FERTILITY AND INFERTILITY
v Definition of fertility
Fertility is a natural capability to produce offspring.
v Factors responsible for fertility are
· Healthy spermatozoa should be deposited high in the vagina.
· The spermatozoa should undergo changes ( capacitation, acrosome reaction ) and acquire motility.
· The motile spermatozoa should ascend through the cervix into the uterine cavity and the fallopian tubes.
· There should be ovulation.
· The fallopian tubes should be patent and the oocyte should be picked up the fimbrial end of the tube.
· The embryo should reach the uterine cavity after 3 – 4 days of fertilization.
· The endometrium should be prepared ( estrogen, progesterone, IGF ) for implantation and the corpus luteum should function adequately.
v Causes of infertility
Conception depends on the fertility potential of both the male and female partner the male is directly responsible for about 30-40 % and both are responsible for about 10 % cases.
A. Male infertility
1. Defective spermatozoa
The scrotal temperature should be 1 to 2 finite less than the body temperature for spermatogenesis. Spermatogenesis and sperm maturation need a high androgenic environment inhibits B inhibits FSH secretion. Spermatogenesis on the Y chromosome. Approximately 74 days are required to complete the process of spermatogenesis and additional 12-20 days are needed for spermatozoa to travel the epididymis.
2. Congenital cause of defective spermatozoa
I. Undescended testis
Vasdeference is absent ( bilateral ) in about 1-2 percent of the infertile male.
II. Karta gene syndrome ( autosomal disease )
There is the loss of ciliary function of sperm motility.
III. Hypospadias
Hypospadias cause failure to deposit sperm high in the vagina.
3. Thermal factor
The scrotal temperature is raised in conditions such as varicocele big hydrocele or filariasis. Other factors are using tight undergarment or working in a hot atmosphere.
4. Infection
Ø Mumps orchitis after puberty may permanently damage spermatogenesis.
Ø The quality of the sperm is adversely affected by chronic systematic illness.
Ø T. mycoplasma or Chlamydia trachomatis infection is also implicated.
5. General factors
A chronic debilitating disease, malnutrition or heavy smoking reduce spermatogenesis. Alcohol inhibits spermatogenesis either by suppressing leading all synthesis of testosterone or possibly by suppressing gonadotropin levels.
6. Endocrine
Testicular failure due to gonadotropin deficiency ( kall man's syndrome ) is rare FSH level is raised in idiopathic testicular failure with germ cell hypoplasia.
7. Genetic
The common chromosomal abnormality is azoospermic male is klinefelters syndrome ( 47 XXY ). Gene detection has been detected in the long arm of the ‘Y’ chromosome for patients with severe oligospermia.
8. Later genetic
Radiation, cytotoxic drugs, nitrofurantoin cimetidine, antihypertensive, anticonvulsant drugs, and anti-depressant drugs are likely to higher spermatogenesis.
9. Immunological factor
Antibodies against spermatozoa surface antigens may be the cause of infertility.
· Obstruction of the efferent duct.
· Failure to deposit sperm high in the vagina.
· Erectile dysfunction.
· Ejaculatory defect.
· Hypospadias.
10. Sperm abnormality
Loss of sperm motility abnormal sperm morphology (round-headed sperm, teratozoospermia ) is an important factor.
11. Errors in the seminal fluid
· Unusually high or low volume of ejaculate.
· Low fructose content.
· High prostaglandin content.
· Undue viscosity.
v Faults in the female
1. Ovarian factors
· Anovulation or oligo-ovulation.
· Luteal phase defect.
2. Tubal factor
Includes defective ovum pickup ( octopus function ), impaired tubal motility, loss of cilia and partial to complete obstruction, infections (pelvic surgery), endometritis.
3. Peritoneal factors
Can cause peritubal adhesions even minimal endometriosis may produce infertility.
4. Uterine factor
The possible factors are uterine hypoplasia, inadequate secretory endometrium, fibroid uterus, endometritis, uterine synechiae or congenital malformation of the uterus.
5. Cervical factor
Anatomic – the anatomic defects preventing sperm ascent may be due to congenital elongation of the cervix, second-degree uterine prolapse, and acute retroverted uterus.
6. Physiologic factor
The fault lies leads to the spermatozoa fail to penetrate the mucus the abnormal constitutes include excessive viscous or purulent discharge as in chronic cervicitis. Presence of antisperm or sperm immobilizing antibodies may be implicated as immunological factors of infertility.
7. Vaginal factor
Congenital problems like atresia, vagina transverse, vaginal septum, or narrow introitus causing dyspareunia. Vaginitis and purulent discharge may at times be implicated but pregnancy too often occurs in presence of vaginitis, specific or nonspecific. however, dyspareunia may be the real problem in such cases.
8. Combined factors
Ø These include the presence of factors both in the male and female partners causing infertility.
Ø Age beyond 35 is in women and the spermatogenesis continues thought-out life although aging reduces the fertility in male also.
Ø Infrequent intercourse lack of knowledge of coital technique and timing of coitus to utilize the fertile period.
Ø Paranoia and dyspareunia.
Ø Anxiety and apprehension.
Ø Use of lubricant during intercourse which may be spermicidal.
Ø Immunological factors.
