Gender and Genetics
Assisted Reproductive Technologies (ARTs)
The medical definition of infertility is the failure to conceive following twelve months of unprotected intercourse. (106) Global estimates of infertility range between 8 and 12% of couples with women of childbearing age, affecting between 50 and 80 million people. (107) Assisted reproductive technologies (ARTs) include in vitro fertilization (IVF) and embryo transfer (ET), intracytoplasmic sperm injection (ICSI), ovarian stimulation with exogenous gonadotropins, surgical laparoscopy, and surrogate motherhood. Such procedures are often invasive and not without risk. ARTs are included in a discussion on gender and genetics because infertility can have a genetic basis, because these techniques endorse the importance of genetic lineage, and because these procedures predominantly affect women.
Infertility is often perceived as a predominantly female disorder, even though male-factor infertility is equally prevalent, and half of infertile couples fail to reproduce because of problems with the man’s fertility. (108) Deletion mapping in infertile men has defined regions on the Y chromosome that are specifically involved in fertility. Indeed, male infertility is a common Y-chromosome associated disorder and approximately 1:1000 men are infertile because of spermatogenic failure. (109) Around 20% of infertility overall cannot be attributed to either gender, and is instead of unknown origin. (110)
Both women and men experience considerable psychological distress when experiencing reproductive health problems, including feelings of low self-esteem, isolation, loss of control, sexual inadequacy and depression. The WHO defines health as “a state of complete physical, mental and social well-being, and not merely the absence of disease or infirmity.” (111) Infertility, accordingly, is a source of diminished health and social well-being.
In addressing infertility, it should be recalled that social and environmental factors, as well as physiological and genetic ones, contribute to the condition. For example, infertility, resulting from sexually transmitted diseases (STDs) or reproductive tract infections is especially problematic in Africa and Latin America. (112) Infertility has been observed to be higher in poor and minority communities with the United States, in which black women have an infertility rate one and one-half times that of white women. (113)Social factors contributing to this enhanced prevalence include greater use of intrauterine devices, lack of access to medical treatment, nutritional deficiencies, and complications or infections following childbirth or abortion. (114)