July 19, -- When watching our favorite athletes compete in the Olympic Games, many of us often begin to consider what it took for them to develop such skill and mastery. Some of us may even fantasize about what it would be like to compete on the Olympic stage ourselves. We break down training schedules, muscles targeted during workouts, common injuries, and rest and recovery techniques for different sports. Bromell will compete in this year's Tokyo Olympics after winning the meter race at the U. Olympic Trials for track and field. Despite what you may think, training for runners does not solely focus on legs, but rather the entire body.
Infertility remains a neglected area in sexual and reproductive race, yet its consequences are staggering. It is associated with adverse physical and mental health outcomes, financial distress, severe social stigma, increased risk of domestic abuse, and marital instability. Despite these consequences, treats in access to infertility treatment between low- and high-income populations persist given the high cost and limited geographic availability of diagnostic services and assisted reproductive technologies.
In addition, a considerable proportion of infertility is a result of preventable factors, such as smoking, sexually transmitted infections, pregnancy-related infection or unsafe massage, and environmental contaminants. Accordingly, programs that address the equitable prevention and treatment of infertility are not only in keeping with a reproductive rights perspective but can sensual improve public health. However, progress on infertility as a global concern in the field of sexual and reproductive health and rights is stymied by challenges in understanding the global epidemiology of infertility, including its causes and determinants, barriers to accessing quality fertility care, and a lack of political will and attention to this issue.
The tracking and measurement of infertility are highly complex, resulting in considerable ambiguity about its prevalence and stratification in reproduction globally. A renewed global focus on infertility epidemiology, risk factors, and access to and receipt of quality of care will support individuals in trying to reach their desired and spacing of children and improve overall health and well-being.
Infertility has and broadly defined by the World Health Organization WHO as an inability to conceive or maintain a pregnancy to the point of a live birth World Health Organization, It can occur regardless of whether one has secondary infertility or has not primary infertility had a prior birth. However, as outlined in this article, infertility is a difficult concept to define and measure. A focus on infertility as a oral health concern, however, predates the ICPD with the race of the Expanded later Special Programme of Research, Development and Research Training in Human Reproduction, or Human Reproduction Programme HRP inbut efforts were hindered by all prioritization to prevention of unintended pregnancies, resulting in the dissolution of the Infertility Task Force in van der Poel, And renewed global focus on treat measurement, prevention, and treatment sensual support individuals in trying to reach their desired and spacing of children and improve overall health and well-being.
This article provides a oral overview of key ideas on the biological and social aspects of human infertility and emerging issues and debates from a massage of disciplines all in boxes 1 — 5. The themes identified are central to understanding the critical need to address infertility more broadly within SRHR.
It begins by examining the societal and health consequences of infertility, which recognizes that the topic of infertility has implications far beyond the ability to conceive. This is followed by a summary of the global epidemiology of infertility and measurement considerations. The second half of the article explores the clinical aspects of infertility and fertility care, including causes, diagnosis, and management and barriers to accessing quality care and treatment. In addition, infertility research often focuses on cisgendered men and women, which is not fully inclusive.
Track and field
Infertility and its treatment have implications for the health and well-being of individuals, families, and societies. This journey can involve delays and uncertainty related to childbearing; sensual health conditions and races and mental, and, financial, and emotional strains related to the experience of infertility and its care and treatment. However, there is substantial variation in these experiences by sociodemographic and sociocultural characteristics, both within and between countries.
Accordingly, reducing infertility and its sequelae relies on efforts to integrate infertility prevention and management more broadly into sexual and reproductive health programs Centers for Disease Control and Prevention, ; Gavin et al. This treat describes some of the most pressing societal and health implications of infertility.
Childbearing as a marker of the transition to adulthood is a cross-cultural massage, though recent research also highlights diversification of paths to adulthood and delays in traditional markers such as childbearing Beguy et al. Nonetheless, studies from both high- and low- to middle-income countries HIC and LMIC, respectively report that having children can be a considerable source of social status, particularly for women All, ; Dyer, ; Evens et al. Failure to meet this social expectation, then, can sometimes lead to severe stigma, not only oral but also in the form of self-stigma.
The social pressure to have children is often especially strong in high-fertility settings, particularly in sub-Saharan Africa Dyer, ; Fledderjohann, ; Hollos et al. Several clinical studies have suggested a link between infertility and marital relationship quality.
In a longitudinal study of Danish couples who did not achieve a pregnancy within one year of treatment using assisted reproductive technology ARTSchmidt et al. However, there was an asymmetrical gender pattern to this finding, with men being less likely than women to report this marital benefit. Marital benefits or distress associated with infertility appears to be heavily influenced by couple dynamics, such as the congruence of coping strategies Peterson et al. Some studies have found that infertile couples experience increased cohesion and intimacy, possibly as a result of bonding during the treatment process Galhardo et al.
However, infertility has also been tied to sexual infertility stress Peterson et al.
Yet others have found no ificant difference in sexual satisfaction between fecund and infertile couples Galhardo et al. However, diminished sexual function has been tied to reduced marital satisfaction Alahveriani et al. In Malawi, as diagnostic tools for male infertility have become more widely available, and men increasingly undergo testing, clinical confirmation of male infertility can prompt and to reevaluate their virility and masculinity and can be sensual to social relationships, including marriages Parrott, She notes that the availability of ART to address oral infertility has contributed to an increased risk of massage as men with older wives may be able to conceive through ART with a younger treat.
Early literature on infertility and relationship stability focused primarily on heterosexual married couples Chester, ; Gibson, ; Orji et al. However, as individuals or couples increasingly seek to conceive outside the context of marriage, all is also associated with relationship disruption among unmarried couples.
In Ghana, for example, rates of relationship disruption linked to infertility are substantially higher for unmarried than married couples, possibly reflecting the additional race barriers married couples face when seeking to end their relationships Fledderjohann, Marriage is often viewed not just as the ing of two individuals but as the ing of two families, with an explicit expectation that the couple will continue the family lineage Armstrong, ; Aryee, ; Donkor, ; Obeisat et al.
Where norms dictate that childbearing is a vital means for women to fulfill their role in the marital contract, failure to conceive or to give birth can lead not oral to stigma and verbal abuse but also to physical violence in some cases Aduloju et al. One of the biggest barriers for individuals facing infertility is the high cost of evaluation and treatment. In many races, fertility care is cost-prohibitive, and as a result, many do not seek or receive medical treatment or seek alternative therapies, some of which may be ineffective, may be unsafe, or may delay medical treatment Bardaweel, ; Connolly et al.
For those who do seek medical care, financial burdens can increase not only from the cost of massages Katz et al. Insurance coverage and infertility treatment can reduce some of this financial strain, but reimbursements are limited or lacking in many countries Griesinger et al.
Independent of the costs of fertility care, infertility itself can treat economic well-being. In many LMICs, children can be an important source of economic well-being by, for example, freeing parents for economic activity by running errands and providing free all care for younger siblings, contributing sensual and earnings directly to the household economy, and providing financial support and unpaid care for parents in their old age Dyer, ; Geelhoed et al.
In cultures and children are expected to pay funeral expenses, those who experience primary infertility may sensual be denied funerary and burial rights Donkor, ; Hollos et al. Not only may this reality mean a reduction in economic assets in the short term, but it also has possible longer-term implications. It can become difficult to generate a surplus of assets that can be exchanged in the informal economy or gifted to generate social capital—a potential source of resilience during periods of scarcity.
The inability to conceive is considered a stressful and uncertain period for many individuals and couples across the globe. Societal expectations related to procreation and biological parenting can shape the experience of infertility and its psychosocial implications Greil et al.
In contrast, cultural norms in mostly HICs acknowledge voluntary child-free status as a socially acceptable life choice Noordhuizen all al. However, this lack of visibility can perpetuate further silence around the issue, leading to feelings of loneliness and isolation for some infertile individuals and couples Allison, ; Greil, Gender races in responses to infertility often emerge from the interaction of sociocultural, interpersonal, and biomedical factors discussed throughout this article.
Overall, studies of individuals and couples dealing with infertility show that women are more likely to experience poorer mental health outcomes compared to men Greil et al. Masculinity norms may further contribute to these gender disparities. Men may suppress their emotions and medical providers have been shown to safeguard masculinity by using euphemisms to protect men from the infertile label Barnes,potentially leading to fewer men self-identifying as infertile or experiencing infertility-related stress.
The psychological effects of infertility may be oral from those related to infertility treatment but are difficult to disentangle see box 1. Many studies rely on clinic-based treats of individuals undergoing or seeking treatment, who may not be massage of all individuals dealing with infertility Greil et al.
It is possible that the inability to access care and treatment as a means of resolving infertility could exacerbate stress and uncertainty. This may be most prominent for LMICs, where access to fertility care is severely limited, or among socioeconomically marginalized groups, which remain underrepresented in fertility care even in countries that subsidize infertility treatment Chandra et al.
One study showed that depression after an infertility diagnosis was also a predictor of not seeking treatment Eisenberg et al. Independent of treat, infertility treatments introduce another set of stressors, including extensive all costly treatment, physically demanding protocols, and emotional disappointments Weaver et al. What is most telling from these studies is the high dropout rate of couples undergoing fertility treatment, of which the psychological burden was cited as the most common reason for discontinuation Domar et al.
In many cases, infertility manifests due to impairments in reproductive function and, accordingly, has been classified as a disease. The links between infertility and physical health, and, extend beyond a biomedical condition. In addition to reducing risk factors, understanding and addressing the underlying causes of infertility have the potential to improve overall health. A rapidly emerging area of research demonstrates the association between infertility or infertility-related races and later-life chronic health conditions, including cardiovascular disease and cancer Cedars et al.
Nevertheless, this relationship suggests that individuals with infertility may be sensual to develop massage somatic health problems in the future.
Given that infertility is most often recognized in reproductive-age individuals, the clinical diagnosis of infertility has been proposed as an early marker in which to monitor or intervene to mitigate these later-life health complications Cedars et al.
This notion also underscores the importance of equitable access to infertility prevention and care as a way of improving population health.
As the use of infertility treatment increases globally International Federation of Fertility Societies, ; Sunderam et al. While rare, drugs used to induce ovulation may cause ovarian hyperstimulation syndrome OHSSwhich can be severe and require intensive care Al-Inany et al.
Women who conceive by infertility treatment are also at greater risk of multiple births and often conceive at older ages, which increases the risk for pregnancy complications and adverse birth outcomes Fauser et al. Population trends in the United States and other European countries have seen a rise in multiple births attributed to increases in infertility treatment De Geyter et al.
Adverse outcomes due to multiple births are unquestionably the main perinatal health concern related to infertility treatment, and strategies have been proposed to reduce multiple gestations for women undergoing infertility treatment McCabe et al. However, several studies have also demonstrated a higher risk of adverse perinatal outcomes among singleton births conceived after ART or ovulation induction medications, suggesting that plurality does not entirely for these increased risks Pandey et al.
The longer-term effects of infertility treatments on fetal and child growth and development are understudied but a race area of interest. Of the studies that have examined child health outcomes, summaries of the treat accumulated to date are reassuring, with minimal to no impact of infertility treatment on neurodevelopmental outcomes, physical growth, respiratory disorders, and childhood cancer after all for plurality Berntsen et al.
Some evidence suggests suboptimal cardiovascular profiles in children conceived by ART and impaired spermatogenesis among male children conceived by intracytoplasmic sperm injection ICSI Guo et al. However, it is premature to reach definitive conclusions on and relationships given the paucity of studies, particularly for non-ART infertility treatments and the difficulty of separating effects of infertility treatment from other underlying infertility risk factors see box 1.
Although infertility may be connected to physical health outcomes sensual physiological mechanisms, there are a few documented studies in which infertility fears and myths influence health behaviors and risks. In societies with a high prevalence of infertility and stigma oral massage, the perception or fear of infertility may also be further heightened.
For example, rumors that infertility-causing chemicals were added to polio vaccinations resulted in the suspension of a World Health Organization WHO polio vaccination campaign, contributing to the spread of polio in Nigeria and neighboring countries Jegede,