Human Infertility
Infertility is a condition of the reproductive system of ether males or females, which prevents conception. An estimated one in sex couples are faced with difficulties in conceiving. Approximately 35-40 per cent of infertility cases are found to be due to female factors and 35-40 per cent of cases are found to be due to male factors. The remanding cases are due to both parties or found to be unexplainable. Many infertility problems can be diagnosed and the majority treated.
There are a number of areas in which a woman may have difficulty leading to infertility. These include Endometriosis, a condition in which endometrial tissue grows outside the Uterus. This condition is a major course of female infertility in which women may suffer from painful menstrual periods and irregular or heavy bleeding. This can also lead to repeated miscarriages. Polycystic Ovary Syndrome is a condition in which the ovaries have many small cysts and hormone imbalances. This can lead to Irregular menstrual periods as well as excessive hair growth and weight gain. Ovulation problems are any condition preventing the mature eggs being released from the ovary. This will often course the menstrual period to be heavy or light and infrequent or even absent altogether. Female Tube Blockage happens when a woman's fallopian tubes get blocked or damaged preventing the egg from getting to the uterus. The main courses are pelvic inflammatory disease, STD's and previous sterilisation surgery. There are no symptoms to indicate that a woman's fertility is affected by Female Tube Blockage. Poor egg quality can prevent a women from sustaining a pregnancy, this is usually age related. The quality of women's eggs declines significantly when they reach there late 30s and early 40s. There are no symptoms to having poor egg quality.
Most infertility problems that men suffer from are without symptoms. Male course of infertility are due to Male Tube Blockage, which is any obstruction in the Epdidymis or Vas Deferens. The most common course Male Tube Blockage is varicose veins in the testicles, STDs is also linked to blockage problems. Sperm problems include low or no sperm counts, abnormally shaped sperm and poor sperm motility. Sperm Allergy, both men and women can have an immune reaction to sperm in which they produce antibodies that kill the sperm. This accounts for 10 per cent of infertile in both men ...
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Most infertility problems that men suffer from are without symptoms. Male course of infertility are due to Male Tube Blockage, which is any obstruction in the Epdidymis or Vas Deferens. The most common course Male Tube Blockage is varicose veins in the testicles, STDs is also linked to blockage problems. Sperm problems include low or no sperm counts, abnormally shaped sperm and poor sperm motility. Sperm Allergy, both men and women can have an immune reaction to sperm in which they produce antibodies that kill the sperm. This accounts for 10 per cent of infertile in both men and women.
20-35 per cent of infertility is due to ether combination or unexplained reasons. Combination infertility is term used to describe a problem with both, male and female fertility, or when one partner has more than one fertility problem. Unexplained is a term used when no course for infertility can be found. Some experts would argue that environmental factors such as toxins consumed or being unhealthily over or under weight may contribute to fertility problems. As of yet, no direct links have been found.
There are many treatments available to treat the verity of infertility difficulties that exist. Fertility drugs can be used to help trigger the release of more eggs per cycle. Clomiphene comes in the form of a pill and can have various side effects such as headaches, hot flushes cramping and visual symptoms. HMG is an injection which can cause bloating and rashes. 70 per cent of those that take fertility drugs for ovulation go on to ovulate, half of which go on to conceive within 6 to 9 months. Men can take fertility drugs to increase sperm the production, of which 25 per cent will go on to impregnate their partner. Surgery can be used to fix many blockage related infertility problems. Surgery is used to remove endometrial scarring, fibroids or ovarian cysts. 40-60 per cent of women who have surgery for Endometriosis blockages become pregnant with in 18 months were as for other types of blockages the success rate can very greatly depending on the severity of the blockage. Previous sterilisation can often be reversed through surgery. Artificial Insemination involves delivering a concentrated dose of sperm into the uterus or fallopian tubes with a catheter. Donor sperm can be used in the procedure. Some women suffer from cramping for a couple of days after the procedure. 5-20 per cent of women become pregnant per attempt of Artificial Insemination. Surrogacy is when another woman carries a couple's embryo to term, the embryo can be donated. This method has many psychological difficulties associated with it for both the couple and the surrogate mother.
In Vitro Fertilisation (IVF) is a procedure were eggs are removed directly from the ovaries. They are then fertilised in a laboratory creating embryos which are then transplanted to the uterus. Fertility drugs used with IVF can cause symptoms such as cramping and ovarian swelling. With IVF there is also the risk of having twins or multiples. Gamete Intrafallopian Transfer (GIFT) as with IVF it involves the harvesting of both sperm which are mixed in a lab. Unlike IVF this mixture is surgically implanted into the fallopian tubes were fertilisation can happen naturally. This treatment has the added side effects related to surgery (laparoscopy) which will involve a longer recovery time. GIFT is not a widely used treatment. Zygote Intrafallopian Transfer (ZIFT) is very similar to GIFT except that doctors confirm fertilisation before surgery to place the eggs in the fallopian tubes. Again like GIFT, ZIFT is not a widely used treatment. Intracytoplasmic Sperm Injection (ICSI) is very similar to IVF except the sperm is often collected strait from the testicles with a microscopic needle or surgical biopsy. This can lead to some discomfort which can be treated with over the counter painkillers. If women have poor egg quality IVF techniques can be used with donated eggs. 43 per cent of women that have fertilised donor eggs implanted in them become pregnant.
Infertility treatments have created many ethical issues; one of these issues is access, who has the right to them. Patients are thought of believing in their right to reproduce or to a particular type of treatment. Were some would argue that access to infertility treatment is not necessarily an issue of rights, to say we have the right to treatment is to imply someone has the corresponding duty to provide for that right. Who is to ensure that right and if that right is not realised who is to blame? Within law there is no right to reproduce or have access to treatment. The law actually considerably restricts access to fertility treatment. The law states within the welfare if the child clause, that a women not can be provided with infertility treatment, unless account has been taken for the welfare of the child. This clause is used to assess patients to see if they are suitable for treatment, which is not based on clinical grounds. This then puts the doctor in the position of assessing the suitability of a patient.
The welfare of the child act has no guide lines for medical professionals to follow. This raises the problem of how these people might assess the welfare of the child, a child not even born yet. Little is known on how the welfare the child clues is put into practice, but there has been some published cases. Such as a case were a woman who had an abortion three children who were put into care because she couldn't cope. 25 years later after apparently turning her life around and being with a new partner was refused treatment. Different clinics approach the issue in different ways. With clinics not righting down why patients are refused and most clinics say that they treat on case by case basis, making it difficult to assess the criteria for treatment.
This practice of clinical staff assessing patients on non medical bases courses a lot of controversy. When a clinic that is staffed with individuals with there own moral ideals, can make decision on who is entitled to treatment with out any clear guidelines. The door is left open for medical professionals to inflect their own preference of control over infertility treatment. This can be fare from the general public opinion. Though who's to say the general public has right to view over an individuals right to reproduce. And in all this who is open to being refused.
Bibliography
Baby Centre, 25/03/06, http://www.babycentre.co.uk/general/6020.html
Advanced Fertility Institute, 25/03/06, http://www.fertilitydocs.com/causesof.html
Bridge, 25/03/06, http://www.thebridgecentre.co.uk/causes1.htm
Advanced Fertility Centre of Chicago, 25/03/06,
http://www.advancedfertility.com/causes.htm
Pro + Choice Forum, 25/03/06 http://www.prochoiceforum.org.uk/ri2.asp
Iain Macdonald
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