What is Infertility?

Infertility is the inability of a couple to conceive after one year of trying to become pregnant during which they have regular, unprotected sex (without using any means to help the pregnancy). Infertility affects both men and women; either partner may be sterile or have a weak reproductive capacity.

Types of Infertility

  1. Primary Infertility: pregnancy never occurred
  2. Secondary Infertility: one or both partners have conceived children previously but the couple are unable to conceive after a full year of trying

Causes of Infertility

It is important to assess the type of interaction between the partners. In 3-4% of the cases, the causes of infertility will not be known. In 40% of the cases, the reasons for infertility can be contributed to the man and in 40% of the cases infertility can be contributed to the woman. Approximately 20% of cases of infertility are attributed jointly to both partners. Environmental, genetic, pathological and nutritional factors that can contribute to infertility include:

  • Problems with the individual’s internal structure
  • Problems with the individual’s glands
  • Genetic problems
  • Immune problems
  • Advanced age
  • Infectious or parasitic diseases (such as malaria or schistosomiasis (not common in Jordan) and Mumps, if no vaccination was provided during childhood
  • Malnutrition
  • Exposure to harmful substances such as those found in cigarettes, caffeine, alcohol, and pesticides
Mumps is a viral infection that primarily affects saliva-producing (salivary) glands that are located behind ears. Mumps can cause swelling in one or both of these glands. It is caused by a virus that spreads easily from person to person through infected saliva. If person is not immune, he/she can contract mumps by breathing in saliva droplets from an infected person who has just sneezed or coughed. You can also contract mumps from sharing utensils or cups with someone who has mumps. Complications of mumps are rare, but some are potentially serious. Most mumps complications involve inflammation and swelling in some parts of the body, such as:
  • Testicles, Orchitis: (inflammation of testis) causes one or both testicles to swell in males who have reached puberty. Orchitis is painful, but rarely leads to the inability to father a child (sterility).
  • Brain: inflammation of the brain (encephalitis). Encephalitis can cause neurological problems and become life-threatening.
  • Membranes and fluid around the brain and spinal cord. This condition, known as meningitis, can occur if the mumps virus spreads through your bloodstream to infect your central nervous system
  • Pancreas. The signs and symptoms of this condition, known as pancreatitis, include pain in the upper abdomen, nausea and vomiting.

Reasons for Infertility in Men

  • The characteristics of the sperm in terms of number i.e. sperm count. Less than 20 million sperm per millimeter may be indicative of infertility and counts of below 10 million are considered poor. Additional characteristics include the structure, speed and quantity of sperm and their ability to penetrate the outer membrane of the egg. To examine these characteristics, a sample of semen is examined under the microscope.
  • Varicocele: the presence of varicose veins in the testicle or scrotum which raises their internal temperature and reduces the number of sperm produced.
  • The testicles fail to drop and/or are absent in the scrotum, or the presence of one testicle rather than two, or the size of the testicles is smaller than average.
  • Previous infection, such as mumps, or injury affecting the function of the testicles.
  • Problems in the structural composition of the man may lead to seme collecting in the bladder instead of being ejaculated from the penis. Scars due to previous infections may also affect the man’s ability to ejaculate, blockages may be present, or sperm may not be produced.
  • The immune system may attack semen (e.g. an autoimmune reaction in which the body reacts to the semen as an infection). Some reasons for this include infection in the testicles, shock to the testicles, operation to the testicles, or varicose veins present in the testicles.
  • Difficulty in erection and ejaculation due to erectile dysfunction or premature ejaculation.
  • Exposure of the man to various toxic substances in addition to side effects of drug abuse, alcohol abuse, steroid use, diabetes, sexually transmitted infections, thyroid problems, and hormonal imbalance.

Reasons for Infertility in Women

  • A history of sexually transmitted infections such as gonorrhea and chlamydia and syphlis that may damage the fallopian tubes.
  • Aging and its relationship to egg quality, increasing the possibility of miscarriages and other complications.
  • Smoking can cause the ovaries to age prematurely, depleting the woman’s number of eggs.
  • Excess weight limits the possibility of natural ovulation which affects the ability to carry.
  • Overuse of alcohol increases the chances of having endometriosis or ovulation abnormalities.
  • Problems in ovulation such as the lack of regular egg production or dysfunction in the thyroid or pituitary glands which produce hormones that affect the regularity of the menstrual cycle.
  • Fibers in the pelvis or uterine tissue outside of their normal position may prevent eggs from descending from the ovaries through the fallopian tube and impeding the fertilization process. These fibers result from pelvic inflammation or infection due to abortions or previous operations.
  • Cervical problems: the cervix may be narrower than normal due to surgery or infection, which can also cause reduction of the glands and thus the mucus they secrete that helps the sperm to move to the uterus.
  • Autoimmune reactions in which the body produces antibodies that attack the sperm as if it were an infection.

Prevention of Infertility

  • Reduce or abstain from smoking, alcohol and caffeine
  • Prevention or treatment of sexually transmitted infections
  • Avoiding unsafe abortion
  • Do not take medicines during pregnancy or before seeking medical advice
  • Maintain genital hygiene
  • Overheating can reduce sperm production. For this reason, men may wish to avoid wearing excessively tight clothing.

Management of Infertility

  • Treatment of factors afflicting men include abstaining from drugs that affect the process of semen production and ejaculation, reducing alcohol intake, and treating thyroid or other hormonal problems. It is also possible to treat varicose veins through surgery or utilize hormone or drug treatments to improve the quality of semen.
  • Artificial Insemination: collecting semen and introducing it to a woman’s cervix or uterus to achieve pregnancy from a means other than sexual intercourse.
  • Utilizing of fertility drugs in tandem with hormone therapy and artificial fertilization in various combinations.

Society's View of Infertility: Causes and Consequences

Because the topic of infertility is not discussed objectively and openly, there is a resulting lack of knowledge regarding its causes, and women are unfairly held accountable for issues of infertility by the community. One common misconception is that family planning causes infertility while science shows the contrary, and many couples link the inability to procreate with impotence. There are many negative effects of infertility, including personal feelings such as grief, disappointment and frustration, the sense of lacking masculinity or femininity, and the feeling of inability to establish a family, which is further exacerbated by society’s expectations of couples and women specifically. Stigmatization, ridicule, economic deprivation, abuse, disruption of the marriage and the urging to find another spouse may ensue.

Living with Infertility

The ways of coming to terms with and living with infertility depend on the couple only, and it is important to not succumb to the pressure of society and its negative perception of the issue. The couple alone should decide on the treatment and the procedures they will take if experiencing infertility. This will depend on the type and intensity of their unique relationship.

Prevention of Mumps

  • The best way to prevent mumps is to be vaccinated against the disease. Most people have immunity to mumps once they're fully vaccinated.
  • The mumps vaccine is usually given as a combined measles-mumps-rubella (MMR) inoculation, which contains the safest and most effective form of each vaccine. Two doses of the MMR vaccine are recommended before a child enters school.
  • Those vaccines should be given when the child is:
    • Between the ages of 12 and 15 months
    • Between the ages of 4 and 6 years

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