1. INFERTILITY PREVENTION, DETECTION AND MANAGEMENT INFERTILITY

2. Infertility definition Infertility is the inability to achieve pregnancy after one year of unprotected intercourse Couples that try to conceive unsuccessfully for a year should try an infertility evaluation. Infertility evaluation in those over 35 years - After six months of unprotected intercourse and not a year Early evaluation- better outcomes

3. Fertility challenges Genetic Abnormalities Infectious agents/ Environmental agents Delayed childbearing Certain behaviors Certain diseases Understanding these factors may enable others adopt corrective behaviors and maintain fertility. NB Early reporting vital – one does not have to wait for a year. e.g irregular menstrual cycles are a pointer to infertility and should be reported promptly to a medical expert. Delayed treatment – should not wait for a year to seek treatment Previous fertility problems need to be reported

4. Significance of problem Over 10 million American women between 15 and 44 have impaired fertility (National Survey of Family Growth). Infertility has been a rising problem over the years Emphasis placed on women, but men affected too Every year, 3 million American couples report about failed conception despite having protected sex Desire to have children widespread and powerful: infertility needs to be tackled

5. Causes a) Female infertility – 40% 1) Ovulatory factors 2) Pelvic factors 3) Cervical factors b) Male infertility – 40% 1) Endocrine disorders 2) Anatomical disorders 3) Abnormal spermatogenesis 4) Abnormal motility 5) Sexual dysfunction Others -20% Age related decline in fertility Choice of prior contraception Idiopathic

6. Causes and prevention 1) Female infertility -30% a) Pelvic factors Pelvic inflammatory diseases (PID) – Causes tubal scarring leading to 18% of infertility causes. Prevented through early detection of STDs like Chlamydia, which complicate to STDs Appendicitis – a treatable condition Uterine adhesions (Asherman’s Syndrome) – managed surgically when picked early DES exposure in utero – minimize or prevent DES exposure in utero Myomas – surgically and medically managed

7. b) Ovulatory factors Hyper-prolactinemia – treated by surgery and drugs Ovarian tumors- early management Metabolic diseases like obesity, renal disease, liver disease – managed early and effectively c) Cervical factors Acquired causes and infections treated early

8. Prevention Male Infertility a) Endocrine disorders – pituitary failure and hyper- prolactinemia investigated and managed early and effectively b) Anatomical disorders- investigated early and corrected c) Varicocoele- More than two thirds male infertility hospital visits in the US. Easily treated d) Environmental and occupational hazards- can be mitigated and avoided. e) Infectious causes- early investigation and management

9. Diagnosis The goals of evaluation Determine probable cause of infertility Provide accurate information on prognosis Counseling, support and education to the affected Guidance on treatment options

10. Management through History Medical history for female factor infertility In utero DES exposure History of puberty development Contraceptive history Prior pregnancy outcomes Previous pelvic surgeries Prior infections History of abnormal pap smear and treatment Prior drugs Prior paternity –males Frequency of intercourse

11. Previous surgery General health condition Summary in Management of infertility Addressing and managing risk factors for infertility Addressing racial and economic barriers to care The role of the public health community in combating infertility and creating awareness.

12. References Centers for Disease Control and Prevention. Sexually transmitted disease surveillance 2006 supplement, Chlamydia Prevalence Monitoring Project annual report 2006. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, 2007 Fidler AT, Bernstein JJ. Infertility: from a personal to a public health problem. Public Health Rep 1999;114:494–511 Farley Ordovensky Staniec J, Webb NJ. Utilization of infertility services: how much does money matter? Health Serv Res 2007;42:971–89 Hamilton BE, Martin JA, Ventura SJ. Births: preliminary data for 2006. Natl Vital Stat Rep 2007;56:18 Lobo RA. Potential optionsfor preservation offertility in women. N Engl J Med 2005;353:64–73. Kinney A, Kline J, Levin B. Alcohol, caffeine and smoking in relation to age at menopause. Maturitas 2006;54:27–38. Rutstein SO, Shah IH. Infecundity, infertility, and childlessness in developing countries. In: DHS comparative reports. Calverton, MD: ORC Macro and the World Health Organization, 2004