Patient clinic treatment factors contribute to burden in assisted reproductive technology

Infertility is known to affect almost 48.5 million adults globally (Mascarenhas, Flaxman, Boerma, Vanderpoel & Stevens, 2012). It is an unforeseen disturbance for individuals and couples who consider 'parenthood' as an important aspect of their adulthood and identity (McQuillan, Greil, White & Jacob, 2003). Infertility experiences are multifaceted causing adverse impact on psychosocial well-being (Cousineau & Domar, 2007). It can create distress impacting all domains of wellness (Tufford, 2011; Watkins & Baldo, 2004). Involuntary childlessness is considered as one of the six maternal morbidities neglected within developing countries (Hardee, Gay & Blanc, 2012). 1.1 OVERVIEW OF INFERTILITY Clinically, infertility is "a disease of the reproductive system defined by the failure to achieve a clinical pregnancy after 12 months or more of regular unprotected sexual intercourse" (ZegersHochschild et. al., 2009, p.2686). Infertility can be categorized into two types. While primary infertility involves lack of pregnancy despite a year of contraceptive less sexual activity (MedlinePlus, 2015), or to women without prior pregnancies (Greil, Shreffler, Schmidt & McQuillan, 2011); secondary infertility refers to patients who have had a history of achieving at least one pregnancy, but are struggling to achieve one now (Greil et. al., 2011; MedlinePlus, 2015). 1.2 FACTORS INFLUENCING INFERTILITY Infertility can be categorised on the basis of its cause, that is, problems are found in the female partner, male partner, both or neither. Some studies found that 35-40% cases may be associated with males, 40% with females and 40% to both (Angard, 1999; as cited in Speroff, Glass & Kase, 1994). On the other hand, there was research suggesting that a third of the cases can be attributed each of these factors respectively - male factors, female factors and both/unknown factors (Cousineau & Domar, 2007; Johnson & Everett, 2000). Cahill and Wardle (2002) attributed about 30% infertility to male factor, 54% of cases to the female, and in 25% of cases causes remained unexplained. These differences could be due to variations in dietary and life-style factors, environmental and occupational factors, and infectious diseases. Some of the behavioral and environmental contributions to decreased fertility include smoking, excessive alcohol use, poor diet, engaging in,