Spermatogenic failure 8 is a genetic cause of male infertility that affects sperm production in the testes. Many living with Spermatogenic failure 8 do not notice day-to-day symptoms, and the condition is often found during an infertility evaluation in adulthood. In simple terms, it means the body makes very few sperm or no sperm, although physical signs can vary and some people have no obvious features at all. Spermatogenic failure 8 is usually lifelong, but it does not usually affect general health or life expectancy. Treatment focuses on fertility care, which may include specialist evaluation, hormone testing, sperm retrieval in selected cases, and assisted reproductive treatment such as IVF.
How many people live with Spermatogenic failure 8?
Worldwide and U.S. population estimates for spermatogenic failure 8 are not consistently reported by a single authoritative source. It is considered very rare, and rare-disease references such as Orphanet do not give separate global or U.S. counts for people living with this condition (Orphanet, 2024).
Overview
Spermatogenic failure 8Symptoms
Spermatogenic failure 8 often causes male infertility, so many only notice it after trouble starting a pregnancy. Some men have no other clear symptoms, while others may have small testicles or signs of low testosterone, such as reduced facial hair.
Outlook and prognosis
Spermatogenic failure 8 mainly affects fertility, often causing very low sperm counts or no sperm, so natural pregnancy can be difficult. Overall health and life expectancy are usually normal, and many living with spermatogenic failure 8 benefit from fertility counseling.
Causes and risk factors
Spermatogenic failure 8 is caused by disease-causing changes in the NR5A1 gene, often inherited from a parent but sometimes new. Family history raises risk. Other health or environmental factors may affect severity, but they are not the main cause.
Genetic influences
Genetics are very important in Spermatogenic failure 8, because it is caused by changes in a specific gene. These genetic variations can disrupt sperm production and are usually inherited in an autosomal recessive pattern.
Diagnosis
Diagnosis of spermatogenic failure 8 usually starts with infertility testing, especially semen analysis and hormone blood tests. Doctors may confirm the genetic diagnosis of spermatogenic failure 8 with genetic tests, along with exam findings and sometimes testicular imaging.
Treatment and drugs
Treatment for Spermatogenic failure 8 focuses on fertility care rather than a standard medication. Many living with Spermatogenic failure 8 are offered genetic counseling and, if any sperm are present, testicular sperm retrieval with IVF-ICSI. Some may consider donor sperm.
Symptoms
Spermatogenic failure 8 usually affects fertility more than day-to-day health. Many people living with spermatogenic failure 8 go through normal puberty, feel well, and do not notice anything unusual until pregnancy does not happen after months of trying. There are often no early features of spermatogenic failure 8 in everyday life. A fertility evaluation, especially semen testing, is often what brings it to light.
The main sign is trouble helping start a pregnancy because the testes make too few sperm or no sperm at all. Many people only learn they have this condition during a fertility workup.
Semen may look normal in amount, but testing can show a very low sperm count or no sperm. In medical terms, this is severe oligospermia or azoospermia, and it points to a problem with sperm production rather than a blockage.
Puberty, facial hair, sex drive, and erections are often typical in people with spermatogenic failure 8. Because sexual function can seem normal, the condition may be easy to miss at first.
Some people have testicles that are smaller than average, while others have no obvious physical changes. Blood tests may also show hormone patterns that suggest the testes are struggling to make sperm.
How people usually first notice Spermatogenic failure 8?
For many people with spermatogenic failure 8, the first signs of spermatogenic failure 8 are not something they can feel at all, and the condition is usually first noticed only when pregnancy does not happen after months of trying to conceive. A fertility evaluation may then show a very low sperm count or no sperm in the semen, even though erections, ejaculation, and everyday health may seem normal. Because this is a genetic cause of male infertility, doctors often first recognize it during infertility testing in adulthood rather than from obvious signs earlier in life.
Types of Spermatogenic failure 8
Spermatogenic failure 8 is already a specific genetic form of male infertility rather than a condition with several well-established clinical variants. In this disorder, the main difference from one person to another is usually severity, such as very low sperm counts or no sperm seen in the semen, not different named subtypes. At this point, no distinct types of Spermatogenic failure 8 are widely recognized.
Can I slow down the onset of symptoms?
Usually no: because spermatogenic failure 8 is an inherited problem with sperm production, there is no proven lifestyle change or medicine that can meaningfully delay when low sperm counts or trouble fathering a pregnancy begin. General healthy habits like not smoking, limiting alcohol, avoiding testosterone or anabolic steroids, keeping a healthy weight, and reducing heat or toxin exposure may support overall sperm health, but they have not been shown to prevent or postpone this condition. Seeing a fertility specialist early may help with testing and, in some cases, sperm freezing for future family planning, and while this does not stop the condition, it can help many people plan ahead.
What genetics can tell you about symptoms
In spermatogenic failure 8, genetics can sometimes help explain how strongly sperm production is affected, including whether someone has very low sperm counts or no sperm in the semen at all. For many living with this condition, there are no obvious day-to-day physical symptoms, so the main sign is often trouble conceiving, and this usually comes to light during fertility testing in adulthood. Genetic findings may give clues about severity, but they do not always predict exactly how infertility will look in each individual.
Causes and risk factors
For many living with spermatogenic failure 8, fertility problems start with an inherited or new gene change that disrupts sperm production in the testicles. This gene change is the main cause of spermatogenic failure 8, not something you caused. Biological factors like hormone problems, undescended testicles, or enlarged veins around a testicle can further lower sperm counts in some people. On top of genetics, everyday habits also matter. Smoking, heavy alcohol use, anabolic steroids, frequent heat exposure, some medicines, chemotherapy, and certain workplace toxins can make sperm production worse.
What are the most common causes or risk factors?
Spermatogenic failure 8 is most often caused by an inherited change in a gene that is needed for the testicles to make sperm, so a family history of male infertility can be an important clue. For this rare form, outside factors are usually not the main cause, but sperm production in general can also be harmed by chemotherapy or radiation, testicles that did not move down normally in childhood, major hormone problems, certain infections, and heavy smoking or alcohol use. Many living with this condition do not have a clear non-genetic risk factor beyond the underlying genetic change.
Environmental and biological risk factors
For spermatogenic failure 8, researchers have not identified clear environmental exposures or non-genetic biological conditions that reliably increase the chance of this specific subtype. Awareness of both biological and environmental influences helps you feel prepared, but here the evidence outside the underlying diagnosis is limited. When people look for the risk factors for spermatogenic failure 8, most published information points to very little that can be changed or prevented.
Unlike some reproductive problems, no specific toxin, infection, or workplace exposure has been firmly shown to cause spermatogenic failure 8. Research is still limited, so doctors usually do not list a proven environmental trigger for this exact subtype.
Common health issues that can affect fertility in general, such as hormone problems or enlarged veins around the testicle, are not established causes of spermatogenic failure 8 itself. They may be present at the same time, but they do not explain this named subtype.
Maternal illness, birth complications, or older parental age are not known to be consistent risk factors for spermatogenic failure 8. At present, there is no well-proven prenatal or birth-related pattern linked to this specific diagnosis.
Genetic risk factors
For some people, infertility shows up as repeated semen tests with very low sperm counts or no sperm at all, even when there is no blockage. In Spermatogenic failure 8, the problem starts with a harmful genetic change that affects how sperm are made. When people ask about the genetic causes of Spermatogenic failure 8, the main risk factor is being born with that gene change, whether it was inherited or started for the first time in that person. Family history can offer clues, but its absence does not rule out this diagnosis.
Gene change: A disease-causing change in a gene involved in sperm development is the main genetic cause of Spermatogenic failure 8. This change can interrupt the normal steps needed to make mature sperm.
Inherited variant: Some people inherit the harmful gene change through their family. A history of unexplained male infertility in close relatives can make an inherited cause more likely.
New variant: Sometimes the genetic change appears for the first time in the affected person instead of being passed down. This means Spermatogenic failure 8 can happen even when there is no known family history.
Family history: Family history is a genetic risk clue, not a requirement for diagnosis. Many living with Spermatogenic failure 8 are the first known person in their family to be identified with it.
Lifestyle risk factors
Spermatogenic failure 8 is an inherited cause of male infertility, so lifestyle habits do not cause the condition itself. Still, how lifestyle affects spermatogenic failure 8 can matter because certain habits may further lower sperm quality, increase oxidative stress in the testes, or reduce the chances of successful conception. In practice, lifestyle risk factors for spermatogenic failure 8 are mainly factors that can worsen already limited sperm production or function.
Tobacco use can increase oxidative stress and DNA damage in sperm. In someone with spermatogenic failure 8, this may further reduce the quality of the small amount of viable sperm that may be present.
Heavy alcohol intake can disrupt testosterone balance and impair normal testicular function. This may add another strain on fertility in men who already have genetically driven spermatogenic problems.
Anabolic steroids, testosterone supplements, and recreational drugs such as cannabis may suppress sperm production or worsen sperm function. In spermatogenic failure 8, these exposures can make an existing infertility problem harder to manage.
Frequent hot tubs, saunas, heated seats, or prolonged laptop heat over the groin can raise scrotal temperature. Higher testicular heat may further impair sperm development in men with spermatogenic failure 8.
Risk prevention
For many living with spermatogenic failure 8, there is usually no proven way to prevent the underlying condition itself because it is linked to inherited changes that affect sperm production. Prevention focuses more on protecting fertility as much as possible, avoiding added harm to the testes, and finding problems early when evaluation may still help with family planning. Different people need different prevention strategies—there’s no single formula. If there is a family history of male infertility, early medical advice can be useful before trying to conceive.
If spermatogenic failure 8 runs in your family, genetic counseling may help you understand personal and family risks before pregnancy planning. This cannot stop the condition from occurring, but it can guide testing and reproductive choices.
Men with delayed fertility should seek assessment sooner rather than later, especially if there is a family history of infertility or absent sperm. Early symptoms of spermatogenic failure 8 are often not noticeable day to day, so testing may be the first clue.
Frequent hot tubs, saunas, and long periods of high heat around the groin can further strain sperm production. Avoiding extra heat may not prevent spermatogenic failure 8, but it can help reduce added stress on already vulnerable testicular tissue.
Anabolic steroids, tobacco, heavy alcohol use, and exposure to certain industrial chemicals can all worsen sperm health. Reducing these exposures may help protect remaining fertility in people with spermatogenic failure 8.
Can you prevent Spermatogenic failure 8?
No, spermatogenic failure 8 usually cannot be prevented because it is a genetic condition that affects how the testicles make sperm. Healthy habits can support overall fertility, but they do not stop this specific condition from happening. If it runs in your family or there are fertility concerns, genetic counseling may help you understand the risk and your options.
Transmission
Spermatogenic failure 8 is not contagious, so it cannot be spread through sex, kissing, blood, food, or everyday contact. Instead, genetic transmission of Spermatogenic failure 8 happens through a gene change that is present from birth and may be passed down in a family.
In some families, the gene change may appear for the first time in one person rather than being clearly inherited from a parent. If you are wondering how Spermatogenic failure 8 is inherited in your family, genetic counseling can help explain the chance of it being passed to children or shared by relatives.
When to test your genes
Consider genetic testing if you have nonobstructive azoospermia, very low sperm counts, or a family history of male infertility. Testing is usually most useful before assisted reproduction, because it can help clarify the cause, guide treatment choices, and inform counseling about the chance of passing a genetic change to children.
Diagnosis
Spermatogenic failure 8 is usually looked into when semen tests show very low sperm counts or no sperm, often during an infertility workup. The diagnosis is based on a mix of medical history, physical exam findings, hormone testing, and genetic testing rather than symptoms you can feel day to day. Getting a diagnosis is often a turning point toward answers and support.
Doctors usually start with semen testing to measure sperm count, movement, and shape. In many people with Spermatogenic failure 8, the main finding is severely reduced sperm production or no sperm in the semen. Repeat testing is often done because results can vary from sample to sample.
A detailed family and health history can help look for other causes of infertility, such as past infections, undescended testicles, surgery, heat exposure, or certain medicines. Family history is also important because some forms of male infertility have a genetic link.
A clinician checks the testicles and surrounding structures for size, firmness, and signs of hormone or developmental problems. This helps show whether sperm production may be affected and can point toward the need for further testing.
Blood tests often include testosterone and hormones that control sperm production, such as follicle-stimulating hormone and luteinizing hormone. These results help doctors understand whether the testicles are not making sperm properly or whether another hormonal problem may be involved.
How is Spermatogenic failure 8 diagnosed?
Spermatogenic failure 8 is usually found during an infertility workup, often after someone has trouble fathering a pregnancy and testing shows a very low sperm count or no sperm in the semen. Doctors usually make the diagnosis with a health history, a physical exam, semen testing, and blood tests to check hormone levels that affect sperm production. Genetic testing may then be used to confirm that this is the inherited form called spermatogenic failure 8, but it is usually added after the standard fertility tests point to a problem with sperm production.
Stages of Spermatogenic failure 8
Spermatogenic failure 8 does not have defined progression stages. This is because it is usually identified as a cause of reduced or absent sperm production, rather than a condition that moves through clear step-by-step phases over time. Often the process begins when you notice changes in daily life, such as trying to conceive for months without success, and doctors usually diagnose spermatogenic failure 8 through semen testing, a medical history, and sometimes hormone and genetic testing. Monitoring is usually focused on fertility evaluation and treatment planning, rather than tracking early symptoms of spermatogenic failure 8 through set stages.
Outlook and prognosis
The outlook for spermatogenic failure 8 is generally defined by persistent male infertility, with many affected men having severely reduced sperm production or no sperm in the semen, so natural conception is often difficult or unlikely. Life expectancy is not thought to be reduced, and this condition is not generally associated with progressive damage to other organs or increased mortality. Prognosis for fertility varies because some men may still have small numbers of sperm detectable in the testes, which can occasionally allow assisted reproductive options such as testicular sperm retrieval with intracytoplasmic sperm injection. Even when treatment does not restore natural fertility, reproductive counseling and specialist fertility care can meaningfully improve family-building options. Emotional and psychological effects can be substantial, so long-term support and genetic counseling are often important parts of care.
Long-term effects
For many people, the main long-term effect of spermatogenic failure 8 is ongoing trouble fathering a biological child, which can shape plans for relationships, family building, and future care. The outlook is often centered on fertility rather than on broader physical illness, because this condition mainly affects sperm production. In some people, the degree of sperm reduction can vary, but severe infertility often remains a lasting feature. Long-term effects vary widely, and some men have no day-to-day physical symptoms outside of infertility.
Spermatogenic failure 8 often leads to very low sperm counts or no sperm in the semen, and this can be long lasting. For many, this means natural conception is difficult or not possible.
Some men with spermatogenic failure 8 still make small numbers of sperm, while others have a more complete failure of sperm production. Even within the same family, the long-term fertility picture can differ.
Many people with spermatogenic failure 8 feel well in everyday life and do not notice clear physical changes outside fertility problems. In general, it is not known for causing major problems with thinking, movement, or lifespan.
Some men show blood test patterns linked to the testes working harder or less efficiently, even when they feel physically normal. These changes may be seen during an infertility workup rather than from obvious symptoms.
How is it to live with Spermatogenic failure 8?
Living with spermatogenic failure 8 usually does not change how your body feels day to day, because many people have no physical symptoms outside of trouble fathering a pregnancy. The biggest impact is often emotional rather than physical: months or years of infertility testing, uncertainty, and hard decisions about fertility treatment or using donor sperm can bring stress, grief, frustration, or strain around timing, intimacy, and future plans. Partners and loved ones may feel that weight too, but clear information, counseling, and support from a fertility team can help many families move forward with a plan that fits their values.
Treatment and drugs
Treatment for spermatogenic failure 8 focuses on fertility support, because there is usually no medicine that can fully correct the underlying genetic problem causing very low sperm production or no sperm production. Doctors may first look for treatable factors that can make sperm production worse, such as hormone problems, certain medicines, heat exposure, smoking, heavy alcohol use, or other health conditions. If pregnancy is the goal, treatment often looks different for each person, and many living with spermatogenic failure 8 are referred to a fertility specialist to discuss options such as sperm retrieval procedures, IVF with ICSI, or donor sperm when needed. Emotional support and genetic counseling can also be an important part of care, especially when people are deciding on next steps for building a family.
Can you cure Spermatogenic failure 8?
No, there is currently no cure for spermatogenic failure 8, a rare inherited cause of male infertility in which the testicles have trouble making sperm. Treatment cannot fix the underlying genetic change, but fertility care may still help some people by checking whether any sperm can be found for use in pregnancy treatment, and by talking through other family-building options if needed.
Non-drug treatment
For many living with spermatogenic failure 8, treatment is less about medicines and more about fertility planning, supportive care, and procedures that may help with family building. There is no proven non-drug therapy that corrects the underlying genetic cause, so care usually focuses on finding any usable sperm, improving overall reproductive health, and discussing realistic options early. Managing this condition often means working with a fertility specialist and, in many cases, a genetics team. If you are searching for treatment options for spermatogenic failure 8, it helps to know that support can include both medical procedures and counseling.
A male fertility specialist can confirm how severe sperm production is and help plan the next steps. This often includes repeat semen testing, hormone review, and scrotal ultrasound when needed to look for other treatable problems.
Genetic counseling helps you understand what spermatogenic failure 8 may mean for fertility, family members, and future children. It can also guide decisions about partner testing and which family-building options may fit your values.
Some men with spermatogenic failure 8 may be offered surgical sperm retrieval, where a specialist looks directly in the testicle for sperm. If sperm are found, they are usually used with IVF and ICSI, a lab technique that injects one sperm into one egg.
When a few sperm are available, IVF with ICSI can offer the best chance of pregnancy. Not every approach works the same way, and success depends on whether usable sperm can be found and on the female partner's fertility as well.
Your genes may have an impact on how drugs work for you
For people with spermatogenic failure 8, the main issue is trouble making sperm, and there are no well-established medicines that reliably fix this problem based on a person’s genes. At this time, doctors do not usually use gene-based drug matching for this condition, because care is more often centered on finding the cause of infertility, checking hormone health, and discussing options such as sperm retrieval or assisted fertility treatment. If medicine is used for related issues, like hormone problems, response can still vary from person to person, but this is not a clearly established part of care for spermatogenic failure 8.
Pharmacological treatments
For people living with spermatogenic failure 8, there is no medicine that can reliably correct the underlying genetic problem or restore sperm production in most cases. Treatment depends on whether testing shows a separate, treatable hormone problem, because medicines only help in some situations. If infertility workup suggests low hormone signals from the brain or pituitary, doctors may use hormone-based treatment to try to support sperm production. Not everyone responds to the same medication in the same way.
There is no approved drug that directly treats spermatogenic failure 8 itself. In many living with this condition, medicines do not reverse the genetic cause of very low or absent sperm production.
Human chorionic gonadotropin, often called hCG, may be used when the testes are under-stimulated because of low pituitary hormone signals. It acts like luteinizing hormone and can help the body make more testosterone inside the testes.
Follicle-stimulating hormone, also called FSH or menotropins in some treatment plans, may be added to hCG in selected men with hormone-related infertility. This is more relevant when doctors find a gonadotropin deficiency rather than primary testicular failure from spermatogenic failure 8.
Gonadotropin-releasing hormone, or GnRH, can be given in pulsatile form in rare cases when infertility is caused by a hypothalamic signaling problem. It is not a standard treatment for the genetic testicular defect itself.
Genetic influences
For many living with spermatogenic failure 8, the main day-to-day impact is difficulty conceiving, often only becoming clear after fertility testing shows the body is making too few sperm or none at all. Spermatogenic failure 8 is a genetically defined form of male infertility caused by changes in the NR5A1 gene, which helps the testes develop and supports the hormone signals needed for sperm production. Even with the same gene change, people can have different levels of sperm production, from a low sperm count to no sperm seen in the semen. These gene changes may be inherited from a parent or happen for the first time in the affected person, so genetic testing for spermatogenic failure 8 can help explain the cause and show whether other family members could also be affected. Knowing the genetic cause can also help with planning fertility care and deciding whether hormone or reproductive evaluation would be useful.
Is Spermatogenic failure 8 genetic?
Genetics are very important in Spermatogenic failure 8, because it is caused by changes in a specific gene. These genetic variations can disrupt sperm production and are usually inherited in an autosomal recessive pattern.
Having a genetic risk is not necessarily a diagnosis
Changes in genes, often called genetic variants, are a normal part of human biology and are common across the general population. Most of these variants do not directly affect health and simply reflect natural differences among people. For many genes, having a variant connected to a condition suggests a possible link rather than a definite diagnosis, especially when several genes and environmental factors are involved. In some cases, though, a single well-understood variant in a particular gene can be enough to confirm a diagnosis.
Pharmacogenetics—how genetics influence drug effects
When pregnancy is not happening despite repeated attempts, many living with spermatogenic failure 8 want to know whether a pill or hormone shot can make a real difference. Because spermatogenic failure 8 is caused by a gene change that disrupts sperm production, there is usually no medication that can fix the underlying problem or reliably bring sperm counts back to normal. Genetics is only one factor, but in this condition genetic results can help doctors avoid treatments that are unlikely to help, check for a separate hormone problem, and discuss options such as a procedure to look for sperm directly from the testicle or in vitro fertilization (IVF) with ICSI. Hormone medicines may help only if low hormone levels are also present, while testosterone itself is generally not used to improve fertility because it can further lower sperm production. For many families, this means that genetic testing for spermatogenic failure 8 can guide treatment choices even when it does not point to a drug that will reverse the condition.
Interactions with other conditions
For many living with spermatogenic failure 8, the main day-to-day issue is trouble fathering a pregnancy rather than symptoms that affect the rest of the body. This form of male infertility is not known to directly cause other diseases, but it may be found during a workup for related problems that can also lower sperm production, such as hormone disorders, testicular injury, or certain genetic conditions. Doctors call it a comorbidity when two conditions occur together, and in practice that matters because another health issue may be the real reason sperm counts are low or may add to the problem. In some people, early symptoms of spermatogenic failure 8 are simply infertility after months of trying to conceive, while others may also have signs linked to an underlying hormone condition, like low sex drive or reduced facial and body hair. Because of this overlap, care often includes checking overall reproductive and hormone health rather than looking at spermatogenic failure 8 in isolation.
How genes can cause diseases
Humans have more than 20,000 genes, each carrying out one or a few specific functions in the body. One gene instructs the body to digest lactose from milk, another tells the body how to build strong bones and another prevents the body's cells from beginning to multiply uncontrollably and developing into cancer. As all of these genes combined are the building instructions for our body, a defect in one of these genes can have severe health consequences.
Through decades of genetic research, we know the genetic code of any healthy/functional human gene. We have also identified that in certain positions on a gene, some individuals may have a different genetic letter from the one you have. We call these hotspots "Genetic Variations" or "Variants" in short. In many cases, studies have been able to show that having the genetic letter "G" in the position makes you healthy, but having the letter "A" in the same position disrupts the gene function and causes a disease. Genopedia allows you to view these variants in genes and summarizes all that we know from scientific research, which genetic letters (Genotype) have good or bad consequences on your health or on your traits.
What other conditions can cause similar symptoms to Spermatogenic failure 8?
Other conditions can also lead to trouble fathering a child because of a very low sperm count or no sperm at all, including hormone problems, enlarged veins around the testicle called a varicocele, blockages in the tubes that carry sperm, and damage from past infections, injury, or cancer treatment. Doctors also often consider other genetic causes of male infertility, especially Klinefelter syndrome and small missing pieces of the Y chromosome, because these can look very similar.
History
For much of history, men who could not help start a pregnancy were rarely studied in a careful medical way. The focus was often placed on the couple as a whole, or unfairly on the woman, so many causes of male infertility went unrecognized. In recent decades, awareness has grown, and doctors began looking more closely at problems inside the testicles that affect sperm production, including conditions now grouped under names such as spermatogenic failure 8.
Early descriptions were based on what doctors could see in semen testing and, later, under the microscope in tissue samples. At first, these cases were usually described in broad terms like very low sperm count or no sperm in the semen, rather than as separate, named conditions. As laboratory methods improved through the 20th century, specialists could sort different patterns of sperm production problems more accurately. That made it easier to recognize that some men had a distinct form of infertility caused by the testes not making healthy sperm in the usual way.
More recently, research has connected some of these patterns to changes in genes involved in sperm development, although the exact cause is not found in every family. This shift mattered because it moved the field beyond simply describing infertility and toward understanding why it happens. For many living with spermatogenic failure 8, that progress can mean a clearer diagnosis after years of unanswered questions, especially when early symptoms of spermatogenic failure 8 may be noticed only during an infertility evaluation.
Today, spermatogenic failure 8 is understood as one of several specific forms of male infertility rather than a vague or unexplained finding. Doctors now combine semen analysis, hormone testing, medical history, and sometimes genetic testing to investigate it. Knowing this history helps explain why a condition like spermatogenic failure 8 may have gone unrecognized in the past, and why modern testing can offer more clarity, support, and informed family planning.