Infertility, which has multiple causes and consequences, is a global public health concern: About 10 percent of all couples worldwide are or have been infertile. Because family planning professionals devote much of their careers to helping clients avoid unintended pregnancies, they may neglect the issue of unintended infertility. But efforts to better prevent, diagnose, and treat the main causes of unintended infertility could help preserve the fertility of millions worldwide. Key points highlighted in this issue of Network are that:
- infertility often involves both members of the couple;
- sexually transmitted infections (STIs) are the primary preventable causes of infertility;
- chlamydial infection and gonorrhea are the two STIs most clearly associated with infertility
- screening can identify these two often-silent STIs;
- postpartum and postabortion infections are also associated with infertility; and
- contraceptive use does not cause infertility.
Although infertility is considered by some to be primarily a woman's problem, men often contribute to and are also affected by it. Thus, the issue explores how infertility affects men, the ways in which men can protect themselves and their partners from STIs, and how reproductive health programs and clinics can help men understand and prevent infertility.
In this issue
Defining Infertility
What does infertility mean for clinicians and clients? This introductory article explores the complex causes and consequences of infertility, which often involves both members of a couple. Although sexually transmitted infections are the primary preventable causes of infertility, postpartum and postabortion infections are also associated with this condition. Other threats to fertility are described in Factors Contributing to Infertility and Harmful Traditional Practices Can Hinder Conception. A common misconception that some contraceptives cause infertility may be a powerful disincentive to contraceptive use, but Contraception and Return to Fertility dispels these misunderstandings. Emphasizing that each case of infertility is unique in its causes, consequences, and outcomes, the article includes One Couple's Story: The Uncertainty of Infertility and a discussion of The Possibility of Assisted Reproduction, with a Web Resource providing an additional source of information on the topic.
Preserving Fertility
This article by Dr. Willard Cates, Jr., president of FHI's Institute for Family Health, underscores the fact that the main preventable causes of infertility are sexually transmitted infections (STIs), primarily chlamydial infection and gonorrhea. Because these widespread and easily transmitted infections are often "silent" or asymptomatic, Dr. Cates argues, active screening of sexually active persons for these particular STIs is crucial. Otherwise, few women will realize that they have a fertility-threatening infection until they try to become pregnant and are unable to do so. Why chlamydial infection and gonorrhea are so widespread is described in The Most Easily Transmitted STIs and evidence linking them to tubal infertility is reviewed in Global Trends Confirm STI-Tubal Infertility Link. Although diagnosing these two infections may be problematic in many developing-world settings, they are easily treatable (STI Treatment Guidelines) with antimicrobial drugs available throughout the world. Because treating men infected with chlamydia can protect the fertility of their partners, an accompanying article explores the question Should Men Be Screened for Chlamydia? A recommendation to expand the dual protection message to include infertility prevention is presented in Triple Protection Addresses Unplanned Pregnancy, Infections, and Infertility. Finally, Programs Begin to Emphasize STI, Infertility Link explores what programs can do to raise awareness.
Men Contribute to and Suffer from Infertility
In about half of all cases of infertility, men are either the single cause of, or contribute to, the couple's infertility. This article describes the causes of male infertility but emphasizes the importance of men protecting their partners from fertility-threatening sexually transmitted infections (STIs) by practicing abstinence, being faithful to one partner, or using condoms. Cultural and social norms that encourage men to behave in ways that put them at greater risk of acquiring and transmitting STIs, as well as the stigmatization that men may suffer if they cannot have children, are described. Helping Men Understand Infertility contains recommendations for reproductive health programs and clinics.
Clinical Challenges
To preserve fertility, is it necessary to take a "vacation" from the pill? Can douching threaten fertility? Is vasectomy a good choice for a husband and wife who are struggling financially and doubt that they will be able to afford more children? Guidance derived from evidence-based medicine is given to help providers handle these clinical challenges.
YouthLens: Abstinence, Fewer Partners, Condom Use Are Complementary Messages
The first phase of a major six-country study suggests that promotion of abstinence from sex to prevent HIV infection contributed to an approximately one-year delay of sexual initiation among youth in two countries — Uganda and Zambia — where HIV prevalence declined throughout the 1990s. In both countries, delayed sexual initiation among youth, abstinence, having fewer partners, and condom use with nonregular partners all contributed to declines in HIV prevalence. Thus, the "ABC strategy" (abstinence, be faithful to one partner or reduce number of partners, or — if "A" or "B" cannot be achieved — use condoms consistently and correctly) continues to be an appropriate general recommendation. And messages to delay sexual initiation or to begin practicing abstinence even after having been sexually active need to be an integral part of programs to prevent HIV, other sexually transmitted infections (STIs), and pregnancy among unmarried youth.
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