Infertility

Infertility implies apparent failure of a couple to conceive, while sterility indicates absolute inability to conceive, for one or more reasons.

If a couple fails to achieve pregnancy after 1 year of ‘unprotected’ and regular intercourse, it is an indication to investigate the couple. 80% of normal couples achieve conception within a year. 50% conceive within 3 months of regular, unprotected intercourse, 75% in 6 months and 80–85% conceive within a year. Physiological sterility is present before puberty and after menopause.

Physiological sterility is present before puberty and after menopause .Regularly lactating women experience a longer duration of amenorrhoea and ovulation is delayed for at least 3 months, or even longer at times more than 6 months.

Optimal age for conception is 20–35 years in a woman. Over the age of 40 years the fertility rate is reduced, and there is an increased risk of chromosomal abnormalities and other malformations in the fetus. For a man age is less important, but after  50 years, decreased libido and sexual dysfunction reduce fertility and predispose to malformed fetus.

Conception is the result of successful fertilization of the female egg by the sperm. Hence, the couple should be counselled individually and then together because both partners contribute varying to the occurrence of the infertile state. It is mandatory to investigate both the partners simultaneously,

CAUSES OF INFERTILITY IN MALE:

1.Low Frequency Intercourse

2.Wrong Time Of Intercourse

3.Impotence

4.Premature Ejaculation

5.Retrograde Ejaculation

6.Smoking

7.Alcohol

8.Tobacco Chewing

9.Prostatitis

10.Mumps

11.Surgery Or Trauma To The Male Genitalia Or Inguinal Region (E.G., Hernia Repair)

12.Unusual Exposure To Environmental Heat.

13.Drugs, Radiation, Calcium Channel Blocker, Anticonvulsants, Antihypertensives, Spironolactone And Cimetidine.

14.Orchitis (Traumatic, Mumps, Tb, Gonorrhoea).

15.Chronic Illness(Kidney Failure, Liver Failure)

16.Immunological Disorders

17.Hyperprolactinaemia Causing Impotence Or Diminished Libido.

18.Hypothyroidism

19.Use of INSECTICIDE,PESTICIDE,RODENTICIDE,WEEDICIDE in agriculture

• Organophosphorus  Poison(Op Poison)-Malathoin, Tetron, Parathion,Chlorthoin,Diazion(Tik 20)
• Organo Chlorines-Ddt,Aldrin,Endrin,Endosulfan,Benzene Hexa Chloride
• Paraquat(Weedol)
• Flourides(Sodium Flourides)
• Zinc Phosphide
• Aluminum Phosphide

Investigations in male

1.History

History includes age of the man, previous children, duration of infertility, and any contraception practiced and for how long. The coital frequency and timing related to ovulation. The occupation—a frequent traveller or working in a hot place. Habit of smoking, alcohol, tobacco and drugs. History of tuberculosis, sexually transmitted infection, diabetes and chronic illness. Diabetic neuropathy can cause impotence and retrograde ejaculation.

Fever of any cause can suppress spermatogenesis for as long as 6 months. Chronic respiratory disease. Operation on the hernia or scrotum, undescended testis. n Any coital problem such as premature and retrograde ejaculation, failure to ejaculate

2.General examination

General height

Weight and obesity may be hormonal defects

3.Local examination

Examination of penis and scrotum, and surgical scar. The normal scrotal volume is 15–35 mL (average 18 mL). Testicular volume of less than 6 mL.

Special investigations

1.Semen analysis.

Volume—2 mL (1.5 mL) n PH—7.2–7.8

Viscosity ,3 (scale 0–4)

Sperm concentration 20 million/mL or more (15 million/mL)

Total sperm count .40 million/per ejaculate or more

Motility .50% or more with progressive motility

Morphology .14% strict criteria (4%) n Viability .75% or more (50%)

White blood cells ,1 million/mL

Aspermia—means no semen. Azoospermia—implies no sperm in semen. Oligospermia—low sperm count. Asthenospermia—no motile sperm or diminished motility. Necrospermia—dead sperms. Teratospermia—abnormal morphology of sperms.

2.Hormonal assays

3.Testicular biopsy.

4.Immunological tests.

5.Chromosomal study.

6.Blood– CBC, sugar ,urea, creatinine , thyroid profile

 

Causes Of Female Infertility:

1.Dyspareunia(Painful Coitus)

2.PCOD

3.Infection Of Lower Genital Tract . Ex: Chamydia Trachomatis,

4.Tubal Blockage

5.Pelvic Inflamatory Disease

6.Endometriosis

7.Adhesions

8.Congenital  Malformation Of Genital Tract

9.Alcohol

10.Smoking

11.Fibroid

12.Chronic Ill Health- Hypothalamic and pituitary disease, hypothyroidism and adrenal cortical dysfunction are the important causes of nonovulation. Diabetes and tuberculosis may lead to infertility. Smoking is known to impair ovarian function and prevent embryo implantation into the endometrium.

Investigations in female

Age of the woman, past obstetric history in secondary infertility regarding puerperal infection, coital difficulty and menstrual history give clues to the possible cause. History of tuberculosis and previous pelvic infection is important. History of diabetes and thyroid dysfunction may be evident. The duration of infertility and previous use of contraceptive and the type may be linked to infertility.

Examination. This includes height and weight of the woman; blood pressure should be checked. Hirsutism, palpation of thyroid and lymph nodes, palpation of the breasts and presence of secretion suggest hormonal dysfunction.

• Blood- CBC, sugar ,urea, creatinine , thyroid profile, lipid profile,FSH,LH,Prolatin,oestrogen,
• Hysterosalpingogram
• Ultrasound abdomen

GENERAL CAUSES IN BOTH PARTNERS

1.Diabetes Mellitus

2.Tuberculosis

3.Hypothyroidism

4.Hyperprolactinaemia

5.Anti Hypertensive Drugs

6.Excessive Use Of Sex Steroids

7.Chemotherapy.

8.Pituitary Disorder

9,Hypothamamic Disorder

10.Smoking

11.Alcohol

TREATMENT

HOMEOPATHY MEDICINE