Dear Colleagues,

Infertility is a disease of the male or female reproductive system defined as inability of a non-contracepting couple to access pregnancy after 12 months of regular sexual relations. Estimates suggest that approximately one in every six people of reproductive age worldwide experience infertility in their lifetime. In the male reproductive system, infertility may be caused by: 1- 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, 2- Hormonal disorders leading to abnormalities in hormones produced by the pituitary gland, hypothalamus and testicles. Hormones such as testosterone regulate sperm production. Examples of disorders that result in hormonal imbalance include pituitary or testicular cancers, 3- Testicular failure to produce sperm, for example due to varicoceles or medical treatments that impair sperm-producing cells (such as chemotherapy) and 4- 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.

In the female reproductive system, infertility may be caused by: 1- 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, 2- 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), 3- Disorders of the ovaries, such as polycystic ovarian syndrome and other follicular disorders and 4- 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. 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. Beyond routine medical treatment, lifestyle changes such as avoid smoking and excessive alcohol intake, body weight management and enough intake of antioxidants including vitamins and minerals and functional foods included in fruits and vegetables and limited intake of saturated fatty acids 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 .

The main objective of this section is to collate the available evidence regarding prevention, diagnosis and treatment of infertility and the role of life style and environmental factors and interventions in female and male fertility, and focusing on mechanism underpinning the efficacy of these interventions. We also highlight the key gaps in the literature and outline recommendations for future research in this field.

We look forward to receiving your contributions.

Dr. Leila Maghsoumi-Norouzabad

Section Editor