Reproduction, Technology,

and the Society

Global prevalence of primary infertility, 2010
Key Facts: World Health Organization
• Infertility is a disease of the male or female reproductive system defined by the failure to
achieve a pregnancy after 12 months or more of regular unprotected sexual intercourse.
• Infertility affects millions of people of reproductive age worldwide – and has an impact on
their families and communities. Estimates suggest that between 48 million couples and 186
million individuals live with infertility globally.
• In the male reproductive system, infertility is most commonly caused by problems in the
ejection of semen, absence or low levels of sperm, or abnormal shape (morphology) and
movement (motility) of the sperm.
• In the female reproductive system, infertility may be caused by a range of abnormalities of the
ovaries, uterus, fallopian tubes, and the endocrine system, among others.
• Infertility can be primary or secondary. Primary infertility is when a pregnancy has never been
achieved by a person, and secondary infertility is when at least one prior pregnancy has been
achieved.
• Fertility care encompasses the prevention, diagnosis and treatment of infertility. Equal and
equitable access to fertility care remains a challenge in most countries; particularly in low and
middle-income countries. Fertility care is rarely prioritized in national universal health
coverage benefit packages.
Normal Fertilization process
Ovulation
Cycle of
Women
Infertility
• Infertility is the inability of couples, under the reproductive years, to
conceive after one (1) year of unprotected coitus. The World Health
organization classify infertility as a disease affecting millions of couples
around the globe. According to a WHO data published in 2004, the
occurrence of infertility among ever-married women in developing
countries, which includes the Philippines, is one out of four couples
translating to about 186 million women. Unfortunately, this rate "hardly
changed over the past 20 years.”

• The impact of AGE: the proportion of mothers aged 35 years and over
increased from about 16.3 % in 1999 to about 23% in 2008.
Fertility declines with age

Genetic anomalies in men also increases with age

Infertility may be caused by a number of different factors, in either the male
or female reproductive systems. However, it is sometimes not possible

• tubal disorders such as blocked fallopian tubes, which are in turn caused by untreated
sexually transmitted infections (STIs) or complications of unsafe abortion, postpartum
sepsis or abdominal/pelvic surgery;
• uterine disorders which could be inflammatory in nature (such as such endometriosis),
congenital in nature (such as septate uterus), or benign in nature (such as fibroids);
• disorders of the ovaries, such as polycystic ovarian syndrome and other follicular
disorders;
• disorders of the endocrine system causing imbalances of reproductive hormones. The
endocrine system includes hypothalamus and the pituitary glands. Examples of
common disorders affecting this system include pituitary cancers and hypopituitarism.
• to explain the causes of infertility.
Anatomy of Female Reproductive
Female Reproductive: causes of infertility
 Surgery may be an option for
infertility, when reasons include
blocked fallopian tubes or
endometriosis.
The relative importance of these causes of female infertility may differ
from country to country, for example due to differences in the
background prevalence of STIs, or differing ages of populations
studied.4

In the male reproductive system, infertility may be caused by:

• obstruction of the reproductive tract causing dysfunctionalities in the ejection of semen. This
blockage can occur in the tubes that carry semen (such as ejaculatory ducts and seminal
vesicles). Blockages are commonly due to injuries or infections of the genital tract.
• hormonal disorders leading to abnormalities in hormones produced by the pituitary gland,
hypothalamus and testicles. Hormones such as testosterone regulate sperm production.
Example of disorders that result in hormonal imbalance include pituitary or testicular
cancers.
• testicular failure to produce sperm, for example due to varicoceles or medical treatments that
impair sperm-producing cells (such as chemotherapy).
• abnormal sperm function and quality. Conditions or situations that cause abnormal shape
(morphology) and movement (motility) of the sperm negatively affect fertility. For example,
the use of anabolic steroids can cause abnormal semen parameters such sperm count and
shape.5
• Environmental and lifestyle factors such as smoking, excessive
alcohol intake and obesity can affect fertility. In addition, exposure to
environmental pollutants and toxins can be directly toxic to gametes
(eggs and sperm), resulting in their decreased numbers and poor
quality, leading to infertility.5 6
Anatomy of Male reproductive
Surrogacy
• Surrogacy continues to be practiced to address infertility in the
Philippines; however, discussions on the method are sparse, given its
limited accessibility and morally questionable procedures that may
concern potential parents in a developing country.

• surrogacy as a compassionate act or a transactional business. 

• continued practice of surrogacy among key players in reproductive

health in developing countries, recognizing the concerns of infertile
couples to enable informed decision-making and policy creation.
Adoption
• Republic Act No. 8552, or otherwise known as the Domestic Adoption
Act of 1998 (“RA 8552”), is the law establishing the rules and policies
on the domestic adoption of Filipino children.
Assisted Reproductive
Technology
ART
• ART is currently a commonplace technology that has successfully
treated millions of infertile couples the world over. However, the
explosion of this technology has introduced a myriad of new social,
ethical, and legal challenges
• History: birth of Louise Brown in 1978 through in vitro fertilization
(IVF). This historic moment was eloquently encapsulated by Howard
Jones who observed “Eleven forty-seven p.m. Tuesday, July 25, 1978,
was surely a unique moment in the life of Patrick Steptoe. This was the
hour and minute he delivered Louise Brown, the world’s first baby,
meticulously, lovingly, and aseptically conceived in the laboratory, but
popularly referred to as the world’s first test tube baby”
WHY ADDRESSING INFERTILITY IS
IMPORTANT?
• PHYSICAL AND MENTAL HEALTH
• HAPPINESS IS HUMAN RIGHT.

• Infertility can negate the realization of these essential human rights.

• Mitigate gender inequality

• Women are often perceived to suffer from infertility
In vitro Fertilization (IVF)
In vitro fertilization is an expensive option for
infertility. In IVF, the man's sperm is mixed with
the woman's eggs in a lab. (Sometimes donor
sperm or donor eggs are used) If the egg and
sperm join, it is called fertilization. The doctor
then puts one or more embryos into the uterus,
hoping they implant and grow. Usually, more
than one embryo is put in the uterus to increase
your chances that one will develop, but that may
result in multiple births.
Assisted reproductive technology (ART) is a general term referring to methods
used to achieve pregnancy by artificial or partially artificial means. It is used
primarily in infertility treatments.

Hormone injections, commonly called

fertility drugs, are used on women to
address unexplained fertility issues or
ovulation problems. They increase the
chance of multiple births.
ICSI (ick-see)
ICSI stands for intracytoplasmic sperm injection. In a lab, the doctor injects one
sperm into one egg. If fertilization occurs, the doctor puts the embryo back into
the uterus via IVF.

Male infertility problems may

include a low sperm count. Sperm
may be collected over time to
produce a concentrated sample of
semen, which is then used for
insemination.
Insemination
Insemination procedures put sperm directly into the woman's reproductive tract (in the
vagina or cervix in artificial insemination… AI) (into the uterus near the fallopian tubes in
intrauterine insemination… IUI) with a tube inserted through the vagina.

This can improve the

chances of conception
in women who have
difficulty conceiving
after intercourse.
Ovulation Induction
Cryopreservation

• a process that preserves organelles, cells, tissues, or any other

biological constructs by cooling the samples to very low
temperatures. 
Status of ART
• still largely unavailable, inaccessible and unaffordable in many parts
of the world, particularly in low and middle-income countries

• Government policies could mitigate the many inequities in access to

safe and effective fertility care

• health policies need to recognize that infertility is a disease that can

often be prevented, thereby mitigating the need for costly and poorly
accessible treatments.
Some forms of ART are also used in fertile couples for genetic reasons… to
avoid the transfer of unwanted genetic characteristics to the embryo.

ART is also used in couples who have certain

communicable diseases, i.e. AIDS, to reduce the risk of
infection when a pregnancy is desired.