Research Paper on FERTILITY, INFERTILITY AND CONTRACEPTIVES

ABSTRACT
This report aims to provide a brief overview of human fertility, human infertility and the role of contraceptives on human reproductive capacity. By embracing a healthy life-style, appropriate medical solutions, fertility, infertility and contraceptives can all provide desirable results that are beneficial to human reproduction. In focus particularly were the causes and factors that affect males and females fertility. Recent medical breakthroughs and solutions that are now readily available to address problems associated with infertility and birth control, which hitherto were not available or not readily accessible. In the development of writing this report, due evaluation was paid to the vast resources of acquired, written and documented wealth of information harnessed from validated medical databases, articles, books and electronic publications round the world, with foci attention on only human fertility, human infertility and contraceptives. Adequate evaluation was paid to the current medical approaches that have gained the approval of internationally recognised medical institutes, agencies and regulatory bodies.

TABLE OF CONTENTS
ABSTRACT ......................................................................................................... i LIST OF FIGURES ............................................................................................. iii 1.0 INTRODUCTION .......................................................................................... 4 2.0 FERTILITY ................................................................................................... 5 2.1 Definition of Fertility .................................................................................. 5 2.2 MEASURING FERTILITY ......................................................................... 5 2.3 HUMAN FERTILITY .................................................................................. 7 2.3.1 FEMALE FERTILITY .......................................................................... 7 2.3.2 MALE FERTILITY .............................................................................. 9 2.3.3 FACTORS AFFECTING FERTILITY IN HUMANS ........................... 11 3.0 INFERTILITY .............................................................................................. 12 3.1 Definition of Infertility............................................................................... 12 3.2 CAUSES OF INFERTILITY ..................................................................... 12 3.3 TREATMENT OF INFERTILITY.............................................................. 14 4.0 CONTRACEPTIVES .................................................................................. 15 4.1 Definition of Contraceptive ...................................................................... 15 4.2 METHODS OF CONTRACEPTIVES ...................................................... 15 4.3 EFFECTS OF CONTRACEPTIVES ........................................................ 17 5.0 CONCLUSION ........................................................................................... 20 6.0 REFERENCES ........................................................................................... 20

LIST OF FIGURES
Figure 3-1: Causes of infertility, data compiled in the United Kingdom ............ 13 Figure 4-1: A rolled up male condom ............................................................... 16 Figure 4-2: Genernal mortality rate as of 2010 .... Error! Bookmark not defined. Figure 4-3: Countries by fertility rate as of 2012 ............................................... 19

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1.0 INTRODUCTION
Fertility is the ability of people or animals to produce healthy offspring. Studies have revealed that human fertility depends on factors of nutrition, sexual behaviour, culture, instinct, endocrinology, timing, economics, way of life, and emotions, etc. Both women and men have hormonal cycles which determine both when a woman can achieve pregnancy and when a man is most fertile. A lack of fertility is simply referred to as infertility. Both women and men can have problems that cause infertility when exposed to the varying factors that affects human reproductive systems. When an infertility problem is discovered and an appropriate self or medical therapy is adopted and well-managed, an infertile male or female can successfully develop a fertile reproductive system. Although fertility is a desirable health condition, but it is not at all times child reproduction is desirable to people who are still sexually active. In this case, the introduction of appropriate contraceptive helps sexual partners to have control over child bearing and avoid unnecessary or unwanted child birth. Ideally, the use of contraceptives is the responsibility of both sexual partners. In reality, the ultimate responsibility for birth control more often than not rests with the woman.

FERTILITY, INFERTILITY AND CONTRACEPTIVES

2.0 FERTILITY
2.1 Definition of Fertility
Fertility is the natural capability to produce offspring. As a measure, "fertility rate" is the number of offspring born per mating pair, individual or population. A lack of fertility is referred to as infertility (Wikipedia, 2014; Kiser

and Whelpton, 1953).

Researches have revealed that fertility in humans depends on factors of nutrition, sexual behaviour, culture, instinct, endocrinology, timing, economics, way of life, and emotions. In demographic contexts, fertility refers to the actual production of offspring and it can be measured.

2.2 MEASURING FERTILITY

The rate of fertility can be done in a variety of ways, which can be broadly broken into two approaches, namely the Period measures and the Cohort measures. Both period and cohort measures are widely used in measuring fertility (Wikipedia, 2014).

a. Period Measures: Period measures refer to a cross-section of the population in

one year. The following

methods are employed with period measures:

i.

Crude birth rate (CBR): The number of live births in a given year per 1,000 people alive at the middle of that year. One disadvantage of this indicator is that it is influenced by the age structure of the population.

ii.

General fertility rate (GFR): The number of births in a year divided by the number of women aged 1544, times 1000. It focuses on the potential mothers only, and takes the age distribution into account.

iii.

Child-Woman Ratio (CWR): The ratio of the number of children under 5 to the number of women 15-49, times 1000. It is especially useful in historical data as it does not require counting births. This measure is actually a hybrid type, because it involves deaths as well as births. (That is, because of infant mortality some of the births are not included; and

because of adult mortality, some of the women who gave birth are not counted either.) iv. Coale's Index of Fertility: A special device used in historical research to determine human fertility.

b.

Cohort Measures: Cohort measures data by following the same people over a
period of decades. It can be determined by using the following techniques (Wikipedia, 2014): i. Age-specific fertility rate (ASFR): The number of births in a year to women in a 5-year age group, divided by the number of all women in that age group, times 1000. The usual age groups are 10-14, 15-19, 20-24, etc. ii. Total fertility rate (TFR): The total number of children a woman would bear during her lifetime if she were to experience the prevailing age-specific fertility rates of women. TFR equals the sum for all age groups of 5 times each ASFR rate. iii. Gross Reproduction Rate (GRR): The number of girl babies a synthetic cohort will have. It assumes that all of the baby girls will grow up and live to at least age 50. iv. Net Reproduction Rate (NRR): The NRR starts with the GRR and adds the realistic assumption that some of the women will die before age 49; therefore they will not be alive to bear some of the potential babies that were counted in the GRR. NRR is always lower than GRR, but in countries where mortality is very low, almost all the baby girls grow up to be potential mothers, and the NRR is practically the same as GRR. In countries with high mortality, NRR can be as low as 70% of GRR. When NRR = 1.0, each generation of 1000 baby girls grows up and gives birth to exactly 1000 girls. When NRR is less than one, each generation is smaller than the previous one. When NRR is greater than 1 each generation is larger than the one before. NRR is a measure of the longterm future potential for growth, but it usually is different from the current population growth rate.

Both period and cohort measures are widely used in measuring fertility

c.

Bongaarts' model of components of fertility: Bongaarts proposed a model

where the total fertility rate of a population can be calculated from four proximate determinants and the total fecundity (TF). These proximate determinants are: The index of marriage (Cm), the index of contraception (Cc), the index of induced abortion (Ca) and the index of postpartum infecundability (Ci). These indices range from 0 to 1. The higher the index, the higher it will make the TFR, for example a population where there are no induced abortions would have a Ca of 1, but a country where everybody used infallible contraception would have a Cc of 0 (Wikipedia, 2014). TFR = TF Cm Ci Ca Cc These four indices can also be used to calculate the total marital fertility (TMFR) and the total natural fertility (TN). TFR = TMFR Cm TMFR = TN Cc Ca TN = TF Ci

2.3 HUMAN FERTILITY

Men and women have hormonal cycles which determine both when a woman can achieve pregnancy and when a man is most virile. The female cycle is approximately twenty-eight days long, but can deviate greatly from this "norm". The male cycle is also variable. Men can ejaculate and produce sperm at any time of the month, but their sperm quality dips occasionally, which scientists guess is in relation to their internal cycle. Furthermore, age also plays an equally significant role for both men and women (Wikipedia, 2014).

2.3.1 FEMALE FERTILITY

The average age of menarche in the United States is about 12.5 years. In post-menarchal girls, about 80% of the cycles are anovulatory in the first year after menarche, 50% in the third and 10% in the sixth year (Apter, 1980). A Womens fertility peaks in the early 20s, and drops considerably after the age 35. Menopause typically occurs during a women's midlife (usually between ages 45 and 55. During menopause, hormonal production by the ovaries is reduced, eventually causing a permanent cessation of the primary function of the ovaries, particularly the creation of the uterine lining (period). This is considered the end of the fertile phase of a woman's life (Leridon, 2004).

According to a computer simulation run by Henri Leridon, PhD, an epidemiologist with the French Institute of Health and Medical Research, of women trying to get pregnant, without using fertility drugs or in vitro fertilization (Leridon, 2004). i. ii. iii. At age 30 75% will have a conception ending in a live birth within one year 91% will have a conception ending in a live birth within four years. At age 35 66% will have a conception ending in a live birth within one year 84% will have a conception ending in a live birth within four years. At age 40 44% will have a conception ending in a live birth within one year 64% will have a conception ending in a live birth within four years.

The use of fertility drugs and/or invitro fertilization can increase the chances of a woman becoming pregnant at a later age (Leridon, 2004).

2.3.1.1 Menstrual Cycle

A woman's menstrual cycle begins, as it has been arbitrarily assigned, with menses. Next is the follicular phase where estrogen levels build as an ovum matures (due to the follicular stimulating hormone or FSH) within the ovary. When estrogen levels peak, it spurs a surge of luteinizing hormone (LH) which finishes the ovum and enables it to break through the ovary wall. This is ovulation. During the luteal phase, which follows ovulation LH and FSH cause the post-ovulation ovary to develop into the corpus luteum which produces progesterone. The production of progesterone inhibits the LH and FSH hormones which (in a cycle sans pregnancy) causes the corpus luteum to atrophy, and menses to begin the cycle again (DuoFertility, 2014). Peak fertility occurs during just a few days of the cycle: usually two days before and two days after the ovulation date.[9] This fertile window varies from woman to woman, just as the ovulation date often varies from cycle to cycle for the same woman.[10] The ovule is usually capable of being fertilized for up to 48 hours after it is released from the ovary. Sperm survive inside the uterus between 48 to 72 hours on average, with the maximum being 120 hours (5 days) (Creinin et al., 2004).

2.3.1.2 Ways of Improving Female Fertility

Focus on a Fertility Diet: here is no question whatever about the fact that we are exactly what we eat. There is no other way in which the cells and tissues of our body can be replenished, except from what we eat and drink

Get the services of a fertility expert or deploy a self-therapy through multimedia message.

Listen to something inspirational; fill your mind with good things. The mind is a powerful tool one you should be using daily to support your fertility journey. S cience has shown that thoughts and emotions have an effect on the physical body, this includes fertility.

Whole Food Multivitamin. In addition to a healthy fertility diet, every woman who is preparing for pregnancy should be taking a whole food prenatal multivitamin. There are many nutrients that are needed to support ovulation, hormonal balance, egg health, etc.

Liquid nutrition makes: It is much easier to get a large amount of these nutrient dense foods into the body. Regardless of what ones diet is lik e right, taking natural juice drinks help to make create a healthier life and reduce cravings for other foods.

Certain occupational habits or requirements and dress choices may cause physical interferences with male fertility. Temperature, exposure to environmental toxins, and certain clothing habits can reduce fertility. Following these steps helps increase sperm count and general health and optimizes males chances of increasing fertility (Hassan

and Killick, 2003).

2.3.2 MALE FERTILITY

Evidence shows that increased male age is associated with a decline in semen volume, sperm motility, and sperm morphology. In studies that controlled for female age, comparisons between men under 30 and men over 50 found relative decreases in pregnancy rates between 23% and 38% (Kidd et at., 2001). Sperm count declines with age, with men aged 5080 years producing sperm at an average rate of 75% compared with men aged 2050 years. However, an even larger difference is seen in how many of the seminiferous tubules in the testes contain mature sperm (Sherman and

Silber, 1991).
In males 2039 years old, 90% of the seminiferous tubules contain mature sperm. In males 4069 years old, 50% of the seminiferous tubules contain mature sperm. In males 80 years old and older, 10% of the seminiferous tubules contain mature sperm.[26]

Research shows increased risks for health problems for children of older fathers. A large scale Israeli study found that the children of men 40 or older were 5.75 times more likely than children of men under 30 to have an autism spectrum disorder, controlling for year of birth,

socioeconomic status, and maternal age.[27] Increased paternal age has also been correlated to schizophrenia in numerous studies (Malaspina et al., 2001). Recent findings by Australian researchers shows evidence to suggest overweight obesity may cause subtle damage to sperm and prevent health pregnancy. They say fertilization was 40% less likely to succeed when the father was overweight (Robotham, 2010).

2.3.2.1 Ways of Improving Male Fertility

Male fertility can depend largely on modifiable factors, such as diet, lifestyle, sexual habits, and occupational exposures. In some cases, simple changes can increase male fertility. Other causes of reduced fertility may take more extensive corrective measures to restore fertility in men. Avoid restrictive clothing: Tight underwear or pants, athletic or swim spandex materials, and harness gear that cuts of circulation to the groin area may interfere with male fertility by harming sperm production or weakening the quality of sperm Limit exposure to harmful chemicals or rays: Exposures to heavy metals, radiation or xrays, and pesticides have been shown to decrease sperm production and even cause infertility in men. Maintaining an appropriate temperature in the groin region. Long periods of sitting, regular sessions in a hot tub or sauna, and wearing overly warm or snug clothing can cause the scrotum to overheat, reducing sperm count and thus, limiting male fertility Taking plenty of antioxidants: Research suggests that by eating a diet rich in antioxidants you may be able to increase sperm count, thus increasing potential male fertility. Vitamins C and E, glutathione, and coenzyme Q10 have all been shown to help treat male infertility. Taking of multivitamin. Daily multivitamin supplements contain vitamins C and E as well as a good supply of other essential nutrients for male reproductive health. Avoid foods that reduce sperm count. Alcohol and red meat have both been associated with poor male fertility while a diet high in fruits, grains, and seafood have been shown to increase fertility. Contrary to common belief, there is no conclusive evidence as to whether or not caffeine affects male fertility. Quit smoking. Tobacco and smoke causes reduced sperm count in men. To increase sperm count and potentially increase fertility, work to cut back or quite smoking altogether and avoid locations with concentrated second hand smoke. Avoid excessive alcohol intake. Men who consume high amounts of alcohol often have lower sperm counts, lower testosterone levels, and even experience erectile dysfunction more frequently.

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Reduce stress levels. Not only can stress interfere with your sexual health, high levels of stress can cause changes in hormones that affect sperm production, reducing fertility.

Maintain a healthy weight. Being underweight, overweight or obese may reduce sperm count and increase the likelihood of producing abnormal sperm.

Certain occupational habits or requirements and dress choices may cause physical interferences with male fertility. Temperature, exposure to environmental toxins, and certain clothing habits can reduce fertility. Following these steps helps increase sperm count and general health and optimizes males chances of increasing fertility (Hassan

and Killick, 2003).

2.3.3 FACTORS AFFECTING FERTILITY IN HUMANS

Fertility is affected by cultural, social, economic, and health factors. Most of these factors operate through four other factors (PRB,

2011):

a. Proportion of women in sexual unions: The percentage of women in sexual unions is sometimes approximated by the percentage of women of reproductive age who are legally married. The percentage married by age group can also be very useful for analysis

b. Percentage of Women Breastfeeding: The percentage of women who are breastfeeding is helpful in determining the number of women who are at risk of pregnancy, because exclusive breastfeeding of an infant can lengthen the period of time before menstruation resumes.

c.

Contraceptive Prevalence Rate: The contraceptive prevalence rate is the number of women of reproductive age who are using contraception per 100 women of reproductive age. This measure provides an indication of the number of women who have a lower risk of conception at a given time. This measure may be calculated for all women or subpopulations such as married women, unmarried women, or women who are sexually active.

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d. Level of induced abortion: The abortion rate is the number of induced abortions per 1,000 women of reproductive age in a given year.

e. Other factors: Human fertility depends on factors of nutrition, sexual behaviour, culture, instinct, endocrinology, timing, economics, way of life, and emotions Knowledge about these four factors provides clues to potential changes in fertility and aids our understanding of past change.

3.0 INFERTILITY
3.1 Definition of Infertility
Infertility is fundamentally the inability to conceive offspring. Infertility also refers to the state of a woman who is unable to carry a pregnancy to full term. There are many biological causes of infertility, including some that medical intervention can treat (Makar

and Toth, 2002).

Infertility has increased by 4 percent since the 1980s, mostly from problems with fecundity due to an increase in age. About 40 percent of the issues involved with infertility are due to the man, another 40 percent due to the woman, and 20 percent result from complications with both partners (Makar

and Toth, 2002).

Demographers tend to define infertility as childlessness in a population of women of reproductive age, whereas the epidemiological definition refers to "trying for" or "time to" a pregnancy, generally in a population of women exposed to a probability of conception. The time needed to pass (during which the couple tries to conceive) for that couple to be diagnosed with infertility differs between different jurisdictions (Gurunath

et al., 2011).

3.2 CAUSES OF INFERTILITY

Factors that can cause male as well as female infertility are: i. DNA damage: DNA damage reduces fertility in female ovocytes, as caused by smoking, other xenobiotic DNA damaging agents (such as radiation or chemotherapy) or accumulation of the oxidative DNA damage 8-hydroxy-deoxyguanosine (Zenzes, 2000). DNA damage reduces fertility in male sperm, as caused by oxidative DNA damage, smoking, other xenobiotic DNA damaging agents (such as drugs or

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chemotherapy) or other DNA damaging agents including reactive oxygen species, fever or high testicular temperature (Zenzes, 2000). ii. Genetic factors: A Robertsonian translocation in either partner may cause recurrent spontaneous abortions or complete infertility. iii. iv.

General factors: Diabetes mellitus, thyroid disorders, adrenal disease. Hypothalamic-pituitary factors: This is mainly Hyperprolactinemia and Hypopituitarism. The presence of anti-thyroid antibodies is associated with an increased risk of unexplained subfertility with an odds ratio of 1.5 and 95%.

v.

Environmental

factors:

Toxins such physical

as agents,

glues, chemical

volatile dusts,

organic solvents or silicones,

and pesticides. Tobacco smokers are 60% more likely to be infertile than non-smokers.

Figure 3-1: Causes of infertility, data compiled in the United Kingdom

In some cases, both the man and woman may be infertile or sub-fertile, and the couple's infertility arises from the combination of these conditions. In other cases, the cause is suspected to be immunological or genetic; it may be that each partner is independently fertile but the couple cannot conceive together without assistance.

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3.3 TREATMENT OF INFERTILITY

Treatment depends on the cause of infertility, but may include counselling, fertility treatments, which include in vitro fertilization. Some couples with an estimated live birth rate of 40% or higher per year are encouraged to continue aiming for a spontaneous pregnancy. Treatment methods for infertility may be grouped as medical or complementary and alternative treatments. Some methods may be used in concert with other methods. Drugs used for women include Clomiphene citrate, Human menopausal gonadotropin, Folliclestimulating hormone, Human chorionic gonadotropin, Gonadotropin-releasing hormone analogs, Aromatase inhibitor and Metformin (ESHRE Capri Workshop Group, 2013). a. At-home conception kit: In 2007 the FDA cleared the first at home tier one medical conception device to aid in conception. The key to the kit are cervical caps for conception. This at home (cervical cap) insemination method allows all the semen to be placed up against the cervical os for six hours allowing all available sperm to be placed directly on the cervical os. For low sperm count, low sperm motility, or a tilted cervix using a cervical cap aids conception. This is a prescriptive medical device, but not commonly prescribed by physicians (NewsRx, 2014). b. Assisted Natural Conception: For some causes of infertility, assisted natural conception can provide couples with a pregnancy rate at least as high as the one provided by fertility treatment. This is typically for couples with unexplained infertility, sperm count above 5M/ml, one tube blocked, or other mild infertility causes (NewsRx, 2014). c. Medical treatments: Medical treatment of infertility generally involves the use of fertility medication, medical device, surgery, or a combination of the following. If the sperm are of good quality and the mechanics of the woman's reproductive structures are good (patent fallopian tubes, no adhesions or scarring), physicians may start by prescribing a course of ovarian stimulating medication. The physician or WHNP may also suggest using a conception cap cervical cap, which the patient uses at home by placing the sperm inside the cap and putting the conception 14

device on the cervix, or intrauterine insemination (IUI), in which the doctor or WHNP introduces sperm into the uterus during ovulation, via a catheter. In these methods, fertilization occurs inside the body. If conservative medical treatments fail to achieve a full term pregnancy, the physician or WHNP may suggest the patient undergo in vitro fertilization (IVF). IVF and related techniques (ICSI,ZIFT, GIFT) are called assisted reproductive technology (ART) techniques. ART

techniques generally start with stimulating the ovaries to increase egg production. After stimulation, the physician surgically extracts one or more eggs from the ovary, and unites them with sperm in a laboratory setting, with the intent of producing one or more embryos. Fertilization takes place outside the body, and the fertilized egg is reinserted into the woman's reproductive tract, in a procedure called embryo transfer. Other medical techniques are e.g. tuboplasty, assisted hatching, and Preimplantation genetic diagnosis (NewsRx, 2014).

4.0 CONTRACEPTIVES
4.1 Definition of Contraceptive
Contraception, also known as Birth Control and fertility control, are methods or devices used to prevent pregnancy (Medicinenet, 2013). Planning, provision and use of birth control is called family planning. Safe sex, such as the use of male or female condoms, can also help prevent sexually transmitted infections. Birth control methods have been used since ancient times, but effective and safe methods only became available in the 20th century (Pavone and Burke, 2007).

4.2 METHODS OF CONTRACEPTIVES

Contraceptive control methods include barrier methods, hormonal birth control, intrauterine devices (IUDs), sterilization, and behavioural methods. They are used before or during sex while emergency contraceptives are effective for up to a few days after sex. Effectiveness is generally expressed as 15

the percentage of women who become pregnant using a given method during the first year, and sometimes as a lifetime failure rate among methods with high effectiveness do occur (Edlin et al., 1999). a. Hormonal contraceptives: This work by

inhibiting ovulation and fertilization. They are available in a number of different forms including oral pills, implants under the

skin, injections, patches, IUDs and a vaginal ring. They are currently available only for women. b. Barrier contraceptives: Are devices that attempt to

prevent pregnancy by the uterus. They caps, diaphragms, (Hannelore, 2012).

physically

preventing sperm from

entering

include

male condoms, female

condoms, cervical

and contraceptive

sponges with spermicide

Figure 4-1: A rolled up male condom

c. Intrauterine devices: The current intrauterine devices (IUD) are small devices, often T-shaped, often containing either copper or

levonorgestrel, which are inserted into the uterus. d. Sterilization: Surgical sterilization is available in the form of tubal ligation for women and vasectomy for men. e. Behavioural: Behavioural methods involve regulating the timing or method of intercourse to prevent introduction of sperm into the female reproductive tract, either altogether or when an egg may be present.

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f. Fertility awareness: Fertility awareness methods involve determining the most fertile days of the menstrual cycle and avoiding unprotected intercourse. g. Withdrawal: The withdrawal method (also known as coitus interruptus) is the practice of ending sexual intercourse ("pulling out") before ejaculation. h. Abstinence: Though some groups advocate total sexual abstinence, by which they mean the avoidance of all sexual activity, in the context of birth control the term usually means abstinence from vaginal intercourse. i. Lactation: The lactational amenorrhea method involves the use of a woman's natural postpartum infertility which occurs after delivery and may be extended by breastfeeding. j. Emergency: Emergency contraceptive methods are medications

(sometimes misleadingly referred to as "morning-after pills") or devices used after unprotected sexual intercourse with the hope of preventing pregnancy.

4.3 EFFECTS OF CONTRACEPTIVES

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i.

Health Benefits Contraceptive use in developing countries is estimated to have decreased the number of maternal deaths by 40% (about 270,000 deaths prevented in 2008) and could prevent 70% of deaths if the full demand for birth control were met. These benefits are achieved by reducing the number of unplanned pregnancies that subsequently result in unsafe abortions and by preventing pregnancies in those at high risk (Cleland et al., 2012).

Figure 4-2: General mortality rate as of 2010

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ii.

Finances In the developing world, birth control increases economic growth due to there being fewer dependent children and thus more women participating in the workforce. Women's earnings, assets, body mass index, and their children's schooling and body mass index all improve with greater access to birth control (Canning, 2012).

Figure 4-3: Countries by fertility rate as of 2012

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5.0 CONCLUSION

6.0 REFERENCES
Apter, D. (1980), "Serum steroids and pituitary hormones in female puberty: a partly longitudinal study", Clinical endocrinology, vol. 12, no. 2, pp. 107-120. Canning, D. and Schultz, T. P. (2012), "The economic consequences of reproductive health and family planning", The Lancet, vol. 380, no. 9837, pp. 165-171. Cleland, J., Conde-Agudelo, A., Peterson, H., Ross, J. and Tsui, A. (2012), "Contraception and health", The Lancet, vol. 380, no. 9837, pp. 149-156. Creinin, M. D., Keverline, S. and Meyn, L. A. (2004), "How regular is regular? An analysis of menstrual cycle regularity", Contraception, vol. 70, no. 4, pp. 289-292. DuoFertility (2014), My Fertile Days, available at: http://www.duofertility.com/articles/my-fertile-days (accessed 16th March, 2014). Edlin, G., Golanty, E. and Brown, K. M. (1999), Essentials for health and wellness, Jones & Bartlett Learning. ESHRE Capri Workshop Group (2013), "Failures (with some successes) of assisted reproduction and gamete donation programs", Human reproduction update, vol. 19, no. 4, pp. 354-365. Gurunath, S., Pandian, Z., Anderson, R. A. and Bhattacharya, S. (2011), "Defining infertility--a systematic review of prevalence studies", Human reproduction update, vol. 17, no. 5, pp. 575-588. Hannelore, R. (2012), "Current Opinion in Obstetrics and Gynecology: Reproductive Endocrinology", Thrombotic risks of oral contraceptives, vol. 24th, no. 4, pp. Obstetrics and Gynecology. Hassan, M. A. and Killick, S. R. (2003), "Effect of male age on fertility: evidence for the decline in male fertility with increasing age", Fertility and sterility, vol. 79, pp. 1520-1527. Kidd, S. A., Eskenazi, B. and Wyrobek, A. J. (2001), "Effects of male age on semen quality and fertility: a review of the literature", Fertility and sterility, vol. 75, no. 2, pp. 237-248.

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Kiser, C. V. and Whelpton, P. K. (1953), "Resume of the Indianapolis study of social and psychological factors affecting fertility", Population Studies, vol. 7, no. 2, pp. 95-110. Leridon, H. (2004), "Can assisted reproduction technology compensate for the natural decline in fertility with age? A model assessment", Human reproduction (Oxford, England), vol. 19, no. 7, pp. 15481553. Makar, R. S. and Toth, T. L. (2002), "The evaluation of infertility", American Journal of Clinical Pathology, vol. 117 Suppl, pp. S95-103. Malaspina, D., Harlap, S., Fennig, S., Heiman, D., Nahon, D., Feldman, D. and Susser, E. S. (2001), "Advancing paternal age and the risk of schizophrenia", Archives of General Psychiatry, vol. 58, no. 4, pp. 361-367. Medicinenet, (2013), Definition of Birth control, available at: http://www.medterms.com/script/main/art.asp?articlekey=53351 (accessed 16th March, 2014). NewsRx (2014), Conceivex Launches Conception Kit, First FDA Cleared Method for Pregnancy That is Less Expensive than the Fertility Workup, available at: http://www.newsrx.com/pr_details.php?type=1&id=2904 (accessed 15th March, 2014). Pavone, M. E. and Burke, A. (2007), "Fertility Control: Contraception, Sterilization, and Abortion", The John Hopkins Manual of Gynecology and Obstetrics (Third Edition).Philadelphia: Lippincott Williams and Wilkins, , pp. 343-354. PRB (2011), "PopulatIon Handbook", Population Reference Bureau, vol. six, no. 14th March, 2014, pp. PRB. Robotham, J. (2010), Fat men linked to lower fertility, available at: http://www.smh.com.au/lifestyle/dietand-fitness/fat-men-linked-to-lower-fertility-20101017-16p6l.html (accessed 16th March, 2014). Sherman, J. and Silber, M. D. (1991), "Effect of Age on Male Fertility", The Infertility Centre of St Louis, vol. 9th, no. 3, pp. Seminars in Reproductive Endocrinology. Wikipedia Website (2014), Fertility in Humans, available at: http://en.wikipedia.org/wiki/Fertility (accessed 14th March, 2014). Zenzes, M. T. (2000), "Smoking and reproduction: gene damage to human gametes and embryos", Human reproduction update, vol. 6, no. 2, pp. 122-131.

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