MOUNT SEENA PUBLIC SCHOOL GROUP OF EDUCATIONAL INSTITUTIONS Affiliated to CBSE, New Delhi, No: 933!3 "R#$ %&: Baith#Sha'i(a Al)*hai'i T'#+t NAGARIPURA-, PALA**AD, *ERALA)./0.12 Pho$e: 19)20/3!32, 20/20., Fa4: 20/132 E)5ail: 5o#$t+ee$a6i765ail8o5, e%+ite: www85o#$t+ee$a8o5
DPEART-ENT OF SCIENCE AND APPLICATIONS CERTIFICATE
This is to certify that this report is based on a bonade work done by__________ Student of class XII carried out the project under my supervision during the academic year 201!"1#
Teacher in Charge Principal
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This project consumed large amount of work, research and dedication. Still, implementation would not have been possible if we did not have a support from many individuals and organizations. Therefore we would like to etend our sincere gratitude to all of them. !irst of all we are thankful to "rs. # $atha %rakash, The principal for providing us the opportunity to go on such a project which has proven to be of much use and for providing necessary guidance concerning projects implementation. &e are also grateful to '("#, %uthiyara, #alicut, )r. *.+. *unjumoideen and )r. Sreeja Sajith for their guidance in the implementation. &ithout their superior knowledge and eperience, the %roject would lack in uality of outcomes, and thus their support has been essential. &e would like to epress our sincere thanks towards volunteer "rs. +maivan *, -iology and science department who devoted their time and knowledge in the implementation of this project. evertheless, we epress our gratitude towards our families and friends for their kind co/operation and encouragement which helped us in completion of this project.
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Infertility is the inability of a person, animal or plant to reproduce by natural means. It is usually not the natural state of a healthy adult organism, except notably among certain e usocial species (mostly haplodiploid insects). In humans, infertility may describe a woman who is unable to conceive as well as being unable to carry a pregnancy to full term. There are many biological and other causes o f infertility, including some that medical intervention can treat. Infertility rates have increased by 4% since the !"#s, mostly from problems with fecundity due to an increase in age. $bout 4#% of the issues involved with infertility are due to the man, another 4#% due to the woman, and #% result from complications with both partners. &omen who are fertile experience a natural period of fertility before and during ovulation, and they are naturally infertile during the rest of the menstrual cycle. 'ertility awareness methods are used to discern when these changes occur by tracing changes incervical mucus or basal body temperature Infertility is a disease of the reproductive system defined b y the failure to achieve a clinical pregnancy after months or more of regular unprotected sexual intercourse (and there is no other reason, such as breastfeeding or postpartum amenorrhea). *rimary infertility is infertility in a couple who have never had a child. +econdary infertility is failure to conceive following a previous pregnancy. Infertility may be caused by infection in the man or woman, but often there is no obvious underlying cause. ne definition of infertility that is fre-uently used in the nited +tates by doctors who speciali/e in infertility, to consider a couple eligible for treatment is0 •
a woman under 12 has not conceived after months of contraceptive3free intercourse. Twelve months is the lower reference limit for Time to Pregnancy (TT*) by the &orld ealth rgani/ation.
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a woman over 12 has not conceived after 5 months of contraceptive3free sexual intercourse
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T3+(4 6esearchers commonly base demographic studies on infertility prevalence on a five3year period. *ractical measurement problems, however, exist for any definition, because it is difficult to measure continuous exposure to the ris of pregnancy over a period of years 5
Primary vs. secondary infertility *rimary infertility is defined as the absence of a live birth for women who desire a child and have been in a union for at least five years, during which they have not used any contraceptives. The &orld ealth rgani/ation also adds that 7women whose pregnancy spontaneously miscarries, or whose pregnancy results in a still born child, without ever having had a live birth would present with primarily infertility +econdary infertility is defined as the absence of a live birth for women who desire a child and have been in a union for at least five years since their last live birth, during which they did not use any contraceptives. Thus the distinguishing feature is whether or not the couple have ever had a pregnancy which led to a live birth.
+66+%TS Psychological impact The conse-uences of infertility are manifold and can include societal repercussions and personal suffering. $dvances in assisted reproductive technologies, such as I8', can offer hope to many couples where treatment is available, although barriers exist in terms of medical coverage and affordability. The medicali/ation of infertility has unwittingly led to a disregard for the emotional responses that couples experience, which include distress, loss of control, stigmati/ation, and a disruption in the developmental tra9ectory of adulthood. Infertility may have profound psychological effects. *artners may become more anxious to conceive, increasing sexual dysfunction :arital discord often develops in infertile couples, especially when they are under pressure to mae medical decisions. &omen trying to conceive often have clinical depression rates similar to women who have heart disease or cancer. ;ven couples undertaing I8' face considerable stress. The emotional losses created by infertility include the denial of motherhood as a rite of passage< the loss of one=s anticipated and imagined life< feeling a loss of control over one=s life< doubting one=s womanhood< changed and sometimes lost friendships< and, for many, the loss of one=s religious environment as a support system. ;motional stress and marital difficulties are greater in couples where the infertility lies with the man.
Social impact In many cultures, inability to conceive bears a stigma. In closed social groups, a degree of re9ection (or a sense of being re9ected by the couple) may cause considerable anxiety and disappointment. +ome respond by actively avoiding the issue altogether< middle3class men are the most liely to respond in this way. In an effort to end the shame and secrecy of infertility, 6edboo in ctober # launched a video campaign, The Truth $bout Trying, to start an open conversation about infertility, which stries one in eight women in the nited +tates. In a survey of couples having difficulty conceiving, conducted by the pharmaceutical company :erc, 5 percent of respondents hid their infertility from family and friends. >early half didn7t even tell their mothers. The message of those speaing out0 It7s not always easy to get pregnant, and there7s no shame in that.
There are legal ramifications as well. Infertility has begun to gain more exposure to legal domains. $n estimated 4 million worers in the .+. used the 'amily and :edical ?eave $ct (':?$) in ##4 to care for a child, parent or spouse, or because of their own personal illness. :any treatments for infertility, including diagnostic tests, surgery and therapy for depression, can -ualify one for ':?$ leave. It has been suggested that infertility be classified as a form of disability.
%$S+S Sexually transmitted disease Infections with the following sexually transmitted pathogens have a n egative effect on fertility0 Chlamydia trachomatis, Neisseria gonorrhoeae, and +yphilis. There is a consistent association of Mycoplasma genitalium infection and female reproductive tract syndromes. M. genitalium infection is associated with increased ris of infertility.
Genetic $ 6obertsonian translocation in either partner may cause recurrent spontaneous abortions or complete infertility.
Other causes 'actors that can cause male as well as female infertility are0 @>$ damage
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@>$ damage reduces fertility in female ovocytes, as caused by smoing,other xenobiotic @>$ damaging agents (such as radiation or chemotherapy)or accumulation of the oxidative @>$ damage "3hydroxy3deoxyguanosine
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@>$ damage reduces fertility in male sperm, as caused by oxidative @>$ damage,smoing,other xenobiotic @>$ damaging agents (such as drugs or chemotherapy)or other @>$ damaging agents including reactive oxygen species, fever or high testicular temperature Aeneral factors
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@iabetes mellitus, thyroid disorders,undiagnosed and untreated coeliac disease adrenal disease
ypothalamic3pituitary factors
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yperprolactinemia
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ypopituitarism
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The presence of anti3thyroid antibodies is associated with an increased ris of unexplained subfertility with an odds ratio of .2 and !2% confidence interval of .B.# ;nvironmental factors
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Toxins such as glues, volatile organic solvents or silicones, physical agents, chemical
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dusts, and pesticides Tobacco smoers are 5#% more liely to be infertile than non3 smoers. Aerman scientists have reported that a virus called $deno3associated virus might have a role in male infertility, though it is otherwise not harmful. ther diseases such aschlamydia, and gonorrhea can also cause infertility, due to internal scarring (fallopian tube obstruction).
Females
The following causes of infertility may onl y be found in females. 'or a woman to conceive, certain things have to happen0 intercourse must tae place around the time when an egg is released from her ovary< the system that produces eggs has to be woring at optimum levels< and her hormones must be balanced. 'or women, problems with fertilisation arise mainly from either structural problems in the 'allopian tube or uterus or problems releasing eggs. Infertility may be caused by blocage of the 'allopian tube due to malformations, infections such as Chlamydia andDor scar tissue. 'or example, endometriosis can cause infertility with the growth of endometrial tissue in the 'allopian tubes andDor around the ovaries. ;ndometriosis is usually more common in women in their mid3 twenties and older, especially when postponed childbirth has taen place. $nother ma9or cause of infertility in women may be the inability to ovulate. :alformation of the eggs themselves may complicate conception. 'or example, polycystic ovarian syndrome is when the eggs only partially developed within the ovary and there is an excess of male hormones. +ome women are infertile because their ovaries do not mature and release eggs. In this case synthetic '+ by in9ection or Clomid (Clomiphene citrate) via a pill can be given to stimulate follicles to mature in the ovaries.
ther factors that can affect a woman7s chances of conceiving include being overweight or underweight, or her age as female fertility declines after the age of 1#. +ometimes it can be a combination of factors, and sometimes a clear cause is never established. Common causes of infertility of females include0 vulation problems (e.g. polycystic ovarian syndrome, *C+, the leading reason why
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women present to fertility clinics due to anovulatory infertility) •
tubal blocage
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pelvic inflammatory disease caused by infections lie tuberculosis
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age3related factors
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uterine problems
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previous tubal ligation
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endometriosis
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advanced maternal age
Male The main cause of male infertility is low semen -uality. In men who have the necessary reproductive organs to procreate, infertility can be caused by low sperm count due to endocrine problems, drugs, radiation, or infection. There may be testicular malformations, hormone imbalance, or blocage of the man7s duct system. $lthough many of these can be treated through surgery or hormonal substitutions, some may be indefinite.Infertility associated with viable, but immotile sperm may be caused by primary ciliary dysinesia
Combined infertility In some cases, both the man and woman may be infertile or sub3fertile, and the couple7s infertility arises from the combination of these conditions. In other cases, the cause is suspected to be immunological or genetic< it may be that each partner is independently fertile but the couple cannot conceive together without assistance.
nexplained infertility In the +, up to #% of infertile couples have unexplained infertility.In these cases abnormalities are liely to be present but not detected by current methods. *ossible problems could be that the egg is not released at the optimum time for fertili/ation, which it may not enter the fallopian tube, sperm may not be able to reach the egg, fertili/ation may fail to occur, transport of the /ygote may be disturbed, or implantation fails. It is increasingly recogni/ed that egg -uality is of critical i mportance and women of advanced maternal age have eggs of reduced capacity for normal and successful fertili/ation. $lso, polymorphisms in folate pathway genes could be one reason for fertility complications in some women with unexplained infertility.
T+$T.+'T Treatment depends on the cause of infertility, but may include counseling, fertility treatments, which include in vitro fertili/ation. $ccording to ;+6; recommendations, couples with an estimated live birth rate of 4#% or higher per year are encouraged to continue aiming for a spontaneous pregnancy. Treatment methods for infertility may be grouped as medical or complementary and alternative treatments. +ome methods may be used in concert with other methods. @rugs used for both women and men includeclomiphene citrate, human menopausal gonadotropin (h:A), follicle3 stimulating hormone ('+), human chorionic gonadotropin (hCA), gonadotropin3releasing hormone (An6)analogues, aromatase inhibitors, and metformin
Medical treatments :edical treatment of infertility generally involves the use of fertility medication, medical device, surgery, or a combination of the following. If the sperm are of good -u ality and the mechanics of the woman7s reproductive structures are good (patent fallopian tubes, no adhesions or scarring), a course of ovarian stimulating medication maybe used. The physician or &>* may also suggest using a conception cap cervical cap, which the patient uses at home by placing the sperm inside the cap and putting the conception device on the cervix, or intrauterine insemination (II), in which the doctor or &>* introduces sperm into the uterus during ovulation, via a catheter. In these methods, fertili/ation occurs inside the body. If conservative medical treatments fail to achieve a full term pregnancy, the physician or &>* may suggest the patient undergo in vitro fertili/ation (I8'). I8' and related techni-ues (IC+I, EI'T, and AI'T) are called assisted reproductive technology ($6T) techni-ues. $6T techni-ues generally start with stimulating the ovaries to increase egg production. $fter stimulation, the physician surgically extracts one or more eggs from the ovary, and unites them with sperm in a laboratory setting, with the intent of producing one or more embryos. 'ertili/ation taes place outside the body, and the fertili/ed egg is reinserted into the woman7s reproductive tract, in a procedure called embryo transfer ther medical techni-ues are e.g. tuboplasty, assisted hatching, and *reimplantation genetic diagnosis.
+7/,+./(*(-4
+66+%TS (' T3+ 7(7*$T/(' *erhaps except for infertility in science fiction, films and other fiction depicting emotional struggles of assisted reproductive technology have had a n upswing first in the latter part of the ###s decade, although the techni-ues have been availabl e for decades. Fet, the number of people that can relate to it by personal experience in one way or another is ever growing, and the variety of trials and struggles is huge. *ixar7s Up contains a depiction of infertility in an extended life montage that lasts the first few minutes of the film. There are several ethical issues associated with infertility and its treatment. •
igh3cost treatments are out of financial reach for some couples.
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@ebate over whether health insurance companies (e.g. in the +) should be re-uired to cover infertility treatment.
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$llocation of medical resources that could be used elsewhere The legal status of embryos fertili/ed in vitro and not transferred in vivo. (+ee also Geginning of pregnancy controversy).
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*ro3life opposition to the destruction of embryos not transferred in vivo.
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I8' and other fertility treatments have resulted in an increase in multiple births, provoing ethical analysis because of the lin between multiple pregnancies, premature birth, and a host of health problems.
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6eligious leaders7 opinions on fertility treatments< for example, the 6oman Catholic Church views infertility as a calling to adopt or to use natural treatments (medication, surgery, andDor cycle charting) and members must re9ect assisted reproductive technologies.
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Infertility caused by @>$ defects on the F chromosome is passed on from father to son. If natural selection is the pri mary error correction mechanism that prevents random mutations on the F chromosome, then fertility treatments for men with abnormal sperm (in particular IC+I) only defer the underlying problem to the next male generation.
:any countries have special framewors for dealing with the ethical and social issues around fertility treatment. •
ne of the best nown is the ';$ B The H7s regulator for fertility treatment and embryo research. This was set up on $ugust !! following a detailed commission of en-uiry led by :ary &arnoc in the !"#s
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$ similar model to the ';$ has been adopted by the rest of the countries in the ;uropean nion. ;ach country has its own body or bodies responsible for the inspection and licencing of fertility treatment under the ; Tissues and Cells directive
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6egulatory bodies are also found in Canada and in the state of 8ictoria in $ustralia
%('%*S/(' Infertility is often not seen (by the &est) as bein g an issue outside industriali/ed countries.This is because of assumptions about overpopulation problems and h yper fertility in developing countries, and a perceived need for them to decrease their populations and birth rates. The lac of health care and high rates of life3threatening illness (such as I8D$I@+) in developing countries, such as those in $frica, are supporting reasons for the inade-uate supply of fertility treatment options.'ertility treatments, even simple ones such as treatment for +TIs that cause infertility, are therefore not usually made available to individuals in these countries. @espite this, infertility has profound effects on individuals in developing countries, as the production of children is often highly socially valued and is vital for social security and health networs as well as for family income generation. Infertility in these societies often leads to social stigmati/ation and abandonment by spouses.Infertility is, in fact, common in sub3+aharan $frica. nlie in the &est, secondary infertility is more common than primary infertility, being most often the result of untreated +TIs or complications from pregnancyDbirth. @ue to the assumptions surrounding issues of hyper3fertility in developing countries, ethical controversy surrounds the idea of whether or not access to assisted reproductive technologies should comprise a critical aspect of reproductive health or at least, whether or not the distribution and access of such technologies should be sub9ect to greater e-uity. owever, as highlighted by Inhorn the overarching conceptualisation of infertility, to a great extent, disguises important distinctions that can be made within a local context, both demographically and epidemiological and moreover, that these factors are highly significant in the ethics of reproduction. $n important factor, argues Inhorn, is the positioning of men within the paradigm of reproductive health, whereby because rates of general infertility mas differences between male and female infertility, men remain a largely invisible facet within the theorisation and discourse surrounding infertility, as well as the related treatments and biotechnologies. This is particularly significant given that male infertility accounts for more than half of all cases of infertility and moreover, it is evident that the attitudes and behaviours of men have profound implications for the reproductive health of both individuals an d couples. 'or example, Inhorn notes that when couples in ;gypt are faced with seemingly intractable infertility problems 3 due to a range of family and societal pressures that centre around the place of children in constituting the gender identity of men and women 3 it is often the women who is forced to see continued treatment< this continues to occur, even in nown instances of male infertility and that the constant seeing of treatment fre-uently becomes iatrogenic for the women. Inhorn states that infertility often leads to marital demise, physical violence, emotional abuse, social exclusion, community exile, ineffective and iatrogenic therapies, poverty, old age insecurity, increased ris of I8D$I@+, and death+ignificantly, Inhorn demonstrates that this phenomenon cannot simply be
explained by a lac of nowledge, rather it occurs in a complex interaction between the centrality of children in the male gender identity as a symbol of maturity and the relative lac of power of women in ;gyptian society, whereby they effectively become scapegoats for a culturally accepted narrative as a site of blame for the lac of childlessness. It should be emphasised that this is not simply an issue of women oppressed by men but rather, that men and women both share the burden of this narrative, but in different, une-ual and highly complex ways. Therefore, while the notion that reproductive health is a Jwomen=s issue=, may have powerful social currency, especially within popular discourse and indigenous systems of meaning, the reality of infertility suggests that medical and health paradigms have a significant part to play in challenging the validity of this entrenched belief . :oreover, the effectiveness of any therapeutic intervention, medical or otherwise will be contingent on such outcomes and has an important part to play in the alleviation of gendered suffering, especially the burden imposed on women, who continue to suffer disproportionately from the effects of infertility. igh costs may also be a factor and research by the Aen Institute for 'ertility Technology, in Gelgium, claimed a much lower cost methodology (about !#% reduction) with similar efficacy, which may be suitable for some fertility treatment. $t the !!4 nited >ations International Conference on *opulation and @evelopment (IC*@) in Cairo, the prevention and treatment of infertility was accepted into the program of action for reproductive healthcare. Infertility has shown to have a greater affect on developing nations than on birth rates or population control, but also on a social level as well. 6eproduction is a large aspect of life for many cultures within developing nations, and infertility can lead to social and familial problems such as re9ection or abandonment as well as personal psychological issues. Currently, fertility treatment options and programs are only available through private health sectors in developing nations and little3to3no treatment is available through public health sectors. The fertility treatment options offered through the private sectors are often costly or not easily accessible. $dditionally, counseling is considered an essential aspect of fertility treatment, and due to lac of education and resources such forms of therapy remain scarce as well. &hile -uality fertility care is not readily available in developing nations (such as sub3+aharan $frican countries), a standard procedure of care could be easily implemented for a low cost as a basic intervention. The lac of fertility treatment is problematic, and high birth and population rates are every reason to implement treatment options rather than re9ect them.
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