Article taken from: World Health Organization (WHO) (Click here)
The World Health Organization (WHO) recognizes the current impact of infertility diagnoses in the world and proposes action strategies to work on this disease for the quality of life and well-being of people. Below we share the research carried out:
Key facts:
1. Infertility is a disease of the male or female reproductive system defined by the inability to achieve pregnancy after 12 months or more of regular unprotected sex. (1)
2. Infertility affects millions of people of reproductive age around the world and has an impact on their families and communities. Estimates suggest that between 48 million couples and 186 million people are living with infertility worldwide. (2, 3, 4)
3. In the male reproductive system, infertility is most commonly caused by problems in the expulsion of semen (1), absence or low levels of sperm, or abnormal shape (morphology) and movement (motility) of sperm.
4. In the female reproductive system, infertility can be caused by a variety of abnormalities of the ovaries, uterus, fallopian tubes, and endocrine system, among others.
5. Infertility can be primary or secondary. Primary infertility is when a person has never achieved a pregnancy, and secondary infertility is when at least one previous pregnancy has been achieved.
6. Fertility care encompasses the prevention, diagnosis, and treatment of infertility. Equal and equitable access to fertility care remains a challenge in most countries; particularly in low- and middle-income countries. Fertility care is rarely prioritized in national universal health coverage benefit packages.
Infertility can be caused by several different factors, either in the male or female reproductive system. However, sometimes it is not possible to explain the causes of infertility.
In the female reproductive system, infertility may be due to:
Tubal disorders, such as blocked fallopian tubes, which in turn are caused by untreated sexually transmitted infections (STIs) or complications from an unsafe abortion, postpartum sepsis, or abdominal/pelvic surgery.
Uterine disorders that could be inflammatory in nature (such as endometriosis), congenital in nature (such as a septal uterus), or benign in nature (such as fibroids).
Ovarian disorders, such as polycystic ovary syndrome and other follicular disorders.
Endocrine system disorders that cause reproductive hormone imbalances. The endocrine system includes the hypothalamus and pituitary glands. Examples of common disorders that affect this system include pituitary cancers and hypopituitarism.
The relative importance of these causes of female infertility may differ from country to country, for example, due to differences in the prevalence of STI antecedents or the different ages of the populations studied. 4
In the male reproductive system, infertility can be caused by:
Obstruction of the reproductive tract causing dysfunctions in semen ejection. This blockage can occur in the ducts that carry semen (such as the ejaculatory ducts and seminal vesicles). Blockages are commonly due to injuries or infections of the genital tract.
Hormonal disorders that result in abnormalities in the hormones produced by the pituitary gland, hypothalamus, and testicles. Hormones such as testosterone regulate sperm production. Examples of disorders that cause a hormonal imbalance include cancers of the pituitary gland or testicles.
Testicular failure to produce sperm, such as due to varicoceles or medical treatments that impair sperm-producing cells (such as chemotherapy).
Abnormal sperm function and quality. Conditions or situations that cause abnormalities in the shape (morphology) and movement (motility) of sperm negatively affect fertility. For example, the use of anabolic steroids can cause abnormal semen parameters, such as sperm count and shape. 5
Environmental and lifestyle factors such as smoking, excessive alcohol intake, and obesity can affect fertility. In addition, exposure to environmental pollutants and toxins can be directly toxic to gametes (eggs and sperm), resulting in a decrease in their number and poor quality, leading to infertility.
Why is it important to address infertility?
Every human being has the right to the enjoyment of the highest attainable standard of physical and mental health. Individuals and couples have the right to decide the number, timing, and spacing of their children. Infertility can negate the realization of these essential human rights. Addressing infertility is therefore an important part of realizing the right of individuals and couples to found a family. 7
A wide variety of people, including heterosexual couples, same-sex couples, older people, people who do not have sex, and those with certain medical conditions, such as some HIV-serodiscordant couples and cancer survivors, may require infertility and fertility treatment. care services. Inequalities and disparities in access to fertility care services negatively affect poor, single, uneducated, unemployed, and other marginalized populations.
Addressing infertility can also mitigate gender inequality. Although both women and men can experience infertility, women in a relationship with a man are often perceived to suffer from infertility, regardless of whether they are infertile or not. Infertility has significant negative social impacts on the lives of infertile couples and particularly women, who frequently experience violence, divorce, social stigma, emotional stress, depression, anxiety, and low self-esteem.
In some settings, fear of infertility can deter women and men from using contraception if they feel socially pressured to prove their fertility at a young age due to the high social value of motherhood. In such situations, education and awareness-raising interventions to address understanding of the prevalence and determinants of fertility and infertility are essential.
The availability, access, and quality of interventions to address infertility remain a challenge in most countries. Infertility diagnosis and treatment are often not prioritized in national population and development policies or reproductive health strategies and are rarely covered through public health funding. In addition, the lack of trained personnel and the necessary equipment and infrastructure, and the current high costs of treatment drugs, are major obstacles even for countries that are actively addressing the needs of people with infertility.
While assisted reproductive technologies (ART) have been available for more than three decades, with more than 5 million children born worldwide from ART interventions such as in vitro fertilization (IVF), these technologies are still unavailable, inaccessible, and inaccessible in many parts of the world. particularly in low- and middle-income countries (LMICs).
Government policies could mitigate the many inequalities in access to safe and effective fertility care. To effectively address infertility, health policies must recognize that infertility is a disease that is often preventable, thereby mitigating the need for expensive and inaccessible treatments. Incorporate fertility awareness into national comprehensive sexuality education programs, promote healthy lifestyles to reduce behavioral risks, including early STI prevention, diagnosis, and treatment, prevent complications of unsafe abortion, postpartum sepsis, and abdominal/pelvic surgery, and address environmental toxins associated with infertility. they are policy and programmatic interventions that all governments can implement.
In addition, enabling laws and policies regulating third-party reproduction and art are essential to ensure universal access without discrimination and to protect and promote the human rights of all parties involved. Once fertility policies are implemented, it is essential to ensure that their implementation is monitored and that the quality of services is continuously improved.
WHO recognizes that the provision of high-quality family planning services, including fertility care services, is one of the fundamental elements of reproductive health. Recognising the importance and impact of infertility on people’s quality of life and well-being, WHO is committed to addressing infertility and fertility care by:
Collaborate with partners to conduct global epidemiological and etiological research on infertility.
Engage and facilitate policy dialogue with countries around the world to frame infertility within an enabling legal and policy environment.
Support the generation of data on the burden of infertility to inform resource allocation and service delivery.
Develop guidelines on the prevention, diagnosis, and treatment of male and female infertility, as part of global norms and standards of quality care related to fertility care.
Continuously review and update other regulatory products, including the WHO laboratory manual for the examination and processing of human semen.
Collaborate with relevant stakeholders, including academic centers, ministries of health, other UN organizations, non-state actors (NSAs), and other partners to strengthen the political commitment, availability, and capacity of the health system to deliver fertility care globally.
Provide technical support at the national level to member states to develop or strengthen the implementation of national fertility policies and services.
World Health Organization (WHO). International Classification of Diseases, 11th revision (ICD-11) Geneva: WHO 2018.
Mascarenhas MN, Flaxman SR, Boerma T, et al. National, regional and global trends in the prevalence of infertility since 1990: a systematic analysis of 277 health surveys. PLoS Med 2012; 9 (12): e1001356. doi: 10.1371/journal.pmed.1001356 [published online first: 2012/12/29]
Boivin J, Bunting L, Collins JA, et al. International estimates of infertility prevalence and seeking treatment: potential need and demand for medical care for infertility. Human Reproduction (Oxford, England) 2007; 22 (6): 1506-12. doi: 10.1093/humrep/dem046 [first posted online: 2007/03/23]
Rutstein SO, Shah IH. Infertility, infertility and childlessness in developing countries. Geneva: World Health Organization 2004.
Gore AC, Chappell VA, Fenton SE, et al. EDC-2: Second Endocrine Society Scientific Statement on Endocrine-Disrupting Chemicals. Endocrine Reviews 2015; 36 (6): E1-E150. DOI: 10.1210/ER.2015-1010
Segal TR, Giudice LC. Before the start: environmental exposures and reproductive and obstetric outcomes. Fertility and sterility 2019; 112 (4): 613-21.
Zegers ‐ Hochschild F, Dickens BM, Dughman ‐ Manzur S. Human rights to in vitro fertilization. International Journal of Gynecology and Obstetrics 2013; 123 (1): 86-89.
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