What Are the Proximate Determinants of Fertility? How Many Are

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What are the proximate determinants of fertility? How many are there, and how do they work? Tell me which of the determinants are considered to be the major and most important ones.

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Definitions:

Systolic Murmur

A heart sound indicating turbulent blood flow that occurs during the heartbeat's systolic phase, often implying valvular heart disease or other circulatory issues.

Patent Ductus Arteriosus

A congenital heart defect where the ductus arteriosus fails to close after birth, allowing blood to flow between the aorta and the pulmonary artery.

Persistent Tachycardia

A consistent rapid heart rate exceeding the normal resting rate, which may indicate an underlying medical condition.

Apical Impulse

The point of maximum impulse felt on the chest wall during palpation, associated with the beating of the heart, often used to assess cardiac function.