Author Name: Dr. Sugata Mishra Mentor Name: Dr. Amol Naik on April 08, 2020
Infertility is defined as the failure to achieve a clinical pregnancy after 12 months of regular unprotected sexual intercourse.
Primary infertility: Couple who have never been pregnant before.
Secondary infertility: Couple has experienced pregnancy before, but failing to conceive again.
Conception depends on fertility potential of both male and female partner. Male infertility contributes 30-40% and female about 40-45% and both are responsible for about 10% of cases.
You should see a gynecologist if you are trying for pregnancy for atleast one year regularly without any contraception. But a woman should see her doctor earlier if,
• Age ≥35 years, especially after trying for more than 6 months
• Has irregular or absent periods
• Very painful periods
• Has been diagnosed with endometriosis or PID
• H/O multiple miscarriages
• Undergone cancer treatment
Men should go to there doctor earlier if
• Semen analysis show low sperm count or any abnormalities in semen parameters
• H/O testicular, prostate or sexual problems
• Undergone cancertreatment
• Swelling in groin region
• Other in family have infertility problems
Abnormal /detective spermatogenesis: The most common problem is in sperm production. Oligospermia-sperm count is ≤15 million/ml or total concentration is ≤39 million
Azoospermia-No sperm in semen
Asthenozoospermia-Reduced sperm motility
Teratozoospermia-abnormal sperm morphology
Lifestyle choices can lower sperm count: Smoking, drinking, certain medications, hormonal issues like Pituitary(master gland)dysfunction, hypothalamus problems, Thyroid dysfunction, Hyperprolactinemiacan reduce the sperm count. Long term sickness like kidney failure, infections like orchitis, mumps can result in low sperm count.
Varicocoele: Varicocoele are swollen veins in the scrotum.more commonly seen in infertile men. They increase the temperature of the scrotum and hamper spermatogenesis.
Obstruction: Male reproductive tract can have obstruction. Repeated infection, surgery, swelling ordevelopmental defects (cryptorchidism) can cause blockage.
A BMI ≥30 can have an impact on sperm quality because fat deposits can overload and influence the metabolism of androgens, especially testosterone
Problems with delivery of sperms-
1. Erectile dysfunction.
2. Ejaculatory defects-premature, absence of ejaculation, Retrograde ejaculation is when semen goes backward in the body. They go into the bladder instead of out of the penis.
Retrograde ejaculation can be caused by surgery, medication or spinal injuries or nerve problems.
Hypospadias- abnormal location of the urethral opening.
Medications: Certain medications can change sperm production, function and delivery particularly antihypertensive, antipsychotic, cancer treatment drugs etc.
Genetic : Certain genetic disorders can cause low count or absence of sperm in semen. There is family history of infertility in such cases.
Immunological infertility: Sometimes a man’s body makes antibodies that attack his own sperms making it nonviable.
Here are some of the common causes affecting female fertility.
Failure to ovulate: The most common overall cause of female infertility is the failure to ovulate, which occurs in 40% of women with infertility issues.Not ovulating can result from several causes, such as
1. primary ovarian insufficiency (POI) or polycystic ovary syndrome (PCOS)
2. Aging, including “diminished ovarian reserve,” or DOR which refers to a low number of eggs in a woman’s ovaries due to normal aging
3. Endocrine disorders, such as thyroid disease or hyperprolactinemia or hypothalamic disorder, which affect the hormones produced by the body so that ovulation is affected.
4.Lifestyle and environmental factors
Problems in the menstrual cycle: Woman who have menstrual cycle problems is mainly due to anovulation or hormonal imbalances or in some cases Absence of menstruation.
Structural problems of the reproductive system :
1. Uterine fibroids, growths that appear within and around the wall of the uterus.Some women with fibroids may not be able to get pregnant naturally or may have multiple miscarriages or preterm labor.
2. Polyps, which are noncancerous growths on the inside surface of the uterus. Surgical removal of the polyps can increase the chances for a woman to get pregnant.
3.Scarring in the uterus from previous injuries, infections, or surgery. Scarring may increase the risk of miscarriage and may interfere with implantation, thus leading to infertility.
4. An unusually shaped uterus, which can affect implantation and the ability to carry a pregnancy to term like septate, bicornuate, unicornuate uterus.
Infection: Chronic Pelvic infections especially TUBERCULOSIS can damage the fallopian tubes leading to BLOCKED FALLOPIAN TUBES.
Failure of egg to mature properly: Generally seen in conditions like PCOS Polycystic ovarian syndrome is the most common cause of female Sub-fertility. There is hormonal imbalance that interferes with the development of ovarian follicles and untimely ovulation which ultimately hampers fertilization.
Endometriosis: Causes inflammatory changes in linning of uterus affecting the embryo’s ability to implant properly, as well as damages the female eggs when it affects the ovaries.
Primary ovarian failure: It is a condition in which a woman’s ovaries stop producing hormones and eggs at a younger age.
Implantation failure: It is the failure of a fertilized egg to implant in the wall of uterus especially when the inner lining of the uterus is severely damaged.
Autoimmune disorders: It causes the body’s immune system to attack normal body tissue.Lupus, Hashimoto’s, rheumatoid arthritis and others like these may affect fertility.
Still ..15% of the couples will have apparently no abnormality in their tests. Such cases are termed as unexplained infertility
Detailed history elicited by your fertility doctor along with examination should help a couple to exactly find the cause of their infertility and then accordingly proceed for the treatment.
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