Infertility

• Infertility


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

  • Primary infertility
  • Secondary infertility
  • Sterility
  • Subfertility
• 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
• Coitus every day decreases the chances of conceiving unlike those who have coitus every other day due to sperm count
• Age is related to subfertility
• Previous oral contraceptive intake can cause difficulty for months after discontinuation
• 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
  • 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
• Spermatozoa must be produced and maintained at a temperature slightly lower than body temp to be motile


  • Testes in scrotal sac away from body heat/ abdominal cavity
  • Increased temperature decreases sperm count
• Cryptorchidism


  • Undescended testes
  • Pelvic cavity = more heat = does not promote sperm production
  • If no surgical repair until puberty or spermatic cord become twisted after surgery = decreased sperm count
• Varicocele

  • Varicosity/ dilation of the spermatic vein
  • Dilated veins = increased temperature = slow or disrupt spermatogenesis
  • Varicocelectomy (removal of varicocele) increases the potential or chance of conception
• Other factors that cause male subfertility

  • 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
• Men who are exposed to radioactive substances in their work environment should be provided with adequate protection of testes
• Conditions associated with sperm motility

  • Mumps orchitis
  • Epididymitis
  • Hypospadias
  • Epispadias
  • Peyronie disease
  • Extreme obesity in a male
  • Erectile dysfunction
  • Premature ejaculation
• Mumps orchitis


  • Testicular inflammation and scarring due to the mumps virus
  • Cause obstruction of pathway that occludes sperm transport
• Epididymitis


  • Inflammation of the epididymis
  • Cause obstruction of pathway that occludes sperm transport
• Hypospadias


  • Urethral opening on the ventral surface of the penis
  • Can cause the sperm to be deposited too far from the cervix

  
• Epispadias


  • Urethral opening on the dorsal surface
  • Can cause the sperm to be deposited too far from the cervix
• Double breasted spongioplasty


  Surgery to correct hypospadias and epispadias by lengthening the urethra
• Peyronie disease


  • A bent penis due to thick deposition on the penis
  • Can cause sperm to be deposited too far from the sexual partner's cervix to allow optimal cervical penetration
  • Non-cancerous condition resulting from fibrous scar tissue that develops on the penis
  • Painful erection

  
• Erectile dysfunction


  • Inability to achieve an erection
  • May be due to psychological problems and some debilitating diseases
• Examples of debilitating diseases that can cause erectile dysfunction

  • Cerebrovascular accident
  • Parkinson's Disease
  • Use of medications that causes erectile dysfunction
• Premature ejaculation

  • Ejaculation before penetration
  • Attributed to psychological causes
  • Adolescence may experience this until they become more experienced in sexual techniques
• 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 (PCOS)
  • Chronic or excessive exposure to X-rays or radioactive substances
  • General ill health, poor diet, and stress
• Polycystic ovary syndrome (PCOS)

  Stimulate ovaries to produce excess testosterone which decreases FSH & LH leading to no ovulation
• Poor diet leading to increased glucose and insulin can disrupt production of FSH & LH
• Anorexia leading to decreased FSH & LH can cause no ovulation
• Stress leading to decreased hypothalamic secretion of GnRH can decrease FSH & LH
• PCOS - no ovulation, high testosterone
• Thick endometrium - good implantation site
• Infection - thick mucus, more acidic pH
• SMALL OVARIES