NCMA 219 CU5

• Subfertility - exists when a pregnancy has not occurred after at least 1 year of engaging in unprotected coitus.
• Secondary subfertility - there has been a previous viable pregnancy, but the couple is unable to conceive at present.
• Primary subfertility - there have been no previous conceptions.
• Sterility - is the inability to conceive because of a known condition, such as the absence of a uterus.
• Sperm count - is the number of sperm in a single ejaculation or in a milliliter of semen.
• Minimum sperm count - considered normal is 20 million/ml of seminal fluid, or 50 million per ejaculation.
• Spermatozoa - must be produced and maintained at a temperature slightly lower than body temperature to be fully motile.
• Chronic infection from tuberculosis or recurrent sinusitis can lower a sperm count.
• Working at desk jobs or driving a great deal everday can increase scrotal heat  that may lead to produce lower sperm counts compared to jobs that allows men to ambulate.
• Frequent use of hot tubs or saunas may also lower sperm counts appreciably.
• Cryptorchidism (undescended testes) may lead to lowered sperm production if surgical repair of this problem was not completed until after puberty or if the spermatic cord became twisted after the surgery.
• A varicocele or varicosity of the spermatic vein could increase temperature within the testes and slow and disrupt spermatogenesis although whether this actually causes much difference is in doubt.
• Surgery to repair the varicocele has the potential to increase the chance for conception.
• Men who are exposed to radioactive substances in their work environment should be provided adequate protection of the testes.

  When undergoing pelvic radiography, be certain that men and boys are always furnished with a protective lead testes shield.
• TIPS: Advice the man to abstain from coitus for 7 to 10 days at a time to increase the sperm count.
• TIPS: Ligation of a varicocele (if present).
• TIPS: Changes in lifestyle (wearing looser clothing, avoiding long periods of sitting, avoiding prolonged hot baths) may be helpful to reduce scrotal heat and increase the sperm count.
• Erectile dysfunction - Condition where a man has difficulty achieving or maintaining an erection
• Causes of erectile dysfunction

  • Psychological problems
  • Cerebrovascular accident
  • Diabetes
  • Parkinson's disease
  • Certain antihypertensive agents
• Primary erectile dysfunction - Man has never been able to achieve erection and ejaculation in the past but now has difficulty.
• Erectile dysfunction is associated with stress is not easily relieved
• Solutions to erectile dysfunction

  • Psychological or sexual counseling
  • Use of a drug such as sildenafil
• Premature ejaculation - Ejaculation before penetration
• Premature ejaculation - May interfere with the proper deposition of sperm.
• Premature ejaculation is often attributed to psychological causes.
• Premature ejaculation in adolescents - may experience it until they become more experienced in sexual techniques
• Obstruction - it may occur at any point along the pathway that spermatozoa must travel to reach the outside.
• Diseases such as mumps orchitis, epididymitis, and tubal infections such as gonorrhea or ascending urethral infection can result in this type of obstruction because adhesions form and occlude sperm transport.
• Congenital stricture of a spermatic duct may occasionally be seen.
• Benign hypertrophy of the prostate gland occurs in most men beginning at about 50 years of age.
• Pressure from the enlarged gland on the vas deferens can interfere with sperm transport.
• Infection of the prostate, through which the seminal fluid must pass, or infection of the seminal vesicles can change the composition of the seminal fluid enough to reduce sperm motility.
• Anomalies of the penis, such as hypospadias or epispadias can cause sperm to be deposited too far from the sexual partner’s cervix to allow optimal cervical penetration.
• Extreme obesity in a male may also interfere with effective penetration and deposition.
• THERAPEUTIC MANAGEMENT: OBSTRUCTION

  If sperm are not motile because the vas deferens is obstructed, the obstruction is most likely to be extensive and difficult to relieve by surgery.
• THERAPEUTIC MANAGEMENT: OBSTRUCTION Sperm can be extracted by syringe from a point proximal to vas deferens blockage and used for intrauterine insemination.
• THERAPEUTIC MANAGEMENT: If the problem appears to be that sperm are immobilized by vaginal secretions because of an immunologic factor, the response can be reduced by abstinence or condom use for about 6 months. However, to avoid this prolonged time interval, washing of the sperm and intrauterine insemination may be preferred.
• THERAPEUTIC MANAGEMENT: The administration of corticosteroids to a woman may have some effect in decreasing sperm immobilization because it reduces her immune response and antibody production.

   
• GRADE A - Sperms have progressive motility (strongest and fast in a straight line).
• GRADE B - Sperms with non-progressive motility (travel in a curved or crooked motion).