Definition of Infertility
Traditionally, infertility has been defined as the inability to conceive for more than two years in spite of sexually active. If however the women is more than 35 yrs old, then the duration is reduced to 1 years as advancing age diminishes the chances of pregnancy.
Although the traditional definition is 2 years, many feel that investigations should be started after I year.
1 year => 50% couple conceive
1 ¼ year => 25% couple conceive
1 ½ year => 5-10% couple conceive
Male infertility
Male factor accounts for more than 30% of infertility . A through and systematic checkup of the male partner is essential before an expensive investigation and treatment of the female partner.
Causes of Infertility
- Anatomical
- Physiological
- Endocrinological
- Pathological
- Immunological
- Psychosexual
- 30% Andrological infertility
- 30% Gynecological failure
- Rest unexplained
- Duration of infertility
- Previous paternity
- General health
- Any urological complaints
- Previous history of sexually transmitted diseases, febrile illnesses, genital infections such as mumps, chickenpox, genital tuberculosis and other types of orchitis.
- Previous torsion , orchioplexy, hernia and hydrocele operations.
- Previous vas ligation.
- Any endocrinological disturbances like hypothyroidism hyperthyrodism, diabetes,
- Hyperprolactinaemia.
- Any delay in the secondary sexual characteristics.
- History of testicular cancer, radiotherapy, Chemotherapy and retroperitoneal node dissection.
- Timing, frequency of intercourse, sexual dysfunction, premature ejaculation may contribute to infertility .
- Environmental exposure to toxins , radiation, chemicals and excessive heat can predispose to infertility .
- The presence of a varicocele contributes to infertility and this needs evaluation and treatment.
- Use of lubricants like KY jelly have a spermicidal effect and may contribute to infertility.
FUNCTIONAL ANATOMY
- The testes normally situated in the Scrotum.
- They are maintained at a temperature 20C lower than a normal body temperature.
- The lower temperature is necessary for normal spermatogenesis.
Criteria Recommendation analysis of SEM
Emission abstinence => >2 and <7 days
No of samples to be analyzed => 2( >7 days and < 3 months apart)
Method of collection => Masturbation
Container => Wide mouthed glass or
Temperature => Room temperature to 370C
Time of analysis => Within one hour of collection plastic never in condom
Normal sperm variables
Parameter Value
Volume >=2.0 ml
PH 7.2 -7.8
Sperm concentration >=20 x 10 6 Sperm /ml
Total sperm count >=40 x 10 6 Sperm
Motility >= 50% with forward progression
Morphology >=50% normal forms
Viability >=50% live forms
White blood cells <1 x 10 6 / ml
Immunobead test <10% sperm with adherent beads
Abnormal sperm variables
Nomenclature Variable
Azoospermia Absence of sperm in ejaculate
Oligozoospermia Reduced sperm count
Asthenozoospermia Reduced sperm motility
Teratozoospermia Reduced normal forms
Oligoasthenoteratozoospermia Reduced sperm count, motility & normal forms
Normozoospermia Normal sperm parameters
SEPRATION OF SPERMATOZOA
The Production of male child depend on male not the female. This due to Y chromosome .
X + X =FEMALE
Y + X =MALE