INFERTILITY

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 ¬ľ year¬†¬† =>¬† 25% couple conceive

1 ¬Ĺ year¬†¬† =>¬† 5-10% couple conceive

infertility

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

sperm

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 .

xx
girl boy

X  +  X =FEMALE

Y    +   X  =MALE