Subfertility

• how many percentage of sperm per ejaculation that has a normal shape?


  30
• how many percent in sperm of every ejaculation that are motile?


  50
• what are the types of suberfertility?


  primary and secondary
• primary subfertility has no previous of conception
• secondary subfertility has a previous conception but cannot conceive at the right moment
• when assessing the sperm, what are the 3 characteristics should be in the following?

  1. Count
  2. Motility
  3. Morphology
• Subfertility

  When a pregnancy has not occurred after at least 1 year of engaging in unprotected coitus
• Primary subfertility


  There have been no previous conceptions
• Secondary subfertility


  There has been a previous viable pregnancy, but the couple is unable to conceive at present
• Sterility


  The inability to conceive because of a known condition, such as the absence of a uterus
• In about 40% of couples with a subfertility problem, the cause of subfertility is multifactorial
• In about 30% of couples, it is the man who is subfertile
• In women seen for a fertility concern, 20 % to 25% experience ovulatory failure
• In about 10% of couples, no known cause for the subfertility can be discovered despite all the diagnostic tests currently available
• Unexplained subfertility

  When no known cause for the subfertility can be discovered despite all the diagnostic tests currently available
• When engaging in coitus an average of four times per week, 50% of couples will conceive within 6 months, and 85% within 12 months
• Couples who engage is coitus daily may have more difficulty conceiving than those who space coitus to every other day
• The chance of subfertility increases with age
• Women who are using oral, injectable, or implanted hormones for contraception may have difficulty becoming pregnant for several months after discontinuing these medications
• Factors that typically lead to male subfertility

  • Disturbance in spermatogenesis
  • Obstruction in the seminiferous tubules, ducts, or vessels preventing movement of spermatozoa
  • Qualitative or quantitative changes in the seminal fluid preventing sperm motility
  • Development of autoimmunity that immobilizes sperm
  • Problems in ejaculation or deposition preventing spermatozoa from being placed close enough to a woman's cervix to allow ready penetration and fertilization

  
• Sperm count


  The number of sperm in a single ejaculation or in a milliliter of semen
• The minimum sperm count considered normal is 20 million/ml of seminal fluid, or 50 million per ejaculation
• At least 50% of sperm should be motile, and 30% should be normal in shape and form

  
• Cryptorchidism

  Undescended testes
• Varicocele

  Varicosity of the spermatic vein
• Conditions that may inhibit sperm production include trauma to the testes, surgery on or near the testis that results in impaired testicular circulation, and endocrine imbalances, particularly of the thyroid, pancreas, or pituitary glands

  
• Erectile dysfunction


  Inability to achieve an erection
• Premature ejaculation


  Ejaculation before penetration
• Hypospadias

  Urethral opening on the ventral surface of the penis
• Epispadias


  Urethral opening on the dorsal surface of the penis
• Extreme obesity in a male may also interfere with effective penetration and deposition
• The factors that cause subfertility in women are analogous to those causing subfertility in men: anovulation (faulty or inadequate production on ova), problems of ova transport through the fallopian tubes to the uterus, uterine factors such as tumors or poor endometrial development, and cervical and vaginal factors that immobilize spermatozoa
• Anovulation


  Faulty or inadequate production on ova
• When either glucose or insulin levels are too high, they can disrupt the production of follicle stimulating hormone (FSH) and luteinizing hormone (LH) leading to subfertility from ovulation failure
• Polycystic ovary syndrome is associated with the metabolic syndrome
• Clomiphene citrate

  A medication used to stimulate ovulation
• Human menopausal gonadotropins

  Combinations of FSH and LH derived from postmenopausal urine used to stimulate ovarian follicular growth
• Human chorionic gonadotropin (hCG)


  A medication administered to produce ovulation
• Excessive intake of protein may be yet another deterrent to fertility
• Exercising 30 minutes a day by walking or doing mild aerobics


  Can help regulate blood glucose levels