infertility

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infertility,

inability to conceive or carry a child to delivery. The term is usually limited to situations where the couple has had intercourse regularly for one year without using birth controlbirth control,
practice of contraception for the purpose of limiting reproduction. Methods of Birth Control

Male birth control methods include withdrawal of the male before ejaculation (the oldest contraceptive technique) and use of the condom, a rubber sheath
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. The term sterility is restricted to lack of sperm production or inability to ovulate. Approximately 40% of reported cases of infertility are due to problems in the male; another 40% to problems in the female; the remaining 20% are of unknown cause or due to problems in both the male and female.

Causes

Infertility can be caused by any interruption in the usual process of fertilization, pregnancypregnancy,
period of time between fertilization of the ovum (conception) and birth, during which mammals carry their developing young in the uterus (see embryo). The average duration of pregnancy in humans is about 280 days, equal to 9 calendar months.
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, and birthbirth
or labor,
delivery of the fetus by the viviparous mammal. Birth is also known as parturition. Human birth normally occurs about 280 days after onset of the last menstrual period before conception.
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, which includes ejaculation of normal amounts of healthy spermsperm
or spermatozoon
, in biology, the male gamete (sex cell), corresponding to the female ovum in organisms that reproduce sexually. In higher animals the sperm is produced in the testis of the male; it is much smaller than the ovum and consists primarily of a head,
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, passage of the sperm through the cervix and into the fallopian tubefallopian tube
, either of a pair of tubes extending from the uterus to the paired ovaries in the human female, also called oviducts, technically known as the uterine tube.
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 of the female, passage of an ovumovum
, in biology, specialized plant or animal sex cell, also called the egg, or egg cell. It is the female sex cell, or female gamete; the male gamete is the sperm. The study of the ovum is included in the science of embryology.
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 (egg) down the fallopian tube from an ovary, fertilization in the fallopian tube, implantation of the fertilized egg in a receptive uterusuterus,
in most female mammals, hollow muscular organ in which the fetus develops and from which it is delivered at the end of pregnancy. The human uterus is pear-shaped and about 3 in. (7.
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, and the ability to carry the fetus to term. In women, the most common problems are failure to ovulate and blockage of the fallopian tubes. In men, low sperm count is the most common problem.

Underlying problems include disease, such as diabetes or mumps in adult men, hormonal imbalances, endometriosis, pelvic inflammatory disease (often caused by sexually transmitted diseasessexually transmitted disease
(STD) or venereal disease,
term for infections acquired mainly through sexual contact. Five diseases were traditionally known as venereal diseases: gonorrhea, syphilis, and the less common granuloma inguinale, lymphogranuloma venereum, and
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, e.g., chlamydiachlamydia
, genus of microorganisms that cause a variety of diseases in humans and other animals. Psittacosis, or parrot fever, caused by the species Chlamydia psittaci, is transmitted to people by birds, particularly parrots, parakeets, and lovebirds.
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), the abuse of alcohol and other drugs, and exposure to workplace hazards or environmental toxins. Uterine irritation or infection that sometimes accompanies IUD use can also reduce fertility. Occasionally there is a chemical or immunological incompatibility between male and female. Psychological factors are difficult to evaluate because of the stressful nature of infertility itself.

The number of couples seeking treatment for infertility has increased as more of them have postponed childbearing to a later age. In women, fertility begins to decline in the mid-twenties, and continues to decline, more and more sharply, until menopausemenopause
or climacteric
, transitional phase in a woman's life when the ovaries stop releasing eggs, ovarian production of estrogen and other hormones tapers off, and menstruation ceases.
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. Male fertility declines gradually until age forty, then declines more quickly.

Evaluation and Treatment

Evaluation includes examination of sperm, observation of basal body temperature or luteinizing hormone peaks (see gonadotropic hormonegonadotropic hormone
or gonadotropin,
any one of three glycoprotein (see protein) hormones released by either the anterior pituitary gland or the placenta (the organ in which maternal and fetal blood exchange nutrients and waste products) that have various effects upon
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) in the female to determine whether ovulation is taking place, the ruling out of obstructions of the fallopian tubes or vas deferens, and blood tests that measure hormone levels. Treatment is geared to the specific problem. The first step may be treatment of underlying disease and, in men, avoidance of substances that might affect sperm count. Fertility drugsfertility drug,
any of a variety of substances used to increase the possibility of conception and successful pregnancy. Different methods are used to correct or circumvent the many different functional disorders of both males and females that can interfere with conception and
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, some of which increase the likelihood of multiple birthsmultiple birth,
bringing forth of more than one offspring at birth. Although many smaller mammals bear several young at a time, multiple births are relatively uncommon in humans and other primates.
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, are often prescribed. If necessary, surgical correction of blocked tubes can be attempted.

Artificial inseminationartificial insemination,
technique involving the artificial injection of sperm-containing semen from a male into a female to cause pregnancy. Artificial insemination is often used in animals to multiply the possible offspring of a prized animal and for the breeding of endangered
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, in which the man's sperm or donor sperm from a sperm bank is inserted directly into the woman or a surrogate mothersurrogate mother,
a woman who agrees, usually by contract and for a fee, to bear a child for a couple who are childless because the wife is infertile or physically incapable of carrying a developing fetus.
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 may be attempted. Another method is in vitro fertilizationin vitro fertilization
(IVF), technique for conception of a human embryo outside the mother's body. Several ova, or eggs, are removed from the mother's body and placed in special laboratory culture dishes (Petri dishes); sperm from the father are then added, or in many cases a
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, in which an egg is taken from the mother or an egg donor and fertilized outside the body by the father's sperm. The resulting embryo is then inserted into the mother's uterus. Gamete intrafallopian transfer (GIFT) mixes the egg and sperm outside the body, then, using laparoscopic surgery (see endoscopeendoscope,
any instrument used to look inside the body. Usually consisting of a fiber-optic tube attached to a viewing device, endoscopes are used to explore and biopsy such areas as the colon and the bronchi of the lungs.
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), introduces them into the fallopian tube. For men with low sperm count or sperm of low quality, a procedure called intracytoplasmic sperm injection can help by inserting a single sperm directly into an egg. If none of these measures succeeds, adoptionadoption,
act by which the legal relation of parent and child is created. Adoption was recognized by Roman law but not by common law. Statutes first introduced adoption into U.S. law in the mid-19th cent.
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 is sometimes considered.

Some controversy has surrounded infertility treatment. Many of the procedures are very expensive, and some question whether insurance plans should be responsible for the cost. The multiple births that sometimes occur with fertility drugs can put great strain on a family's resources. The legal rights of surrogate mothers and sperm donors are also of concern to all parties and have sometimes been resolved only after extended court cases. The wisdom of stretching the definition of "the childbearing years" has come into question as well, as methods used for treating infertility have been used to allow postmenopausal women to have children. Some are uncomfortable with the ability to choose the sex of the child or the screening of sperm or egg donors for characteristics such as height and intelligence.

See also gynecologygynecology
, branch of medicine specializing in the disorders of the female reproductive system. Modern gynecology deals with menstrual disorders, menopause, infectious disease and maldevelopment of the reproductive organs, disturbances of the sex hormones, benign and malignant
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; obstetricsobstetrics
, branch of medicine concerned with the treatment of women during pregnancy, labor, childbirth (see birth), and the time after childbirth. Obstetricians work to ensure that pregnancy culminates in the delivery of a healthy baby, without impairing the health of the
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.

The Columbia Electronic Encyclopedia™ Copyright © 2013, Columbia University Press. Licensed from Columbia University Press. All rights reserved. www.cc.columbia.edu/cu/cup/

infertility

[‚in·fər′til·əd·ē]
(medicine)
Involuntary reduction in reproductive ability.
McGraw-Hill Dictionary of Scientific & Technical Terms, 6E, Copyright © 2003 by The McGraw-Hill Companies, Inc.
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