Infertility means not being able to get pregnant after one year of Most cases of female infertility are
ility are caused by problems with
trying (or six months if a woman is 35 or older). Women who can get
pregnant but are unable to stay pregnant may also be infertile.
About 10 percent of women (6.1 million) in the United States ages
15-44 have difficulty getting pregnant or staying pregnant, according
to the Centers for Disease Control and Prevention (CDC).
Pregnancy is the result of a process that has many steps. To get
pregnant:
 A woman's body must release an egg from one of her
ovaries (ovulation).
 The egg must go through a fallopian tube toward the
uterus (womb).
 A man's sperm must join with (fertilize) the egg along the
way.
 The fertilized egg must attach to the inside of the uterus
(implantation).
Infertility can happen if there are problems with any of these steps.
Is infertility a common problem?
Yes. About 10 percent of women (6.1 million) in the United States
ages 15-44 have difficulty getting pregnant or staying pregnant,
according to the Centers for Disease Control and Prevention (CDC).
Is infertility just a woman's problem?
No, infertility is not always a woman's problem. Both women and
men can have problems that cause infertility. About one-third of
infertility cases are caused by women's problems. Another one third
of fertility problems are due to the man. The other cases are caused
by a mixture of male and female problems or by unknown problems.
What causes infertility in men?
Infertility in men is most often caused by:
A problem called varicocele (VAIR-ih-koh-seel). This happens when
the veins on a man's testicle(s) are too large. This heats the testicles.
The heat can affect the number or shape of the sperm.
Other factors that cause a man to make too few sperm or none at
all.
Movement of the sperm. This may be caused by the shape of the
sperm. Sometimes injuries or other damage to the reproductive
system block the sperm.
Sometimes a man is born with the problems that affect his sperm.
Other times problems start later in life due to illness or injury. For
example, cystic fibrosis often causes infertility in men.
What increases a man's risk of infertility?
A man's sperm can be changed by his overall health and lifestyle.
Some things that may reduce the health or number of sperm
include:
 Heavy alcohol use
 Drugs
 Smoking cigarettes
 Age
 Environmental toxins, including pesticides and lead
 Health problems such as mumps, serious conditions like
kidney disease, or hormone problems
 Medicines
 Radiation treatment and chemotherapy for cancer
What causes infertility in women?
ovulation. Without ovulation, there are no eggs to be fertilized.
Some signs that a woman is not ovulating normally include irregular
or absent menstrual periods.
Ovulation problems are often caused by polycystic ovarian
syndrome (PCOS). PCOS is a hormone imbalance problem which can
interfere with normal ovulation. PCOS is the most common cause of
female infertility. Primary ovarian insufficiency (POI) is another
cause of ovulation problems. POI occurs when a woman's ovaries
stop working normally before she is 40. POI is not the same as early
menopause.
Less common causes of fertility problems in women include:
 Blocked fallopian tubes due to pelvic inflammatory
disease, endometriosis, or surgery for an ectopic
pregnancy
 Physical problems with the uterus
 Uterine fibroids, which are non-cancerous clumps of tissue
and muscle on the walls of the uterus.
What things increase a woman's risk of infertility?
 Age
 Smoking
 Excess alcohol use
 Stress
 Poor diet
 Athletic training
 Being overweight or underweight
 Sexually transmitted infections (STIs)
 Health problems that cause hormonal changes, such as
polycystic ovarian syndrome and primary ovarian
insufficiency
How does age affect a woman's ability to have children?
Many women are waiting until their 30s and 40s to have children. In
fact, about 20 percent of women in the United States now have their
first child after age 35. So age is a growing cause of fertility
problems. About one-third of couples in which the woman is over 35
have fertility problems
 Her ovaries become less able to release eggs
 She has a smaller number of eggs left
 Her eggs are not as healthy
 She is more likely to have health conditions that can cause
fertility problems
 She is more likely to have a miscarriage
 How long should women try to get pregnant before calling
their doctors?
 Most experts suggest at least one year. Women 35 or
older should see their doctors after six months of trying. A
woman's chances of having a baby decrease rapidly every
year after the age of 30.
women should talk to their doctors if they have:
 Irregular periods or no menstrual periods
 Very painful periods
 Endometriosis
 Pelvic inflammatory disease
 More than one miscarriage
Some common tests of fertility in women include:
Hysterosalpingography (HIS-tur-oh-sal-ping-GOGH-ru-fee): This is
an x-ray of the uterus and fallopian tubes. Doctors inject a special
dye into the uterus through the vagina. This dye shows up in the x-
ray. Doctors can then watch to see if the dye moves freely through
the uterus and fallopian tubes. This can help them find physical
blocks that may be causing infertility. Blocks in the system can keep
the egg from moving from the fallopian tube to the uterus. A block
could also keep the sperm from reaching the egg.
Laparoscopy (lap-uh-ROS-kuh-pee): A minor surgery to see inside
the abdomen. The doctor does this with a small tool with a light
called a laparoscope (LAP-uh-roh-skohp). She or he makes a small
cut in the lower abdomen and inserts the laparoscope. With the
laparoscope, the doctor can check the ovaries, fallopian tubes, and
uterus for disease and physical problems. Doctors can usually find
scarring and endometriosis by laparoscopy.
How do doctors treat infertility?
Infertility can be treated with medicine, surgery, artificial
insemination, or assisted reproductive technology. Many times
these treatments are combined. In most cases infertility is treated
with drugs or surgery.
Doctors often treat infertility in men in the following ways:
Sexual problems: Doctors can help men deal with impotence or
premature ejaculation. Behavioral therapy and/or medicines can be
used in these cases.
Too few sperm: Sometimes surgery can correct the cause of the
problem. In other cases, doctors surgically remove sperm directly
from the male reproductive tract. Antibiotics can also be used to
clear up infections affecting sperm count.
Sperm movement: Sometimes semen has no sperm because of a
block in the man's system. In some cases, surgery can correct the
problem.
What medicines are used to treat infertility in women?
Clomiphene citrate (Clomid): This medicine causes ovulation by
acting on the pituitary gland. It is often used in women who have
polycystic ovary syndrome (PCOS) or other problems with ovulation.
This medicine is taken by mouth.
Human menopausal gonadotropin or hMG (Repronex, Pergonal):
This medicine is often used for women who don't ovulate due to
problems with their pituitary gland. hMG acts directly on the ovaries
to stimulate ovulation. It is an injected medicine.
follicle-stimulating hormone or FSH (Gonal-F, Follistim): FSH works
much like hMG. It causes the ovaries to begin the process of
ovulation. These medicines are usually injected.
Gonadotropin-releasing hormone (Gn-RH) analog: These medicines
are often used for women who don't ovulate regularly each month.
Women who ovulate before the egg is ready can also use these
medicines. Gn-RH analogs act on the pituitary gland to change when
the body ovulates. These medicines are usually injected or given
with a nasal spray.
Metformin (Glucophage): Doctors use this medicine for women who
have insulin resistance and/or PCOS. This drug helps lower the high
levels of male hormones in women with these conditions. This helps
the body to ovulate. Sometimes clomiphene citrate or FSH is
combined with metformin. This medicine is usually taken by mouth.
Bromocriptine (Parlodel): This medicine is used for women with
ovulation problems due to high levels of prolactin. Prolactin is a
hormone that causes milk production.
Many fertility drugs increase a woman's chance of having twins,
triplets, or other multiples. Women who are pregnant with multiple
fetuses have more problems during pregnancy. Multiple fetuses
have a high risk of being born too early (prematurely). Premature
babies are at a higher risk of health and developmental problems.
Intrauterine insemination (IUI) is an infertility treatment that is
often called artificial insemination. In this procedure, the woman is
injected with specially prepared sperm. Sometimes the woman is
also treated with medicines that stimulate ovulation before IUI.
Assisted reproductive technology (ART) is a group of different
methods used to help infertile couples. ART works by removing eggs
from a woman's body. The eggs are then mixed with sperm to make
embryos. The embryos are then put back in the woman's body.
the average percentage of ART cycles that led to a live birth were:
 39 percent in women under the age of 35
 30 percent in women aged 35-37
 21 percent in women aged 37-40
 11 percent in women aged 41-42
What are the different types of assisted reproductive technology
(ART)?
In vitro fertilization (IVF) means fertilization outside of the body. IVF
is the most effective ART. It is often used when a woman's fallopian
tubes are blocked or when a man produces too few sperm. Doctors
treat the woman with a drug that causes the ovaries to produce
multiple eggs. Once mature, the eggs are removed from the woman.
They are put in a dish in the lab along with the man's sperm for
fertilization. After 3 to 5 days, healthy embryos are implanted in the
woman's uterus.
Zygote intrafallopian transfer (ZIFT) or Tubal Embryo Transfer is
similar to IVF. Fertilization occurs in the laboratory. Then the very
young embryo is transferred to the fallopian tube instead of the
uterus.
Gamete intrafallopian transfer (GIFT) involves transferring eggs and
sperm into the woman's fallopian tube. So fertilization occurs in the
woman's body. Few practices offer GIFT as an option.
Intracytoplasmic sperm injection (ICSI) is often used for couples in
which there are serious problems with the sperm. Sometimes it is
also used for older couples or for those with failed IVF attempts. In
ICSI, a single sperm is injected into a mature egg. Then the embryo is
transferred to the uterus or fallopian tube.
Surrogacy
Women with no eggs or unhealthy eggs might also want to consider
surrogacy. A surrogate is a woman who agrees to become pregnant
using the man's sperm and her own egg. The child will be genetically
related to the surrogate and the male partner. After birth, the
surrogate will give up the baby for adoption by the parents.
Gestational carrier
Women with ovaries but no uterus may be able to use a gestational
carrier. This may also be an option for women who shouldn't
become pregnant because of a serious health problem. In this case,
a woman uses her own egg. It is fertilized by the man's sperm and
the embryo is placed inside the carrier's uterus. The carrier will not
be related to the baby and gives him or her to the parents at birth.
LONG-ACTING REVERSIBLE CONTRACEPTION(LARC)
Intrauterine Methods
An intrauterine device (IUD), also known as an intrauterine system
(IUS), is a small, T-shaped device that is inserted into the uterus to
prevent pregnancy. A health care provider inserts the device. An IUD
can remain in place and function effectively for many years at a
time. After the recommended length of time, or when the woman
no longer needs or desires contraception, a health care provider
removes or replaces the device.
 A hormonal IUD or IUS releases a progestin hormone
(levonorgestrel) into the uterus.3 The released hormone
causes thickening of the cervical mucus, inhibits sperm
from reaching or fertilizing the egg, thins the uterine
lining, and may prevent the ovaries from releasing eggs.
The failure rate of a hormonal IUS is less than 1%;
however, a small percentage of women may experience
expulsion of the device and have to have it reinserted.3
Some research also suggests that these IUDs maintain
their effectiveness up to a year beyond their
recommended use period.4 This method may also be used
to treat heavy menstrual bleeding because the hormone
often reduces or eliminates uterine bleeding.
 A copper IUD prevents sperm from reaching and fertilizing
the egg, and it may prevent the egg from attaching in the
womb.3 If fertilization of the egg does occur, the physical
presence of the device prevents the fertilized egg from
implanting into the lining of the uterus. The failure and
expulsion/reinsertion rates of a copper IUD is similar to
those of a hormonal IUD.3 Copper IUDs may remain in the
body for 10 years.3 A copper IUD is not recommended for
women who may be pregnant, have pelvic infections, or
had uterine perforations during previous IUD insertions. It
also is not recommended for women who have cervical
cancer or cancer of the uterus, unexplained vaginal
bleeding, or pelvic tuberculosis. Currently, ParaGard® is
the only FDA-approved copper IUD.
Implants
Implants are implantable rods. Each rod is matchstick-sized, flexible,
and plastic. The method has a failure rate of less than 1%.3 A
physician surgically inserts the rod under the skin of the woman's
upper arm.
The rod releases a progestin and can remain implanted for up to 5
years. Currently, Implanon® and Nexplanon®, which release
etonogestrel, are the only implantable rods available in the United
States. A two-rod method, Jadelle®, which releases levonorgestrel, is
FDA approved but not currently distributed in America. A new
levonorgestrel-releasing, two-rod method, Sino-implant (II)®, is in
clinical development.
HORMONAL METHODS
Short-Acting Hormonal Methods
Hormonal methods of birth control use hormones to regulate or
stop ovulation and prevent pregnancy. Ovulation is the biological
process in which the ovary releases an egg, making it available for
fertilization. Hormones can be introduced into the body through
various methods, including pills, injections, skin patches,
transdermal gels, vaginal rings, intrauterine systems, and
implantable rods. Depending on the types of hormones that are
used, these methods can prevent ovulation; thicken cervical mucus,
which helps block sperm from reaching the egg; or thin the lining of
the uterus. Health care providers prescribe and monitor hormonal
contraceptives.
Short-acting hormonal methods (e.g., injectables, pills, patches,
rings) are highly effective if used perfectly, but in typical use, they
have a range of failure rates.
 Injectable birth control. This method involves injection of
a progestin, Depo-Provera® (depot medroxyprogesterone
acetate [DMPA]), given in the arm or buttocks once every
3 months.5 This method of birth control can cause a
temporary loss of bone density, particularly in adolescents.
However, this bone loss is generally regained after
discontinuing use of DMPA. Most patients using injectable
birth control should eat a diet rich in calcium and vitamin
D or take vitamin supplements while using this medication.
A new self-injectable formulation of DMPA, Sayana® Press,
is approved in the United Kingdom and is expected to be
approved more widely in the near future. This
subcutaneous injectable product has a lower amount of
hormone and may be more acceptable for some users.
 Progestin-only pills (POPs). A woman takes one pill daily,
preferably at the same time each day. POPs may interfere
with ovulation or with sperm function. POPs thicken
cervical mucus, making it difficult for sperm to swim into
the uterus or to enter the fallopian tube. POPs alter the
normal cyclical changes in the uterine lining and may
result in unscheduled or breakthrough bleeding. These
hormones do not appear to be associated with an
increased risk of blood clots.
Combined Hormonal Methods
Combined hormonal methods contain a synthetic estrogen (ethinyl
estradiol) and one of the many progestins approved in the United
States. All of the products work by inhibiting ovulation and
thickening cervical mucus. The combined estrogen/progestin drugs
can be delivered by pills, a patch, or a vaginal ring. The combined
hormonal methods have some medical risks, such as blood clots,
that are associated with the synthetic estrogen in the product. These
risks have not been observed with progestin-only hormonal
methods such as injectable birth control, POPs, or hormonal LARCs.
Your health care provider can discuss your risk factors and help you
select the most appropriate contraceptive method for you.
 Combined oral contraceptives (COCs, "the pill"). COCs
contain a synthetic estrogen and a progestin, which
functions to inhibit ovulation. A woman takes one pill
daily, preferably at the same time each day. Many types of
oral contraceptives are available, and a health care
provider helps to determine which type best meets a
woman's needs.
 Contraceptive patch. This is a thin, plastic patch that sticks
to the skin and releases hormones through the skin into
the bloodstream. The patch is placed on the lower
abdomen, buttocks, outer arm, or upper body. A new
patch is applied once a week for 3 weeks, and no patch is
used on the fourth week to enable menstruation.3
Currently, Ortho Evra® is the only patch that is FDA
approved.
 Vaginal ring. The ring is thin, flexible, and approximately 2
inches in diameter. It delivers a combination of ethinyl
estradiol and a progestin. The ring is inserted into the
vagina, where it continually releases hormones for 3
weeks. The woman removes it for the fourth week and
 reinserts a new ring 7 days later. Risks for this method of
contraception are similar to those for the combined oral
contraceptive pills. A vaginal ring may not be
recommended for women with certain health conditions,
including high blood pressure, heart disease, or certain
types of cancer.6 Currently, the NuvaRing® is the only FDA-
approved vaginal ring. A new contraceptive vaginal ring
that can be used for 13 cycles is under clinical
development.
BARRIER METHODS
Designed to prevent sperm from entering the uterus, barrier
methods are removable and may be an option for women who
cannot use hormonal methods of contraception. Failure rates for
barrier methods differ depending on the method.7
Types of barrier methods that do not require a health care provider
visit include the following:
 Male condoms. This condom is a thin sheath that covers
the penis to collect sperm and prevent it from entering the
woman's body. Male condoms are generally made of latex
or polyurethane, but a natural alternative is lambskin
(made from the intestinal membrane of lambs). Latex or
polyurethane condoms reduce the risk of spreading
sexually transmitted diseases (STDs). Lambskin condoms
do not prevent STDs. Male condoms are disposed of after
a single use.
 Female condoms. These are thin, flexible plastic pouches.
A portion of the condom is inserted into a woman's vagina
before intercourse to prevent sperm from entering the
uterus. The female condom also reduces the risk of STDs.
Female condoms are disposed of after a single use.
 Contraceptive sponges. These are soft, disposable,
spermicide-filled foam sponges. One is inserted into the
vagina before intercourse.8 The sponge helps block sperm
from entering the uterus, and the spermicide also kills the
sperm cells. The sponge should be left in place for at least
6 hours after intercourse and then removed within 30
hours after intercourse. Currently, the Today® Vaginal
Contraceptive Sponge is the only sponge approved by the
FDA.
 Spermicides. A spermicide can kill sperm cells. A
spermicide can be used alone or in combination with a
diaphragm or cervical cap. The most common spermicidal
agent is a chemical called nonoxynol-9 (N-9). It is available
in several concentrations and forms, including foam, jelly,
cream, suppository, and film. A spermicide should be
inserted into the vagina close to the uterus no more than
30 minutes prior to intercourse and left in place 6 to 8
hours after intercourse to prevent pregnancy. Spermicides
do not prevent the transmission of STDs and may cause
allergic reactions or vaginitis (pronounced vaj-uh-NAHY-
tis).9
 Diaphragms. Each diaphragm is a shallow, flexible cup
made of latex or soft rubber that is inserted into the
vagina before intercourse, blocking sperm from entering
the uterus. Spermicidal cream or jelly should be used with
a diaphragm. The diaphragm should remain in place for 6
to 8 hours after intercourse to prevent pregnancy, but it
should be removed within 24 hours. Traditional latex
diaphragms must be the correct size to work properly, and
a health care provider can determine the proper fit.A
diaphragm should be replaced after 1 or 2 years. Women
also need to be measured for a new diaphragm after
giving birth, having pelvic surgery, or gaining or losing
more than 15 pounds.10 Newer diaphragms, such as
Caya®, are designed to fit most women and do not require
fitting by a health care provider.
 Cervical caps. These are similar to diaphragms but are
smaller and more rigid. The cervical cap is a thin silicone
cup that is inserted into the vagina before intercourse to
block sperm from entering the uterus. As with a
diaphragm, the cervical cap should be used with
spermicidal cream or jelly. The cap must remain in place
for 6 to 8 hours after intercourse to prevent pregnancy,
but it should be removed within 48 hours. Cervical caps
come in different sizes, and a health care provider
determines the proper fit.3 With proper care, a cervical
cap can be used for 2 years before replacement.2
Currently, FemCap is the only cervical cap approved by the
FDA.
EMERGENCY CONTRACEPTION
Emergency contraception can be used after unprotected intercourse
or if a condom breaks.
 Copper IUD. The copper IUD is the most effective method
of emergency contraception. The device can be inserted
within 120 hours of unprotected intercourse. The method
is nearly 100% effective at preventing pregnancy and has
the added benefit of providing a highly effective method
of contraception for as long as the device remains in place.
There are very few contraindications to use of the copper
IUD, and there are no issues related to weight or obesity
associated with the effectiveness of the method.
 Emergency contraceptive pills (ECPs) are hormonal pills,
taken either as a single dose or two doses 12 hours apart,
that are intended for use in the event of unprotected
intercourse. If taken prior to ovulation, the pills can delay
or inhibit ovulation for at least 5 days to allow the sperm
to become inactive. They also cause thickening of cervical
mucus and may interfere with sperm function. ECPs should
be taken as soon as possible after semen exposure and
should not be used as a regular contraceptive method.
Pregnancy can occur if the pills are taken after ovulation or
if the woman has unprotected sex in the same cycle.
STERILIZATION
Sterilization is a permanent form of birth control that either
prevents a woman from getting pregnant or prevents a man from
releasing sperm. A health care provider must perform the
sterilization procedure, which usually involves surgery. These
procedures usually are not reversible.
A sterilization implant is a nonsurgical method for permanently
blocking the fallopian (pronounced fuh-LOH-pee-uhn) tubes.11 A
health care provider threads a thin tube through the vagina and into
the uterus to place a soft, flexible insert into each fallopian tube. No
incisions are necessary. During the next 3 months, scar tissue forms
around the inserts and blocks the fallopian tubes so that sperm
cannot reach an egg. After 3 months, a health care provider
conducts tests to ensure that scar tissue has fully blocked the
fallopian tubes. A backup method of contraception is used until the
tests show that the tubes are fully blocked.
 Tubal ligation (pronounced TOO-buhl lahy-GEY-shuhn) is
a surgical procedure in which a doctor cuts, ties, or seals
the fallopian tubes. This procedure blocks the path
between the ovaries and the uterus. The sperm cannot
reach the egg to fertilize it, and the egg cannot reach the
uterus.12
 Vasectomy (va-SEK-tuh-mee) is a surgical procedure that
cuts, closes, or blocks the vas deferens (pronounced vas
 DEF-uh-renz). This procedure blocks the path between the
testes and the urethra (yoo-REE-thruh).13 The sperm
cannot leave the testes and cannot reach the egg. It can
take as long as 3 months for the procedure to be fully
effective. A backup method of contraception is used until
tests confirm that there is no sperm in the semen.
CONGENITAL MALFORMATIONS
Congenital malformations, also known as congenital disorders or
birth defects, are conditions or defects that affect the baby from
birth.
Also defined as structural, behavioral, functional and metabolic
disorders present at birth There are many synonymous terms used
like congenital malformations, birth defects, etc. InIn 40 to 60% of
persons with birth defects, the cause is unknown.
Congenital anomalies can be of various types:
1.Structural: Where external form or structure is abnormal.
2.Functional: Where the function of the organ is affected. In
functional anomaly the defect can be at cellular level, where a
particular enzyme may not be formed normally, e.g. in hemophiliaa
particular factor essential for clotting is absent.
3.Metabolic: Where there can be defect in metabolism because of
absence or defect in one or more enzymes.
FACTORS
Genetic factors
Genes play an important role in many congenital anomalies. This
might be through inherited genes that code for an anomaly, or
resulting from sudden changes in genes known as mutations.
The following are for elaboration only kath. Thank you.)
Genetic or inherited causes include:
 chromosomal defects – caused by too few or too many
chromosomes, or problems in the structure of the
chromosomes, such as Down syndrome and extra copy of
chromosome 21 and sex chromosome abnormalities
 single gene defects – a mutation in one gene causes the
defect
 dominant inheritance – when one parent (who may or
may not have the disease) passes along a single faulty
gene, such as achondroplasia and Marfan syndrome
 recessive inheritance – when both parents, who do not
have the disease, pass along the gene for the disease to
the child, such as cystic fibrosis
Socioeconomic and demographic factors
Low-income may be an indirect determinant of congenital
anomalies, with a higher frequency among resource-constrained
families and countries. It is estimated that about 94% of severe
congenital anomalies occur in low- and middle-income countries. An
indirect determinant, this higher risk relates to a possible lack of
access to sufficient, nutritious foods by pregnant women, an
increased exposure to agents or factors such as infection and
alcohol, or poorer access to healthcare and screening. Factors often
associated with lower-income may induce or increase the incidence
of abnormal prenatal development.
Maternal age is also a risk factor for abnormal intrauterine fetal
development. Advanced maternal age increases the risk of
chromosomal abnormalities, including Down syndrome.
Environmental factors
Maternal exposure to certain pesticides and other chemicals, as well
as certain medications, alcohol, tobacco and radiation during
pregnancy, may increase the risk of having a fetus or neonate
affected by congenital anomalies. Working or living near, or in,
waste sites, smelters or mines may also be a risk factor, particularly
if the mother is exposed to other environmental risk factors or
nutritional deficiencies.
Infections
Maternal infections such as syphilis and rubella are a significant
cause of congenital anomalies in low- and middle-income countries.
More recently, the effect of in utero exposure to Zika virus on the
developing fetus has been reported.
Maternal nutritional status
Maternal folate insufficiency increases the risk of having a baby with
a neural tube defect while excessive vitamin A intake may affect the
normal development of an embryo or fetus.
GLOSSARY:
Teratogens- an agent or factor which causes malformation of an
embryo.
Congenital- a disease or physical abnormality present from birth.
Malformations- a deformity; an abnormally formed part of the body
or a condition marked by impaired muscle coordination (spastic
paralysis) and/or other disabilities, typically caused by damage to
the brain before or at birth.
Disruptions -morphological alterations of already formed structures
and are due to destructive processes.
Dysplasia -abnormal tissue formation
Deformations- mechanical forces that mold a part of the fetus over
a prolonged period.
Spina Bifida- a congenital defect of the spine in which part of the
spinal cord and its meninges are exposed through a gap in the
backbone. It often causes paralysis of the lower limbs, and
sometimes mental handicap.
Limb Defects- “limb reduction” because a limb is reduced from its
normal size or is missing. Congenital absence of foot and toes.
What Are STDs?
STDs are sexually transmitted diseases. This means they are most
often -- but not exclusively -- spread by sexual intercourse. HIV,
chlamydia, genital herpes, genital warts, gonorrhea, some forms of
hepatitis, syphilis, and trichomoniasis are STDs.
STDs used to be called venereal diseases or VD. They are among the
most common contagious diseases. More than 65 million Americans
have an incurable STD. Each year, 20 million new cases are reported;
half of these infections are among people ages 15 to 24 and they can
have long-term consequences.
STDs are serious illnesses that require treatment. Some STDs, such
as HIV, cannot be cured and can be deadly. By learning more about
STDs, you can learn ways to protect yourself.

You can get a STD from vaginal, anal, or oral sex. You can also be
infected with trichomoniasis through contact with damp or moist
objects such as towels, wet clothing, or toilet seats, although it is
more commonly spread by sexual contact. You are at high risk if:
 You have more than one sex partner
 You have sex with someone who has had many partners
 You don't use a condom when having sex
 You share needles when injecting intravenous drugs
 You trade sex for money or drugs
STD prevention
Avoiding sexual contact is the only foolproof way to avoid STDs. But
if you do have vaginal, anal, or oral sex, there are ways to make it
safer.
High-risk strains: High-risk strains do not cause warts but can, rarely,
cause cancer. This is why they are called high-risk strains.
WHAT IS PENILE CANCER?
Penile cancer is a rare condition which occurs when malignant
(cancerous) cells form in the tissue of the penis. Uncircumcised men
over the age of 50 are most at risk of getting penile cancer. Men
with a history of genital warts and human papillomavirus (HPV or
the wart virus) are also at higher risk. Men should discuss any penile
changes with their doctor. Partners of men with penile cancer
should also be screened for other forms of cancer caused by HPV in
the genital area – this includes cervical, vulvar and anal cancer.
WHAT IS PROSTATE CANCER?
Prostate cancer is the most common cancer in men in Aotearoa New
Zealand. There are around 2,500 new diagnoses each year.

When used properly, condoms provide effective protection against Men who develop prostate cancer are mostly over the age of 65. It
many STDs. For optimal protection, it’s important to use condoms rarely occurs in men younger than 55. In very elderly men, prostate
during vaginal, anal, and oral sex. Dental dams can also provide cancer often grows very slowly and may cause no symptoms. All
protection during oral sex. men over 45 should discuss with their doctor whether to have
prostate cancer screening.
Condoms are generally effective at preventing STDs that spread
through fluids, such as semen or blood. But they can’t fully protect WHAT IS TESTICULAR CANCER?
against STDs that spread from skin to skin. If your condom doesn’t
Testicular cancer is the most common cancer in men aged between
cover the infected area of skin, you can still contract an STD or pass
15 and 35 years but it can happen to men of any age.Testicular
it to your partner.Condoms can help protect against not only STDs,
cancer is almost always curable, particularly if it is diagnosed and
but also unwanted pregnancy.
treated at an early stage.
In contrast, many other types of birth control lower the risk of
unwanted pregnancy but not STDs. For example, the following forms
of birth control don’t protect against STDs:

 birth control pills

 birth control shot
 birth control implants
 intrauterine devices (IUDs)

Reproductive cancers are cancer that is in the organs related to

reproduction. The most common reproductive cancers in women
are:

 Cervical cancer: Cancer of the cervix, the lower end of the

uterus that extends to the vagina.
 Ovarian cancer: Cancer in the ovaries, the two organs that
make female hormones and produce a woman’s eggs.
 Uterine cancer: Cancer in the uterus (womb), the organ
where the baby grows when a woman is pregnant.
 Vaginal cancer: Cancer of the vagina, the hollow channel
that leads from the uterus and cervix to the outside of the
body.
 Vulvar cancer: Cancer of the vulva, the area around the
opening of the vagina.
 Breast cancer is sometimes considered a reproductive
cancer. Breast cancer is in the tissues of the breast.

HPV is a virus that is spread during sexual contact. There are about
40 different strains (types) of HPV that can infect the genital area.
About a dozen of these can cause cancer.

There are two types or strains of HPV:

Low-risk strains: Low-risk strains of HPV can cause warts on the

genitals. Warts can be itchy, embarrassing, and unpleasant, but
these strains are considered low risk because they do not cause
cancer.