Infertility
What is infertility?
Infertility is defined as the inability to conceive after at least one year of intercourse while not using any contraceptive method. A normal fertile couple having regular sex and wishing to have a baby have a pregnancy rate of 50% in five months, 75% in 12 months, and 85-90% at end of 24 months.
Infertility refers to a condition where there is no pregnancy, even after one year of regular sexual intercourse. It covers a broad spectrum of conditions which can be minor or serious. Infertility related to men is initially investigated usually with a physical examination along with a discussion about past and present medical history. A physical exam determines the general health of both partners. The doctor will pay special attention to the outer sex organs as well as characteristics such as breast development and body hair in both partners to check for structural abnormalities or signs of possible hormone problems. The medical history gathers information that may suggest causes for infertility in each of the partners. Issues that will be discussed during the medical history apply to both the man and the woman.
Cause of infertility in men -
There are number of test to establish the cause of infertility. The first tests are done to check the man's semen (Semen Analysis). A sample of semen may be analyzed to know the sperm count and quality of sperm. The Sperm mucus Penetration Test and the Sperm Penetration Assay (SPA) are used to test the sperm's function. Scanning of the reproductive organs to see if there is a physical abnormalities and blood or urine test to check the hormone levels are also done.
What are the causes of infertility in males?
 
  • Men normally produce at least 20 million sperm per ml of semen. If the sperm count is less than this it may adversely affect fertility.
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  • Of the sperms present in the semen, 50% must be actively moving sperms for conception to occur. A lower percentage of actively moving sperms will be unable to swim through the cervix to meet the egg in the fallopian tube.
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  • If more than 50% sperms are abnormal in shape and function, this can also lead to infertility.
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  • If the testes do not produce sperms or these are unable to come out due to blockage of the vas deferens, the tube which carries the sperms from testis out.
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  • Inability to perform normal intercourse due to difficulties in ejaculation, impotence or structural abnormalities of the penis.
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    What are the causes of infertility in women?
     
  • The ovaries do not produce eggs, or these may be defective.
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  • The fallopian tubes or the tubes that transfer the egg from the ovary to the uterus may be blocked or non-functional. This may happen in cases of infections like tuberculosis, endometriosis, or previous surgery of tubes or ovaries.
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  • The uterus and cervix normally produce a thin discharge. If this mucous is excessively thick or contains substances that kill the sperms, then this prevents sperms from swimming through it into the uterine cavity and then to the tubes.
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  • Distorted or partially blocked uterine cavity as in fibroids.
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    Treatments -
    The treatments include drug therapy or possibly surgery to improve the situation. There is no effective treatment for lack of sperm. Low sperm count can be treated with artificial insemination or in vitro fertilization with partner or donor sperm. A testicular biopsy is done for men who have no sperm in the ejaculate to find out whether they have immature sperm in the testes. In vitro fertilization, intrauterine insemination, or gamete intrafallopian transfer are done for reproduction in such cases. For retrograde ejaculation (the ejaculation of semen into the bladder rather than out through the penis), sperm may be recovered from the bladder, washed, and used for insemination. Surgery can be done to reverse a vasectomy or to repair enlarged veins in the scrotum (varicocele repair). Surgery also may be done to correct blockages or absence of the vas deferens.