Infertility

• Infertility


  Condition where pregnancy doesn't happen after at least a year of unprotected coitus
• Types of infertility

  • Primary infertility
  • Secondary infertility
• Primary infertility


  There have been no previous conception at all
• Secondary infertility


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


  Inability to conceive because of a known condition like absence of the uterus
• Subfertility


  Lessened ability to conceive
• Factors that cause male subfertility

  • Problem in spermatogenesis (inadequate sperm count)
  • Inadequate production of FSH and LH in the pituitary, which stimulates the production of sperm
• Male infertility factors

  • Obstruction in seminiferous tubules, ducts or vessels. Preventing the continuous moving of the sperm
  • Qualitative or quantitative changes in the seminal fluid preventing sperm motility
  • Development of autoimmunity, which immobilizes sperm
  • Problems in ejaculation or deposition
• Inadequate sperm count


  The total number of sperm cell in a single ejaculation or in a milliliter of semen
• Normal sperm count is 33 million to 46 million per mL of seminal fluid or 50 million per ejaculation. 50% should be motile and 30% should be in normal shape and form
• Causes of inadequate sperm count

  • Cryptorchidism (undescended testes)
  • Varicocele (varicosity of the spermatic vein)
  • Trauma
  • Surgery on or near the testicles that has resulted in impaired testicular circulation
  • Endocrine imbalances, particularly of the thyroid, pancreas, or pituitary glands
  • Drug use or excessive alcohol use
  • Environmental factors, such as exposure to X-rays or radioactive substances
• Obstruction or impaired sperm motility


  May occur at any point along the pathway that spermatozoa must travel to reach the outside: seminiferous tubules, the epididymis, vas deferens, ejaculatory duct or the urethra
• Conditions associated with sperm motility

  • Mumps orchitis (testicular inflammation and scarring due to the mumps virus)
  • Epididymitis (inflammation of the epididymis)
  • Hypospadias (urethral opening on the ventral surface of the penis)
  • Epispadias (urethral opening on the dorsal surface)
  • Peyronie disease (a bent penis that can cause sperm to be deposited too far from the sexual partner's cervix to allow optimal cervical penetration)
  • Extreme obesity in a male
• Ejaculatory problems

  • Erectile dysfunction (inability to achieve an erection, may be due to psychological problems and some debilitating diseases)
  • Premature ejaculation (ejaculation before penetration)
• Factors that cause female subfertility

  • Limited production of FSH and LH, which interfere with ova growth
  • Anovulation (faulty or inadequate expulsion of ova)
  • Problems of ova transport through the fallopian tubes to the uterus
  • Uterine factors, such as tumors or poor endometrial development
  • Cervical and vaginal factors (that immobilizes the spermatozoa)
  • Poor nutrition, increased body weight, and lack of exercise
• Anovulation


  Absence of ovulation or release of ova from the ovary
• Causes of anovulation

  • Genetic abnormality as Turner's syndrome (hypogonadism)
  • Hormonal imbalance (hypothyroidism)
  • Ovarian tumors or polycystic ovary syndrome
  • Chronic or excessive exposure to X-rays or radioactive substances
  • General ill health, poor diet, and stress
• Tubal transport problems


  May be due to scarring of the fallopian tubes secondary to PID
• Uterine problems


  Poor secretion of estrogen or progesterone from the ovary may result in inadequate endometrium formation. Conditions like endometriosis (abnormal growth of endometrial cells outside the uterus) may also interfere with the uterine fertility
• Cervical and vaginal problems

  At the time of ovulation, the cervical mucus is thin and watery and can be easily penetrated by spermatozoa for a period of 12 to 72 hours. Infection of the vagina can cause the pH of vaginal secretions to become acidotic. Some women appear to have sperm-immobilizing or sperm-agglutinating antibodies in their blood plasma
• Diagnostic tests for male infertility

  • Sperm analysis
  • Testicular ultrasound
• Diagnostic tests for female infertility

  • Cervical mucus test / Spinnbarkeit Test
  • Pelvic ultrasound
  • Hormonal test
  • Hysterosalpingogram
  • Hysteroscopy
• Alternative insemination


  Instillation of sperm from a masturbatory sample into the female reproductive tract by means of a cannula to aid conception at the time of ovulation
• IVF with intracytoplasmic sperm injection (ICSI)


  a single healthy sperm is injected directly into each mature egg
• IVF with egg donor


  an IVF cycle in which donated eggs are used rather than the female partner's eggs
• Varicocelectomy - removal of varicocele
• High temperature = decrease in sperm count
• gonad shield/ lead - used to protect a male who is always exposed to radiation
• Double breasted spongioplasty - is used to repair epispadias and hypospadias
• Erectile dysfunction is aka as impotence
• Congenital Anomalies of the Uterus

  1. Normal uterus
  2. Bicornuate uterus
  3. Septum-dividing uters
  4. Double uterus
• Clomiphene Citrate - medication that stimulates ovulation
• (Hydrocephalus) Transillumination using chun gun
• Term spina bifida is a Latin for Divided Spine