Infertility is defined as the inability to conceive or carry a pregnancy to live birth after one year of regular unprotected sex. There are various medical and demographic definitions of infertility, with medical definitions focusing on the inability to conceive and demographic definitions including the inability to carry a pregnancy to term. Infertility can be primary or secondary, with primary infertility referring to those who have never conceived and secondary referring to those who have previously conceived. Infertility is estimated to affect around 15% of reproductive aged couples globally based on WHO data, though estimates vary significantly between studies and regions.

1. Infertility

2. outline:
● Definintion(s)
● How to measure

3. Is it a problem ?

4. Yes, it is
WHO, 1975

5. Major Difficulties
● Disambiguities
● Lots of common sense
● Myths & Legends/Anecdotes & Fantasies
Probable source:
(After creating) … God said to them, "Be fruitful and multiply, and fill
the earth …’ (Genesis, 28)
Thus inability to be fruitful is a sin
Is this a command, or a blessing?

6. Reproductive period (the US data about 2000)
For a female normally 15-49, for a male usually greater

7. For instance in Uganda:
From:
Mother or nothing: the agony of infertility
Rita Sembuya,
founder of the Joyce Fertility Support Centre in Uganda
Ugandan women are not accepted by society
unless they have a child.

8. more
“Services to assist infertile couples need to be integrated and holistic
– starting from the community level to demystify the cause and
prevent infertility when possible, and to provide referral for
affordable care if infertility is unavoidable”

9. Lots of magic
Source:
buzzfeed.com

10. In English
• Infertility
• Sterility
• Infecundity
• Subfertility
• Impaired fecundity
Recommendation:
Look for the operational definition,
what and how had been measured

11. Two French definitions
“Sterility – the inability to produce a live birth”
(Roland Pressat)
“Sterility or infecundity is the inability to conceive or bear
children”
(Henry Leridon)

12. Centers for Disease Control and Prevention (CDC):
"infertility” refers to problems getting pregnant.
"Impaired fecundity” includes problems getting pregnant and
problems carrying a baby to term.

13. Demography v. Medicine
• In English demographic terminology, infertility (also called sterility) is
defined as the inability to bear any children, either due to the inability to
conceive or the inability to carry a pregnancy to a live birth (during 2-5
years).
• In medical studies, however, infertility is usually defined only as the
inability to conceive (during 1 year).

14. In Russian
Two paradigms:
● Medical — inability to conceive during a period of time (normally a year
or two)
● Demographic — proportion of childless women at age 49 (from census)
either total or in marriage

15. Why a year is bad
See:
Trussell J.
Contraceptive efficacy
Hatcher R.A., Trussell J, Nelson A, Kowal D. and Policar M. (eds.).
Contraceptive Technology:
Twentieth Revised Edition. New York NY: Ardent Media, 2011.

16. Primary and secondary infertility
Primary
WHO estimates that about 5% of the population suffer from infertility
associated with anatomical, genetic, endocrine, immunological, that is
unavoidable, factors.
Secondary
the main causes of secondary infertility: STIs, illegal abortions (acquired)

17. According to WHO
For a woman, infertility (or a state of subfertility) can manifest itself as either:
● the inability to become pregnant
● an inability to maintain a pregnancy
● an inability to carry a pregnancy to a live birth.
When men and women attempt to have a child or to expand their family, the
causes and the difficulties encountered can be complex. Many simple, as well
as more complex medical interventions can be attempted to help a couple or
an individual to reach a state of pregnancy or to be able to maintain a
pregnancy which results in a live birth.

18. Marital fertility of some historical populations
might be considered as fecundability
Jane Menken, James Trussell, Ulla Larsen. Age and Infertility // Science, New Series, Vol. 233, No. 4771 (Sep.
26, 1986), pp. 1389-1394
If
F(20-24)=1,
Then
F(25-29)=.94
F(30-34)=.86
F(35-39)=.69
Fem
For males
F(50–54)=.73

19. Model Extimates

20. How to measure infertility?

21. Systematic Analysis
National, Regional, and Global Trends in Infertility Prevalence Since 1990: A Systematic Analysis of 277 Health Surveys
PLOS Medicine
By applying a consistent algorithm to demographic and reproductive surveys
available from developed and developing countries, we estimate infertility
prevalence and trends, 1990 to 2010, by country and region.
We used a demographic infertility measure with live birth as the outcome
and a 5-y exposure period based on union status, contraceptive use, and
desire for a child.

22. Primary
Prevalence of primary infertility among women who seek a child, in 2010.
Infertility prevalence is indexed on the female partner; age-standardized
prevalence among women aged 20–44 y is shown here.

23. Secondary
Prevalence of secondary infertility among women who have had a live birth
and seek another, in 2010.
Infertility prevalence is indexed on the female partner; age-standardized
prevalence among women aged 20–44 y is shown here.

24. Census Data, Russia, 2002
Percentage childless

25. Survey Data
QQ:
As far as you know, would you, yourself, have any difficulty getting pregnant
or carrying a baby to term?
What is the reason that it would be difficult for you to have another baby?
Russian GGS (2004, 2007, 2011):
"Do you think that you are physically able to have a child (ren), if you want
this?"

26. RGGS, 2007

27. RGGS, 2007, female answers by age
Blue = unable to have, red = able to have

28. Unable to have a child:
A — likely unable
B — definitely unable
C — unable, but wish to have
Mean C = 1.8 per cent

29. RRHS, 2011
Q:
"Was you or was your husband/partner ever diagnosed with
"infertility? "
A:
"Yes," answered 4.7 per cent of married or ever-married women;
55% of them had at least one live birth.

30. warning
15 per cent — very popular estimate of infertility/sterility
Remember the Trussell table

31. Curios offer
Looking for a collaborator to prepare a live video to prove that:
THE UTERUS DOES THE GENDER SELECTION
We discovered an amazing phenomenon in women. Just like there are two kinds of sperms,
women have been found to have gender specific menstrual cycles. One cycle is for
conceiving a boy and the next one for a girl. This gender specificity alternates. We have
enough data to prove that if 100 couples try to conceive, say a boy, and if all of them
conceive in boy cycle advised by us, 92 of them are already getting boys. This much
success makes us believe that the uterus selects X and Y sperms depending upon the cycle
she is in.
We are now interested to show this phenomenon in form of a lab video. If you are a researcher in the field of ob/gyn or in-
vitro fertilization, this is a chance to make a big name. We can jointly publish our findings in reputed journal. Please
forward this message to anyone you know who can help. We are prepared to give this project to any student aspiring to get
admission to medical school. If interested, please call:
313 574 7500 Dr. Kuldeep Verma, President, Urobiologics LLC, www.urobiologics.com

32. More to read on the topic
● WHO manual for the standardized investigation and diagnosis of the
infertile couple
● Infecundity, infertility, and childlessness in developing countries.
Demographic and Health Surveys (DHS) Comparative reports No. 9
● National, regional, and global trends in infertility: a systematic analysis of
277 health surveys
● Infertility/subfertility