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Infertility synthesis

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Infertility synthesis

  1. 1. Haramaya UniversityMPH-ISynthesis on infertility and sexualdysfunctionGroup 41. Abdifatah Ahmed2. Annimaw Yibeltal3. Meskerem Abate6-Jun-13infertility
  2. 2. Outline of the presentation Introduction Global status and trends Highly affected regions Causes Impact Coping-Adoption-Treatment Sexual dysfunction – types-causes-solutionsConclusionRecommendation6-Jun-13infertility
  3. 3. Introduction Infertility is a disease of the reproductive system Affect both men and women in equal proportion Devastating condition leading to distress and depression,as well as discrimination and ostracism. Childbearing and raising means ultimate goals ofcompleteness, happiness and family integration. A global picture of infertility is not available partly due tothe difficulty in defining the conditions An accurate profile required – neglected disability6-Jun-13infertility
  4. 4. What is infertility? Couples that have been unable to conceive a childafter 12 months of regular sexual intercoursewithout birth control are infertile. Women who have repeated miscarriages are alsosaid to be infertile.6-Jun-13infertility
  5. 5. Global Status Sub-Saharan Africa have Prevalence rates ofinfertility of 20-30%. Rates of primary infertility are generally between 1%and 8% with rates of secondary infertility reaching ashigh as 35% DHS Comparative report captured data from 47countries. It was estimated that over 186 millioncouples in developing countries (excluding China)suffer from infertility, with an estimate of as many as1 in every 4 couples unable to have children.6-Jun-13infertility
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  8. 8. Highly affected regions An infertility belt has been described in Africa. This stretches from West Africa, through Central toEast Africa Nigeria, Cameroon, Gabon, Democratic Republicof Congo, Central African Republic, Chad,Burundi, Uganda and Kenya. In Gabon, it is estimated that more than 33% ofwomen and in Nigeria from 20-45% are infertile infertility is more or less a problem of Africa andother Developing countries6-Jun-13infertility
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  10. 10. Regional Difference, prevalence3 3.2 2.91.818.58.5 7.9 802468101214161820Sub saharanand westernafricaNorth Africa/EasternmediterianregionCentral Southand south eastasiaLatin America/south AmericaPrimarysecondary6-Jun-13infertility
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  12. 12. Trends primary or secondary—have risen because ofsexually transmitted infections includingHIV, environmental factors, or changes in sexualand reproductive behaviours. A decline may be expected with an upsurge intreatment-seeking behaviour and increased useof modern technologies of assisted reproduction.6-Jun-13infertility
  13. 13. Percentage of currently marries women(40-44), married for at least 5 years and noliving children,WFS,DHS012345678197819986-Jun-13infertility
  14. 14. Percentage of currently marrieswomen(25-49), married for at least 5years and no living children,WFS,DHS012345678197819986-Jun-13infertility
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  16. 16. CausesAfrica Infertility in Africa is due largely to reproductive tractinfections, STI being most. Infertility in Africa conforms to sections and regionsin the continent that have comparatively higher ratesof STI’s Infection associated with unsafe abortion is anotherleading cause of infertility in Africa.Developed world Endometriosis, anovulation from polycystic ovariandisease, Hyperprolactinaemia6-Jun-13infertility
  17. 17. Consequences of STI These infections produce extensive damage to thefallopian tubes leading to tubal occlusion and peritubaladhesions These infections often damage the tubes, resulting inirreversible bilateral tubal occlusion unsafe abortion can lead to infertility as a result ofAsherman’s Syndrome produced by excessive curettageof the uterine endometrium during dilatation and curettage Another cause of infertility in African women is infectionarising From puerperal sepsis6-Jun-13infertility
  18. 18. The paradox for developing countries Although women are usually stigmatized and blamedfor a couples inability to have a child, mostsignificantly from a social and socioeconomiccontext, male factor infertility has been cited asrepresenting 20-50% contribution to a couplesfailure to conceive. Men in some countries will divorce or may partake inpolygamous relationships in order to bearchildren, and women may also attempt multiplepartnerships.6-Jun-13infertility
  19. 19. Infertility Etiology – developing world40%40%15%5%Male factorfemale factorBothunexplainable6-Jun-13infertility
  20. 20. Female Infertility6-Jun-13 infertility In order for a woman to become pregnant: Egg must be released from one of her ovaries (ovulation) Egg must go through the fallopian tube toward the uterus Sperm must join with the egg in the fallopian tube (fertilization) Fertilized egg must attach to the uterine wall (implantation) Infertility can result from problems that interfere withany of these steps.
  21. 21. What Increases the Risks?6-Jun-13 infertility Age Stress Poor diet Smoking Alcohol STDs Overweight Underweight Caffeine intake Too much exercise
  22. 22. The Age Factor A womans fertility naturallystarts to decline in her late20s. After age 35 a womansfertility decreases rapidly. A woman is born with all theeggs shell have, and withtime, the supply diminishes. The remaining eggs also agealong with the rest of thebody.6-Jun-13infertility
  23. 23. Common Causes of female Infertility6-Jun-13 infertility Severe endometriosis Pelvic Inflammatory Disease (PID) Ovulation disorders Elevated prolactin Polycystic ovary syndrome (PCOS) Early menopause Benign uterine fibroids Pelvic adhesion
  24. 24. Unsafe abortion, infection and infertility The WHO estimates that about 20-30% of unsafeabortions result in reproductive tract infections andthat about 20-40% of these result in upper genital-tract infection and secondary infertility. An estimated 2% of women of reproductive age aresecondarily infertile as a result of unsafe abortionand 5% have chronic infections which may lead tosecondary infertility in themselves and/orinfertility/low fertility in their male partners.6-Jun-13infertility
  25. 25. Common causes of male infertility Low Sperm Count Dilated Veins around Testicles (Varicocele) Damaged Vas Deferens or Epididymis Hormone Deficiencies Impotence Incidental Causes Prostatitis Undescended Testes Other Congenital Defects6-Jun-13infertility
  26. 26. Impact of infertility The onus of infertility in most societies is placed onthe woman. when the couple is unable to produce children, thecouple may divorce or separate, or the man maytake another wife if they live in a culture that permitspolygyny. In some cultures, the woman needs to ―prove‖ herfertility before entering into a formal union. In these societies, women may remain unmarried ifthey cannot bear children.6-Jun-13infertility
  27. 27. Impact on women Overall, women who have never had a child or arecurrently childless are more likely to be divorced orseparated, 14 percent for primary sterility and 12percent for childlessness. Childless women are 13 percent more likely to havemarried more than once than women with children Feel isolated and pull away from their partners Depression, anger, anxiety, feelingworthlessness, stigma6-Jun-13infertility
  28. 28. Vulnerability of childless women to contractsexually transmitted infections, including HIV "One of the few means a childless woman may haveto regain respect, recognition and value is to proveher fertility. To achieve this she may need to have unprotectedsexual intercourse with several partners. In a society in whichsyphilis, gonorrhoea, Chlamydia and HIV infectionare prevalent, the risk of acquiring these diseasemay be substantial."6-Jun-13infertility
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  30. 30. Regional difference -impact By region, sub-Saharan Africa has the greatestdifference in percent remarried between childlessand non childless women (17 percent) and primarilyand secondarily infertile women (10 percent each). In contrast, in Latin America and theCaribbean, childless and primarily infertile womenare less likely to have had a second or later unionthan are other women, and the difference forsecondarily infertile women is minimal.6-Jun-13infertility
  31. 31. SSA In nine sub-Saharan countries, the difference is 20percent or more for women with a second or laterunion between childless women and women withchildren. Outside of sub-Saharan Africa, the difference is 20percent or more only in Morocco, Indonesia, andUzbekistan. For primary infertility, six countries have a differenceof 20 percent or more. For secondary sterility, onlythree countries have that large a difference: CentralAfrican Republic, Madagascar, and Mozambique.6-Jun-13infertility
  32. 32. Polygamy Instead of divorcing or separating from his wife whenthe union is infertile, a man may take another wife inthose societies where polygyny is allowed. Overall, sexually experienced childless and primarilyinfertile women are 18 percent less likely to be livingin a monogamous first union than sexuallyexperienced women with children.6-Jun-13infertility
  33. 33. Secondary infertility - impact Women who have had a child but are unable to havemore were 12 percent less likely to be living in amonogamous first union. A portion of the relationship between secondary sterilityand monogamous first union ship may be due to theeffects of age; older women are more likely to besecondarily sterile and to have had more exposure todivorce, separation, and polygyny.6-Jun-13infertility
  34. 34. Coping with infertility The most important way for couples to cope withinfertility is to adopt children. DHS data in sub-Saharan African has shown thatchildlessness and infertility increase adoption rates onaverage by 17 and 11 percent, respectively. In five countries in West Africa, more than half of thecouples who are childless live in households withadopted children under age 15: Niger (61percent), Guinea (59 percent), Benin (56 percent), Togo(56 percent), and Cameroon (53 percent).6-Jun-13infertility
  35. 35. Treatment- grouped in to three1. Medicines to improve fertility-these are sometimes used alone, but can alsobe used in addition to assisted conception.2. Surgical treatments- these may be used when a cause of the infertilityis found that may be helped by an operation.3. Assisted conception-this includes several techniques such asintrauterine insemination (IUI), in vitro fertilisation(IVF), gamete intrafallopian transfer (GIFT), andintracytoplasmic sperm injection (ICSI).6-Jun-13infertility
  36. 36. Medicines that may improve fertility Medicines are mainly used to help with ovulation6-Jun-13infertility
  37. 37. Mechanisms of ovulation Ovulation is partly controlled by hormones calledgonadotrophins. These are made in a gland just under the brain (thepituitary gland). A gonadotrophin is a hormone that stimulates theactivity of the gonads (the ovaries in women and thetestes in men). The main gonadotrophins made by the pituitarygland are called follicle-stimulating hormone (FSH)and luteinising hormone (LH).6-Jun-13infertility
  38. 38. Clomifene It works by blocking a feedback mechanism to thepituitary gland. This results in the pituitary makingand releasing more gonadotrophin hormones thannormal. The extra amount of gonadotrophinhormones may stimulate the ovaries to ovulate. Other Medicines that contain gonadotrophinsare used prior to IUI and IVF, to cause ovulation..6-Jun-13infertility
  39. 39. Metformin offered to women with polycystic ovary syndrome(PCOS) who have infertility but have not respondedto clomifene.6-Jun-13infertility
  40. 40. Surgical treatments Situation that require include-Fallopian tube problems- Endometriosis- Polycystic ovary syndrome- Fibroids- Male infertility6-Jun-13infertility
  41. 41. Assisted conception- IUI6-Jun-13infertility
  42. 42. In vitro fertilisation (IVF)6-Jun-13infertility
  43. 43. Intracytoplasmic sperm injection(ICSI)6-Jun-13infertility
  44. 44. Male sexual dysfunction : Causes of erectiledysfunction6-Jun-13 infertilityAnything that interferes with the nerve pathway cancause erectile dysfunction Trauma such as head and spinal cordinjuries, stroke, and diseases with systemiceffects such as multiple sclerosis and diabetescan diminish nerve function and lead toimpotence. Aging medications and alcoholism can also causeimpotence
  45. 45. Sexual dysfunction The male sexual problems is a very wide problemaround the world, its more common than peoplerealize. It affect around 7% of the young population inthe 20 to 40 age group, and it could become 40% forthe over the 60s6-Jun-13infertility
  46. 46. Main reasons There are two main sexual problems are verycommon, and they may affect any man in anyage. And they are the erectile dysfunction(impotence), and the premature ejaculation.6-Jun-13infertility
  47. 47. Erectile Dysfunction (impotence):It means inability of the man to get or to keep theerection. It may affect the man in any time in his life orhe may experience that in some times but not all thetime, but it become a problem when it becomespersistent and recurrent, and when it interfere with thesexual life.6-Jun-13infertility
  48. 48. Causes of the erectile dysfunction: There are many causes for the erectile problems, andthey vary from each others, some problems are Psychological issues which tendto affect younger men, such as first night nerves andso on. Thinking of work, money, relationship, family, or evenworry about not getting an erection, all of that can bePsychological factors for problem, and thepsychosexual therapist can help in you to pass thisproblems.6-Jun-13infertility
  49. 49. Medical and health conditions affect theerection function: Heart disease Diabetes Raised blood pressure Raised cholesterol Low testosterone Smoking and alcohol Some prescription drugs: beta-blockers, antidepressants, antipsychotic, anticonvulsantdrugs.6-Jun-13infertility
  50. 50. Ejaculatory failure6-Jun-13 infertilityEjaculatory failure can be grouped under 4 categories –A. unejaculation – no ejaculation of sperms.B. Retrograde ejaculation – semen is ejaculated inbladder.C. Premature ejaculation – inability to controlejaculation for sufficient length of time duringintravaginal containment to satisfy female partnerD. Ejaculatory obstruction – failure to achieve erection.
  51. 51. Premature ejaculation: Its defined as ejaculation with minimal stimulationoccurs before the person wishes it. Its only aproblem if it bothers him or his partner. And this happens either when you are veryexcited with your partner "may be with the newpartner", or when there is hypersensitivity of thelocal nervous system, and this trigger orgasm tooearly. Anxiety about sexualperformance, stress, unresolved issues in arelationship, or depression, may are also a risk tohave a premature ejaculation. 6-Jun-13infertility
  52. 52. There are some options may start with it.• Adjust lifestyle factors that might be risk factors.• Stop drinking and stop smoking.• Put you on other prescribed drugs if they were thecause.• Treat with hormone replacement therapy, if the lowtestosterone was the cause.6-Jun-13infertility
  53. 53. Conclusion For most countries there has been a decline in thepercentage of women reporting no pregnancy or no livebirth in the past 20 years. An important way of coping with infertility is adoption. Infive West African countries more than half of childlesscouples live in households with adopted children. Treatment and surgical operations and assistedreproductive technology, also contribute a lot in thereduction of the problem.6-Jun-13infertility
  54. 54. Recommendation The field of public health should contribute its skillsto infertility research, raising awareness of the scopeof infertility,. Developing and enforcing public policies on infertilityand its treatment, and involving society in the ethicaldebates raised by involuntary childlessness we must adhere to human rights ideals promotedand advocate for their use in order to provideeveryone with the highest possible quality ofreproductive health care6-Jun-13infertility
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