Infertility: addressing its causes and providing treatment

DOC 04: Oral presentation

Title: Gender, Human rights and socio-cultural dimension of HIV/AIDS in Rurual African communities: the case of Nigeria.
Author: Bob, B. B and Bob,B.B (2012)Journal: The 1st African Regional Educational HIV/AIDS submits,Abuja, ICEDCP. 2011, Nov (1) 12-20)
Source: African Journal: The 1st African Regional Educational HIV/AIDS Submit/ICEDCP

Abstract:
The epidemic of HIV/AIDS spread, within the context of Gender, human Rights and Sociocultural phenomenon or factor in many rural communities in Africa is largely invisible and insidious. until very recently, there was hardly any consideration of the influence of the existing inequalities, Human Rights abuse and cultural issues on the spread in the spread of HIV/AIDS and on the outcomes of the infection between the sexes. For instance: The phenomenon of increasing Male Sexual Risk during wife pregnancy, by the traditional proscription against sex for women during pregnancy in Oyo state south west Nigeria, cultural practices in south east Nigeria(Awka) that encourage the establishment od sexual network by men in the community with some marrie

Abstract
Background: Infertility is a major medical condition that affects many married couples in sub-Saharan African and as such associated with several social meanings.
Methods: This study used in-depth, key informant interviews and focus group discussions with infertility couples, fertile couples, and key informants to understand the cause of infertility. Results: The study revealed that infertility was caused by both social and biological factors. Socially couples could become infertile through supernatural causes such as bewitchment, and disobediences of social norms. Abortion, masturbation and use of contraceptives were also identified as causes of infertility. Most childless couples seek treatment from spiritualist, traditional healers and hospital.
Conclusion: Childbearing is highly valued in the community and Childlessness is highly engendered, and stigmatized in this community with manifold social consequences. In such a community therefore, the concept of reproductive choice must encompass policies that make it possible for couples to aspire to have the number of children they wish.

The exact mechanisms of HIV infection on biological fecundity are not fully understood, but epidemiological evidence provides support for the hypothesis that HIV-positive women have lower pregnancy rates, take longer to become pregnant, and experience higher rates of fetal loss. However, these studies often fail to disentangle behavioral and biological responses to HIV acquisition on reproduction. The present study attempts to isolate the biological effects of HIV infection on fecundity by employing a time-to-pregnancy (TTP) study design. Using contraceptive calendar and HIV serostatus information from 9 Demographic and Health Surveys, we use cox proportional hazard models to assess the relative TTP among HIV-negative and HIV-positive women who desire children. Our analysis demonstrates that HIV-positive women who desire a child present with a longer TTP. The findings from this study can inform reproductive and maternal health program strategies for HIV-positive women, which include ensuring future integration of fertility awareness education, and providing subfertility and infertility diagnostic and management services.

The incidence of infertility in a population has important demographic and health implications as it is closely linked with country’s overall fertility and psychological wellbeing of couples. Though in Sri Lanka, many couples expect a child soon after marriage, a considerable proportion of them are unable to conceive even after one year of regular sexual intercourse, without contraception. Previous research has focused on medical aspects and rarely examined socio-demographic factors related to infertility. Using data from 150 infertile couples from infertility clinics, we explore the demographic and socioeconomic factors of infertility. The findings reveal that primary infertility among couples is higher than the secondary infertility. It is also found that couple’s demographic factors such as age of woman, age at marriage, frequency of sexual intercourse within the fertile period and women’s irregular menstruation significantly influence on infertility. In addition, couple’s socio economic factors such as education, occupation, number of working hours per day, distance to work place and level of income affect infertility in Sri Lanka. Furthermore, health related factors such as reproductive system related problems, usage of long term drugs, body mass index, and mental illnesses have directly affected on the infertility.

Purpose:
The purpose of this study is to identify factors influencing pregnancy rate among unexplained infertile couples who received treatment of ART, Intra-Uterine Inseminations.
Method:
Medical records of 24,201 cases of unexplained infertility among total 31,684 intrauterine insemination treatment cases, which were benefited by 'National Medical-aid Program for ART in 2011' were used for this analysis.
Result:
Age(OR=0.948), frequency of IUI(OR=0.862), and medical cost(OR=1.022) were significant factors on pregnancy rates in logistic regression analysis.
Conclusion:
- Factors, such as infertile woman's age, frequency of IUI, medical cost were positively influenced pregnancy rate. However, age of spouse was not significant variable.
- Prioritize the infertile couples that one year even with regular and unprotected sexual intercourse for treatment.
- The results showed that about 70% of Korean infertile couples were unexplained infertility. The higher proportion of unexplained infertility rather than that of clinical standard. Therefore, we should assess for reasons through the future studies. In addition, affective or emotional factors influencing unexplained infertility need to be researched further.

The problem of infertility became aggravated in Russia from the depopulation beginning in the 1990th when 15-17% pairs of reproductive age fixed inability to the birth of own children (80% female, 45% male factor). Inclusion in practice of public health care Assisted Reproductive Technologies allowed to solve essentially this question and by 2010 apprx. 0,5% of all newborns were born after conceptions with help of In Vitro Fertilisation. ART – the only way of treatment of often meeting forms of man's infertility therefore «classical» IVF (46,4%) and IKSI (33,6%) are most demanded, and in every seventh or eighth case are supplemented with a cryopreservation of cells or embryos that allows parents to choose time of repeated childbirth. Availability of ART raised after introduction of the state financial support (2007 - quota from the federal budget on hi-tech treatment in state hospitals, 2013 - payment on system of obligatory medical insurance working). New problems – multiple pregnancies as result of transfer more than 1 embrio (25-30% twins, 3% triplets), «hereditary infertility», «hereditary subfertility», ART application in not medical purposes, refusal of customers of children in case of surrogacy, unreasonable Cesarean section.

Assisted reproductive technologies (ART) have buttressed its position as a key alternative of natural conception. The notion of the technology is socially-ethically-legally intertwined with the newer understanding of family and responsibility. The application of ART by IVF practitioners has been implicated not only in the decision-making process borne by the patient-clinician bond but also from the outcome of the knowledge level of couple concerning the number of options. There is a significant association between the access of technology available to couples and the extent of technology usage to be opted by the IVF practitioners poses a serious challenge pertaining to the safety and ethics of the impact of the procedure. The point of conflict rises about the discretionary approach of whether couples primarily require treatment coverage against reproductive disorders or undergoing an ART procedure for assisted conception. This immediately brings about two pertinent questions of rights to be enjoyed by the couples for baby and by the IVF practitioners for using the respective technology. In this paper, I will discuss issues of rights to be imposed by the government, clinicians and couples for ‘better understanding of this field’ eventually to seek a rationale about the usage of this technique for couple’s family procreation.

The desire to have one’s own biological children can be strong and compelling so the effects of infertility for women who are unable to conceive are seen socially irrespective. Although many effective programs are running in India for covering the reproductive and maternal health related issues, but till now, the infertility is not taken as an essential component in those programs. The purpose of this paper is to understand the differential in infertility treatment seeking behavior and its respective results in India by developed verses developing states. District Level Household Survey-3, a cross sectional data in India covered 643 994 ever married women. For first time it had a special section of Infertility that covered problems & treatment seeking for infertile ever married women of 15-49 years of age. Results of this study show the proportion of overall infertile women is higher in developing states compare to developed states. The result of the treatment is also in favor of developing states. In developed states only 78.6% of infertile women are seeking the treatment while in developing states its 83.9%. The result of treatment is also effective for developing states as 78.5% of women are conceive while in developed its 61.5%.

Globally, approximately 50 to 80 million people facing infertility problem. It is also an emerging heath issue in developing country. This study highlights the extent of infertility and treatment seeking behaviour among currently married women in India using large scale survey data (DLHS-3). The study reveals that 8.3 % currently married suffering any infertility problem and most of them are secondary infertile (5.75%). About 76 % infertile women faced problem during their first pregnancy. Result indicates that 80 % of infertile women sought any treatment but a considerable proportion (33 %) received non allopathic and traditional treatment due to expensive modern treatment and lack of awareness. The study presents evidence that allopathic or modern treatment received is higher for rich women than poor. The study incorporates some policy issues in order to improve the exiting service and quality of care for the infertile couple.

The study explored the factors influencing fertility among women in central region of Uganda. UDHS (2006) dataset was used as the source in this research where a sample size for central region was 1583 extracted from the whole female data of 8531.The study focused on women age 15-49 (reproductive age group). Two levels of analysis were used, univariate and bivariate and the data was analysed using SPSS.
According to this research, the results from the study suggest that the study population comprise mainly young age group (below 25 years of age) and age group 15-19 had the highest distribution and the number of mothers married was falling by their age at first marriage and most women were Catholics with 39 percent. Place of residence, age at first marriage, education status and contraceptive-use were significantly associated with fertility, however religion was not significant.
The study concluded that, early age at first marriage is responsible for the delay fertility transition in any society and keeping girls in school would reduce on their exposure to risk of child bearing. Education is inversely associated with fertility levels of woman because of its effects of keeping girls at school there by reducing on their exposure to risk of child bearing. In addition education helps in improving the mothers’ acceptabil