
• VF treatment is very expensive with the total price amounting around $12,000 to $15,000.
• IVF treatment is physically and emotionally demanding and if women over the age of 45 use IVF there is a chance of serious injury and in some cases death
• The highest percentage is below 50 both live birth rate and clinical pregnancy rate which is very low, considering all the disadvantages that come with the use of IVF.

Recommendation

It is strongly agreed that Jan and Brian should not undergo the IVF method. This is because the disadvantages severely outweigh the advantages. Firstly, because figure 6 shows that the live birth rate of a women 45+ years old using IVF is only a 2 – 3% success rate. Especially with the high costs they could be spending 10s of thousands of dollars on multiple trials with no reward. Additionally, because Jan is at an older age the physical toll that the procedure would take on her body would likely lead to her suffering from an illness, injury or even mortality. However, there is the slight chance that there is a successful pregnancy, through using donated eggs because of Jan’s ovarian deficiency and somehow having a successful live birth. Ultimately, it is up to Jan and Brian to decide whether they go through with the IVF procedure although, it is recommended that this would not be best for them.

Children provide their parents the existential role of participating in the continuity of the family, culture, and the community. Most societies especially in developing countries are structured to rely on children for the future care and maintenance of older family members (Hala, Adlah&Lynn 2014). The ability to have children is considered a socially assumed aspect of one’s biological composition. Hence, African couples who wish to expand their family do not anticipate encountering difficulties procreating (Laura,2018).In Africa, motherhood is used as a measure of a woman’s reputation in society, whilst it is also considered as a source of power, pride, and an important aspect of life(Donkor, Naab & Kussiwash, 2017) and women’s health has been located in her capability to reproduce for more than a hundred years, her ability to menstruate and bear children is the main focus of her bodily health, therefore, when the woman’s body is unable to perform these activities, she will be seen as faulty, deviant and incomplete (Batool & De Visser 2014).

Infertility is a global reproductive health problem, affecting an estimated 48.5 million – 186 million in three published global infertility surveys (2004, 2007, 2012) (Dierick, Coene, Jarju & Longman 2019; Inhorn & Patrizio 2015), and its definition varies amongst clinicians, epidemiologist, and demographers. By definition, it is the inability of a couple to achieve conception or inability of a woman to carry a pregnancy to term following 12months (clinical definition), 2years (epidemiological definition), or 5years (demographical definition), despite exposure to the risk of pregnancy (VanderPoel 2012). According to the latest definition by WHO, infertility is a disease that generates disability as an impairment of function (Zegers – Hochschild et. al., 2017). Infertility is primary if the woman has never been pregnant despite actively trying for a certain number of years and this is the commoner entity in developed countries, while secondary infertility is the subset in which the woman has previously been pregnant irrespective of the outcome, and this is the commonest type in developing countries (Aghoja-Omo 2015).

The prevalence of infertility in reproductive-aged women has been estimated to be one in every seven couples in the western world and one in every four couples in developing countries, in some regions of the world, including South Asia, some countries of sub-Saharan Africa, the Middle East and North Africa, Central and Eastern Europe and Central Asia infertility rates may reach 30% (Vander Borght & Wyns 2018). The very high primary and secondary infertility rates in West Africa largely result from poorly managed or untreated reproductive tract infections, including sexually transmitted infections and pregnancy-related sepsis such as postpartum, post-abortion, and iatrogenic infections (Inhorn & Patrizio 2015). This high prevalence in Sub Sahara Africa can also be attributed to lack of infertility prevention and treatment services which is often justified as a form of population control, as infertility may be seen as a solution to overpopulation or a low priority issue by the policymakers in the context of scarce health care resources, poor medical infrastructure, and the heavy burden of other life-threatening problems such as HIV/AIDS (acquired immune deficiency syndrome), malaria and maternal mortality (Inhorn & Patrizio 2015; Mascarenhas et al 2012). In Nigeria, one in five (or even a third) of couples suffer the ill effect of infertility with the rate as high as 20-45% (Aghoja-Omo. 2015). It has been described as the most important reproductive health concern of Nigerian women and accounts for between 60% and 70% of gynecological consultations in tertiary health institutions (Omoaregbe, James, Lawani, Morakinjo & Olotu, 2013).

Infertility is problem affecting many couples with a child wish, affecting almost 15% of all couples. In these couples, half of these problems can be attributed from the male.

Infertility is defined as being unable to get pregnant despite having frequent, unprotected sex for at least a year. In almost 20% of male patients, a chromosomal or genetic defect can be identified. This research investigation will be focusing on male’s infertility and if X-linked genetic abnormalities increase their risk. The X-chromosome is a frequent interest in the genetic study of male infertility, this is due to males only having one X- chromosome. This means mutations in an X-linked gene would not be covered by a normal allele and thus would be evident in males.

This investigation will primarily focus on understanding whether males only having one X-chromosome (no compensatory allele), means that they are at risk of infertility due to X-linked, recessive disorders. The research investigation first had a broad claim of ‘Biological males are less susceptible to infertility problems than biological females.’ To narrow the focus, the study will be analysing the X-linked genetic abnormalities of the deletion of the TEX11 of chromosomes (Consequence of too little X), Klinefelter Syndrome (Consequence of too much X) and the amount of infertility problems, due to genetic abnormalities compared to women.

Evidence

Klinefelter’s syndrome is caused by an extra copy of the X chromosome in each cell (XXY) and having ‘too much’ of the X-Chromosome. Klinefelter’s syndrome causes problems with male’s testicles and prevents them from making enough normal sperm, resulting in 95-99 % of those with the syndrome to struggle with infertility. This genetic abnormality occurs in 1:600 male newborns and is the most frequent form of failure in production of the testis. An investigation was conducted to find more research on male infertility, and in this case Klinefelter’s Syndrome in azoospermia infertile males. Azoospermia is the medical condition of a man whose semen contains no sperm and is associated with infertility, but many forms are amenable to medical treatment. The investigation is also aimed to find more research, as much information about X-chromosomes and infertility as most of this study is still unknown. 30 azoospermia infertile males from AVBR hospital in India were selected for a study to find the percentage of Klinefelter’s syndrome in azoospermia infertile males and analysed in a cytogenic laboratory.

Findings from the investigation resulted in 3 of the 30 azoospermia infertile subjects to have chromosomal abnormalities of 47 chromosomes. This means 3 of the subjects had an aneuploidy number of chromosomes, as the usual number is only 46 for all men. This means they have XXY (Klinefelter’s syndrome), as shown in Table 1, resulting in 10% of the subjects to be diagnosed with the syndrome. The karyotype, which is a picture of a person’s chromosome was found and showed there was a numerical aberration with an extra ‘X’ chromosome which was suggestive of the Klinefelter’s syndrome. This data was confirmed using the G-banding technique which produces the visible karyotype by staining condensed chromosomes (Table 3). However, the remaining 90% of subjects had a normal chromosomal count of 46 (XY) and did not have a genetic abnormality in this area of study.

Hence, it can be concluded that without X-linked genetic abnormalities and mutations relating to Klinefelter’s syndrome, there would not be any infertility problems with men. This means that these mutations do increase a male’s risk of infertility and have a 10% chance of being diagnosed as shown in the investigation above.

However, a limitation of this data is the size of the cohort, the tests only included 30 subjects, and a larger data base would give more data to analyse. The investigation did include that the Klinefelter’s syndrome does increase a male’s risk of infertility, but the extent of this hasn’t been finalised, which means the conclusion can’t be drawn with confidence.

Testis-expressed gene 11 (TEX11), a different genetic abnormality, is an X-linked gene and is essential for meiotic, a form of cell division recombination and chromosomal synapsis. As males are hemizygous for the X-chromosome, meaning that there are only half as many alleles as normally present for a diploid individual, mutations in a single-copy X-linked genes cannot be compensated by the other X-chromosome. Therefore, mutations in X-linked genes, such as TEX11 gene is essential for male fertility mutations in men, as the gene causes meiotic arrest in males resulting in azoospermia. Since TEX11 is essential for meiotic recombination and chromosomal synapsis and TEX11 also causes meiotic arrest and male infertility, the identification of TEX11 mutations has become important to determine the underlying causes of male infertility, especially in men with azoospermia. A pedigree was conducted of an azoospermia male patient and his family, to help understand this X-linked mutation in TEX11.

The pedigree (family tree) shown in figure 3 demonstrates that only men have been diagnosed with azoospermia, including patient WHT3759, also meaning that this genetic abnormality is very likely to be from an X-chromosome. Males are more susceptible to inherit this mutation as they only have one X-chromosome unlike the mother who didn’t show any symptoms, meaning she is symptomatic as she has two (XX) chromosomes. Therefore, this X-linked genetic abnormality of the TEX11 gene in figure 3 can confirm that it does increase a male’s risk of infertility, due to having only one X-chromosome.

However, the data indicates a certain limitation such as, the trend would not continue, as the graph only shows one family pedigree. If more family data were collected it would show that not all male infertility places are affected by the TEX11 mutation, meaning the investigation research question cannot be answered with assurance. -either talk about a third mutation or answer claim and compare it to females

Evaluation

• Limitation is only 2-3 x-linked genetic abnormalities were analysed, meaning the question can’t be made focusing on all X-linked genetic mutations and if they increase a biological male’s risk of infertility
• most limitation include the investigation only focuses on 1 family, meaning if more family’s came into the equation the results may not be the same, may just be a ‘fluke’ of data
• extension can include making a bigger experiment with all patients with azoospermia to connect and maybe examine all the x-linked genetic conditions and compare with them to see if x-linked do increase a male’s risk of infertility

Reference List

1. Gajanan, L 2016, Klinefelter’s syndrome in azoospermia infertile males of Vibarbha region, Central India, viewed 10 June 2020, https://www.msjonline.org/index.php/ijrms/article/view/647
2. Yanwei, S 2018, A novel TEX11 mutation induces azoospermia: a case report of infertile brothers and literature review, viewed 10 June 2020, https://bmcmedgenet.biomedcentral.com/articles/10.1186/s12881-018-0570-4
3. Androl, J 2019, Regulation of male infertility by X-linked genes, viewed 10 June 2020, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2931805/
4. Vockell, M 2019, The X chromosome and Male Infertility, viewed 10 June 2020, https://link.springer.com/article/10.1007/s00439-019-02101-w

Most people consider having a child to be one of the biggest achievements that one could reach in their lifetime. Without the ability to reproduce at a consistent rate the world, along with the species that inhabit it, will parish. Having a child gives a person a chance to not only make sure that their own genic code will live on for another generation, but it also gives a person a chance to pass on their views on how life should be lived as far as lifestyle, religion and overall wisdom. According to the Central Intelligence Agency the current birth rate for the world is approximately 259 children born world wide per minute, which equates to about 4.3 births every second (CIA, 2018). The total fertility rate for women as of 2018 is about 2.4 children born per woman (CIA, 2018). Unfortunately, not every woman has the opportunity to experience the trials and tribulations of childbirth by natural means. While there are many different definitions, one definition of infertility is a disease of a persons reproductive system, which results in their inability to conceive a child though natural means of sexual intercourse or to carry a child to full term after trying to conceive over the span of 12 months (WHO, 2019). About 11% of women in the United States between the ages of 15 and 44 are either unable to get pregnant or cannot carry a child to full term (Boulet, Smith, Crawford, Kissin, & Warner, 2017). People have placed more of a priority on their individual independence and financial health than they have on settling down and starting a family. While in past years it was normal for a person to be married with a child by the age of 21, more and more people are waiting to have their first child later in life in their late 30’s and early 40’s. Even though there is nothing wrong with wanting to be established before bringing another life into the world, after the age of 35 a woman’s chances of naturally conceiving declines (WebMD, 2005). If the woman is able to become pregnant after the age of 35, their pregnancy is considered to be “geriatric” meaning they are at a higher risk of complications such as a miscarriage at any time during the pregnancy (WebMD, 2005). Apart from known physical implications on fertility, there are many women and men that have no true diagnosis on why they are unable to conceive a child by natural means.

There are several methods of combating infertility such as the use of a surrogate, in-vitro fertilization (IVF), and artificial insemination (AI). Options such as these may not be available to all that require the services due to the excessive cost of the procedures. Unfortunately, even with the advances in medical reproduction practices, there are still those that experience infertility and difficulty carrying a child to full term. Infertility is something that far too many people experience and can easily create a heavy burden on both the man and the women that are experiencing it. It has been shown that infertility can have not only had a negative affect on peoples’ mental health, but their physical health and marital status could be at risk also. The articles that were reviewed looked at how physical, mental, emotional and marital health has been affected by infertility struggles for both men and women.

The first article that was reviewed focused on the quality of life for women that had either experienced infertility or difficulty remaining pregnant as it related to their overall health. The study sought out to determine if women who had experienced infertility or difficulty getting pregnant had a lower health related quality of life (HRQOL) than those that had never experienced either scenario. To conduct the study information from the Behavioral Risk Factor Surveillance Survey (BRFSS) was gathered. The BRFSS is a telephone survey that collects information on chronic conditions (such as high blood pressure and diabetes) and health behaviors of an individual, as well as their mental and physical function along with their health status (Boulet, Smith, Crawford, Kissin, & Warner, 2017). The data is specific to each state for U.S. residents (Boulet, Smith, Crawford, Kissin, & Warner, 2017). The survey was used to gather information on how many women had reported to have experienced infertility, difficulty staying pregnant, never experienced infertility, and never experienced difficulty staying pregnant. The findings from the analysis of the BRFSS were then compared against the health related quality of life indicators to determine the health of women who fall into one of the four infertility categories. Results of the research found that women who have experienced infertility reported twice as many days of poor overall health, chronic conditions, and depressive disorders than the women who have not gone through infertility or had not experienced difficulty staying pregnant for a full term (Boulet, Smith, Crawford, Kissin, & Warner, 2017). Women who had difficulty staying pregnant were also found to have a higher report of depression and limited overall physical activity (Boulet, Smith, Crawford, Kissin, & Warner, 2017). It was concluded that women who experience infertility or difficulty staying pregnant have a lower physical and mental health quality than women who do experience these things (Boulet, Smith, Crawford, Kissin, & Warner, 2017). However, women who reported with difficulty staying pregnant had the lowest out of all four categories for health related quality of life (Boulet, Smith, Crawford, Kissin, & Warner, 2017). The article stated that infertility is an important health concern based on the quality of life measures for women and men who have gone through the experience (Boulet, Smith, Crawford, Kissin, & Warner, 2017). While infertility can affect the physical and mental health of women, it can also have negative effects on the marital status of those that are having trouble successfully reproducing.

The purpose of the second article reviewed was to determine the relationship between stress related to infertility, marital satisfaction, and emotional distress. The information for this study was gathered by inviting 78 males and 72 females in an infertility clinic in France, who had been trying to conceive for about 3 years, to participate in the study anonymously. Participants were told that they could leave the study at any time (Gana & Jakubowska, 2014). The people that participated in the study filled out a fertility problem inventory (FPI) questionnaire, which assessed the individual’s social concern, sexual concern, relationship concern, need for parenthood, and rejection of a childfree life (Gana & Jakubowska, 2014). Participants rated how much they agreed with each query as it related to marital status on a scale of 0-5 with higher scores indicating higher marital satisfaction (Gana & Jakubowska, 2014). Those who participated also filled out a Beck Depression Inventory (BDI) that measures depressive characteristics as well as a State-Trait Anxiety Inventory (STAI) to measure the state and trait of the participants’ anxiety (Gana & Jakubowska, 2014). The collective results of each survey determined that infertility directly relates to emotional distress as well as to marital dissatisfaction (Gana & Jakubowska, 2014). It was also found that there were gender differences between men and women on marital satisfaction (Gana & Jakubowska, 2014). The study determined that women experience more infertility stress than men (Gana & Jakubowska, 2014). The women in this study who have experienced infertility were found to have higher marital satisfaction than men. This finding was inconsistent with findings from other research studies that found women to have a lower marital satisfaction rating than men who are experiencing infertility (Gana & Jakubowska, 2014). The study was found to be limited because data was only taken from a small number of people from one infertility clinic (Gana & Jakubowska, 2014).

With the importance that some people place on having a child, I agree with the findings of each of these studies. Those that go through the difficulties of infertility may feel as though they are a failure and ultimately start to develop more depressive thoughts and actions. The strain that this puts on individuals will ultimately affect the way they interact with those closet to them. Knowing several people who have gone though infertility or failure to maintain a pregnancy to full term due to explained and unexplained medical conditions, I have seen how people start to display more signs depression and decreased physical activity. I feel that the research from the first article was conducted adequately with the given sample size and was successful in breaking down the information into several categories in order to determine both the physical and mental health of women how are infertile and those that have trouble carrying a baby full term versus those that have not experienced either event. The second article could have improved on its sample size. Having a sample size of only 150 people from one infertility clinic in France does not give a good indicator on the overall population. While the research did find gender differences between the stress and mental health of men and women who undergo infertility, both articles could have expanded their research to determine if there was a difference between races, socioeconomic statues, or same sex couples versus heterosexual couples. Both studies relied on the participant to self-report on their emotions or recall specific events, which could have skewed the end results of each study. Since it was shown that chronic conditions that contribute to infertility have a negative impact on both men and women’s’ health, it would be helpful to determine ways that chronic conditions can be avoided all together in an effort to minimize infertility as a whole.

A question that remains to be answered is if the distresses of infertility on mental and physical health improve if the person utilizes other options such as adoption. It has yet to be determined that if the infertility related depression is due solely to lack of being able to conceive or carry a baby to term or if it is due to lack of a baby in the household all together. Most people want a baby that shares their genome but is it possible for them to be just as happy or feel as though they have succeeded with a child that is not biologically theirs? There are many crises throughout our lives that we are consistently trying to overcome. While many of us will achieve success in our different struggles that life throws at us, there are many never reach their personal goals and must figure out ways to continue to progress in their lives in positive way. It is important that those undergoing infertility and difficulty staying pregnant have a strong support system around them and are not afraid to reach out for professional help on their mental status if at all needed.

Works Cited

1. Boulet, S. L., Smith, R. A., Crawford, S., Kissin, D. M., & Warner, L. (2017, July 18). Health-Related Quality of Life for Women Ever Experiencing Infertility or Difficulty Staying Pregnant . Matern Child Health Journal .
2. CIA. (2018). World Fact Book. Retrieved November 20, 2019, from Central Intelligence Agency: https://www.cia.gov/library/publications/the-world-factbook/geos/xx.html
3. Gana, K., & Jakubowska, S. (2014). Relationship between infertility- related stress and emotional distress and marital satisfaction. Journal of Health Psychology .
4. WebMD. (2005). Managing a High-Risk Pregnancy . Retrieved November 20, 2019, from WebMD: https://www.webmd.com/baby/managing-a-high-risk-pregnancy#1
5. WHO. (2019). World Health Organization. Retrieved November 20, 2019, from Infertility Definitions and Terminology: https://www.who.int/reproductivehealth/topics/infertility/definitions/en/

SUMMARY

Since the introduction of ICSI back 28 years till now ICSI is widely used to treat malefactor as well as female factor infertility. However, studies had shown concern of the pregnancy outcome in ICSI over conventional IVF in couples with non-male factor infertility. Studies had shown an+ altered pregnancy outcome in ICSI compared with natural conception. So far no difference in neurodevelopment in ICSI and spontaneously conceived (SC) children has been found. Additionally, epigenetic disorders and imprinting disorders have also been found in ICSI born children in some studies but opposing studies have also been found in literature.

Even though studies had found various outcome data in ICSI conceived children, there are limitations in the study conducted so far. Further studies in future which look into the more developmental aspect as well as long term studies are required for the better understanding of ICSI outcome.

INTRODUCTION

Over the past 40 years assisted reproductive technologies (ART) have been acting as a treatment for infertility together with conventional IVF (In vitro Fertilization) and ICSI (Intracytoplasmic sperm injection) (Crawford & Ledger, 2018). These highly complex technologies are used in increasing frequencies all over the world and over five million babies are conceived worldwide in this manner (Adamson et al., 2013). In conventional IVF, the oocyte and several thousand spermatozoa are placed together in a petri dish in the laboratory in which the spermatozoa are left to spontaneously find and fertilize the oocyte where as in case of ICSI a single sperm is injected directly into an oocyte to assist fertilization.

Since the birth of the first babies using ICSI in 1992, ICSI has become quintessential to modern ART (Carmelidi, 2016). Worldwide, most clinics perform ICSI for moderate-to-severe male factor infertility. ICSI is the preferred method of fertilizing oocytes in men with ejaculatory dysfunction, retrograde ejaculation or paraplegia-associated complications (Trofimenko et al., ‎2016). ICSI is also indicated in couples with a history of poor fertilization or complete fertilization with conventional IVF. Many clinics utilize ICSI for non-male factor indications, often at their own discretion. Some of these indications include unexplained infertility, low oocyte yield, advanced age and cryopreservation of embryos for fertility preservation (Zheng et al., ‎2019)

Concerns have been raised regarding the safety of the procedure since its introduction. The primary concern in the invasive nature of the procedure and the fact that it bypasses the natural selection process and use of sperm that would not be able to fertilize the oocyte without ART intervention (Alukal et al., 2008). The latest world report on fertility treatment suggests that in many countries ICSI has become the standard infertility treatment even in couples who would also get pregnant with IVF. The percentage of ART procedures is significantly increasing all over the world. With this increased usage, the need to understand any potential adverse effects on ICSI-conceived offspring is imperative (Alukal & Lamp., 2008).

REVIEW

ART& ICSI

Compared to other therapeutic procedures used in medicine, ART had never undergone rigorous safety testing before its clinical trials (Friedler et al., 2012). Since infertility treatment overcome the natural barrier that prevent fertilization and in many cases infertility phenotype may have a genetic basis, the possibilities of unwanted genetic traits getting transmitted to offspring can’t be neglected (Alukal et al.,2008). In case of untreated couple their infertility represents the lethality within the gene pool, as it blocks the transmission of undesired genes to any offspring (Cariati et al., ‎2019). When it comes to ART treatment large number of couples undergo fertility treatment without a proper knowledge regarding the base of their infertility as well as the potential long term risk for their offspring (Zagami et al.,2019).

Despite the standardization of ICSI over the past 25 years, concerns about the technique have arisen (Pereira et al., ‎2017). The concern regarding ICSI arises from the perception that the spermatozoon for injection is selected arbitrarily and also important steps of fertilization like sperm-zona binding and oolemma fusion are completely bypassed (Neri et al., ‎2014). Moreover, there is still concern about the transmission of undesirable genetic traits from suboptimal spermatozoa which leads to genomic or phenotypic abnormalities in the progeny (Alukal et al., ‎2008). So far may studies have done to analyze the long-term clinical data associated with the pregnancy, perinatal, developmental and health outcomes of ICSI children.

ICSI & pregnancy outcome

Even though pregnancies after ART mostly result in normal healthy outcomes, there is an increased concern for the obstetric and neonatal complications compared to naturally conceived pregnancies (Zhu et al., 2016). So far various studies have looked into the pregnancy outcome of IVF/ICSI, the results are often inconclusive (Datta et al., 2015). A study conducted by Nouri et al., comparing IVF versus ICSI-conceived pregnancies during the period of 2003-2009 found that course of pregnancy to be more complicated after IVF, whereas the primary fetal outcome seemed to be better in this group than after ICSI treatment (Nouri et al., ‎2013). Since ICSI is widely used nowadays regardless of the type of infertility, impact of ICSI on non-male factor infertility is a concern. Studies have shown that fertilization rate, clinical pregnancy rate, live birth rate were significantly higher in the IVF group compared with ICSI in normospermic men (Sustar et al., 2019).

In case of azoospermia which contribute to 10% of male infertility, implication of ICSI allowed the possibility to father their own progeny (Halliday et al., ‎2012). An earlier study conducted by Wang et al., in 2002 could find that risk of gestational hypertension was doubled in women treated with ICSI by surgically obtained sperm and the risk of pre-eclampsia was tripled compared to the control group (Wang et al., ‎2002). One of the latest study published in 2020 in China over a period of 10 years could find that the clinical pregnancy rate as well as implantation rate of surgically retrieved sperm group were significantly higher than ejaculated sperm group. Most of the clinical pregnancy outcomes were comparable between surgically retrieved sperm group and ejaculated sperm group the miscarriage rate per transfer, ectopic pregnancy rate per clinical pregnancy, induced abortion rate per clinical pregnancy and fetal deaths per clinical pregnancy. Interestingly they could find that the live delivery rate per transfer of surgically retrieved sperm group was significantly higher than that of ejaculated sperm group (Jin et al., 2020).

In case of different types of azoospermia, pregnancy outcome studies had shown a strong tendency towards lower gestational age among the singletons and a higher percentage of premature twins in the non-obstructive azoospermia group, when comparing two different subgroups of azoospermic patients (Esteves et al., ‎2013).

ICSI & postnatal outcomes

Earlier studies of ICSI outcomes has demonstrated a higher rate of preterm birth and low birth weight, there are limitation in considering these data because these outcomes were mainly mediated by multifetal gestation due to multiple embryo transfer. In literature long-term outcome of ICSI is studied under 4 major categories which include, perinatal outcome and congenital malformation, developmental outcomes, medical health and reproductive health (Pereira et al., 2017).

Congenital malformation

Various studies have looked into major and minor congenital malformations; the studies cannot be compared due to limitations in the sample. ASRM had reported previously that the risk of having congenital malformation is 4.2% in IVF/ICSI cycles. Even though previous studies did not shown much differences between IVF and ICSI, study by Davies et al. showed a clear association of increased birth defect in ICSI even after multivariate adjustment (Wong et al., 2013)

Moreover, there is a limited data available on ICSI fetal karyotypes reveal that when compared with general neonatal population, there is a slight increase in chromosomal anomalies especially in sex chromosomes (Bonduelle et al., ‎2002).

A review conducted by Esteves et al., in 2018 about the consequence of ICSI for male infertility to the offspring. The study had shown that there is an increased risk of chromosomal abnormalities, particularly affecting the sex chromosomes in children conceived through ICSI when compared with naturally conceived children. Also they had pointed out the uncertainty about the increased risk of cancer in children conceived using ICSI even though some evidence indicates that certain cancer types are more common in children conceived using ICSI than in naturally conceived children (Esteves et al., ‎2018). Further studies are required for a clear understanding about these associations.

Developmental outcome

Earlier studies before 2000 had raised the concern of neurodevelopment of ICSI conceived children as many of the previous studies had shown data supporting the statement showing lower score of Bayley mental development index (MDI) and developmental delay ICSI born compared to the spontaneously conceived babies (Papaligoura et al., 2004). A systematic review of long-term follow-up of ICSI conceived offspring compared with spontaneously conceived offspring post neonatal period was published in 2018 and had shown that most studies of good quality suggest strongly that there is no difference in neurodevelopment in ICSI and spontaneously conceived (SC) children as indicated by similar cognitive and motor performance, and in some studies behavior and family relations (Catford et al., ‎2018). Although few studies had shown significant differences between the groups the majority of which present clinically insignificant findings or have important methodological limitations (Bowen et al., 1998; Ponjaert-Kristoffersen et al., 2004, 2005; Sanchez-Albisua et al., 2007; Knoester et al., 2008a).

General health

When reviews looked into the general health of ICSI conceived offspring, fair quality data suggested that they are at an increased risk of urogenital surgeries, undescended testis, surgical interventions, hospital admissions compared to SC children (Catford et al., ‎2018). Although the studies are limited to childhood assessment, future studies on young adults will be helpful to overcome the confusion and give a better picture of the situation.

So far three studies published between 2006 and 2010 had looked into the vision and hearing of ICSI born at 5 years of age, and they had shown that these characteristics are comparable between ICSI and SC children. Evidence of abnormal retinal vascularization was found in some reports which leads to the conclusion that ICSI-conceived offspring may be at increased risk of cardiovascular disease.

Reproductive health

One of the contributing factor for male infertility is thought to be genetic etiology (Karanfilska et al., ‎2012). In such cases there is a high risk of transmission of these causes to offspring. Congenital bilateral absence of the vas deferens (CBAVD), Y chromosome microdeletions are transmitted to male offspring by ICSI in such manner (Alukal et al., 2008). Studies so far conducted on pubertal ICSI-conceived offspring are reassuring, but they have the limitation of incomplete data. Recent studies had shown impaired spermatogenesis in ICSI-conceived young adult male compared to the control. Belva et al., in 2016 looked into the semen quality of young adult ICSI offspring, the study was carried out on 54 young adult ICSI men of the age 18-21, in result they could find that young ICSI adults had a lower median sperm concentration, total sperm count and total motile sperm count in comparison to spontaneously conceived (Belva et al., ‎2016). But the study has its own limitation due to the small sample size. Due to the time barrier the fertility of ICSI conceived males also the extent of their transgenerational inheritance of infertility is still unknown. Further studies in the future will be needed for better understanding of the remaining concerns.

ICSI has been widely opened the door of parenthood for patients with azoospermia even in case severe testicular failure. Due to the existing concern of increased chromosomal aneuploidy, follow up studies are extremely important. A systematic review by Esteves et al. shown either a decrease or no difference in pregnancy outcomes with ICSI in cases of nonobstructive azoospermia and obstructive azoospermia. In an overall there was no significant differences were found in short-term neonatal outcomes and congenital malformation rates between children from fathers with nonobstructive azoospermia and obstructive azoospermia. A study by Jin et al., in 2020 showed that there is no difference in the incidence of congenital malformations between epididymal sperm, testicular sperm and ejaculated sperm groups (Jin et al., 2020.)

ICSI &epigenetic disorders

Since ART procedures are involved with handling of germ cells and preimplantation embryo in vitro at critical stage of development during which genome-wide epigenetics reprogramming occur (Kohda et al., ‎2013). Concern has raised that such epigenetic changes may be transmitted to offspring leading to a high risk of imprinting and other disorders. Studies published previously had suggested that ART have increased the incidence of Beckwith-Wiedemann syndrome (BWS), Angelman syndrome (AS), Prader-Willi syndrome (PWS), and Silver-Russell syndrome (SRS) (Hattori et al., 2019)

A study by Cox et al., reported on two unrelated children having Angelman syndrome, both of whom were conceived by ICSI. Molecular investigation of the cases found that they were caused by sporadic imprinting defect. There is a strong possibility of rare coincidence exist in this two cases, but authors pointed out the possibility of artificial fertilization by ICSI interfering with establishment of the normal methylation pattern in the oocyte (Cox et al., ‎2002).

But there are contradicting studies Santos et al. showed following research on 76 ICSI embryos that insemination procedure does not cause an increase in incidence of epigenetic error. The study has also shown that DNA methylation pattern was consistent up to blastocyst stage when compared with those obtained from conventional insemination (Santos et al., ‎2010). Ghosh et al. compared methylation status of CCGG sites in the placentas between ICSI and IVF and no significant differences were obtained (Ghosh et al., 2017). Further studies are most certainly needed, and given that these defects are usually quite rare, long-term follow-up of large cohorts from multiple centers will be needed get conclusive result.

CHALLENGES AND FUTURE ASPECTS

So far in the literature, many studies had looked into the various outcome of ICSI including pregnancy outcome, perinatal development, postnatal development etc. There are certain challenges associated with comparing the outcomes of ICSI from various studies and coming to a conclusive data. It includes lack of standardized reports of various parameters used for ICSI outcome studies especially congenital abnormalities, lack of standardization of ovarian stimulation during oocyte pick up, lack of comparable study groups, inability to design and execute prospective, blinded, and well-controlled trials due to obvious ethical constraints.

Another concern while studying risk associated with ICSI as it is difficult to understand the reason behind risk, whether it is technique related or related to genetic defects of the parents. Since the oldest child conceived by ICSI is about 28 years old now, there are only limited long term studies of ICSI offspring are available. There are certain limitations in the follow up studies also, since few couple seek treatment at clinics far from their home and once pregnancy is achieved follow up treatment are continued by community physicians, such couples are often lost during follow-up studies. Due to the mobile nature of society, patients are lost from follow up for other reasons also.

There are additional challenges faced by ICSI/IVF follow up studies. Often assessment of IVF/ICSI offspring are often carried out by pediatricians as part of a routine neonatal health exam, yet a genetic division may have a different criterion for a disorder. Also there is a possibility of the ICSI conceived children undergoing more close examination than the naturally conceived children- the closer you look there is a greater likelihood of finding an abnormality.

Future studies with long term follow up and more detailed data will be helpful to attain a conclusive idea regarding the outcomes of ICSI.

REFERENCES

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