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
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)
17.Hyperprolactinaemia Causing Impotence Or Diminished Libido.
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
- Flourides(Sodium Flourides)
- Zinc Phosphide
- Aluminum Phosphide
Investigations in male
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
Weight and obesity may be hormonal defects
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.
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.
6.Blood– CBC, sugar ,urea, creatinine , thyroid profile
Causes Of Female Infertility:
3.Infection Of Lower Genital Tract . Ex: Chamydia Trachomatis,
5.Pelvic Inflamatory Disease
8.Congenital Malformation Of Genital Tract
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,
- Ultrasound abdomen
GENERAL CAUSES IN BOTH PARTNERS
5.Anti Hypertensive Drugs
6.Excessive Use Of Sex Steroids