infertility-pic
Infertility means a disease of the reproductive system characterised by the inability to achieve a clinical pregnancy after 12 months or more of regular unprotected sexual intercourse. (And there is no other reason, such as breastfeeding or postpartum amenorrhoea). The Word Health Organisation (WHO), defines infertility as “the inability of a couple to achieve conception or to bring a pregnancy to term after a year or more of regular, unprotected intercourse”. Global estimate of infertility range between 8 and 12% of couples with women of child bearing age, affecting between 50 to 80 million people. Infertility affects both man and woman.
Infertility is categorised in to two (2) places, which includes;
Primary: when there has been no prior conception
Secondary: if there has been a previous pregnancy irrespective of the outcome.
Couples now have fewer than two children on average in most European countries and they tend to postpone these births until a later age when there is a natural reduction in fertility. Under normal circumstances, the chance of a couple conceiving within one menstrual cycle is 20 to 25% given that unprotected intercourse occurs at the optimum time. Whereby, the female partner is ovulating regularly and the male partner is producing sperm of sufficient quality.
The factors responsible for infertility are many and varied. With an incidence in men up to 30% and for women about 40%. Approximately one-third of cases of infertility involve problems with both partners and in one-third of couples the causes of infertility remain unexplained. The most common causes are ovulation failure and sperm disorder.
-Dysfunction of hypothalamus, pituitary, adrenal and thyroid glands.
-Systemic disease, diabetes mellitus, coeliac disease and renal failure
b)Testicular disorders like:
-Trauma
-Environmental (high temperature)
-Congenital (hydrocele, undescended testes)
-Occupational (furnace man, long-distance lorry driver)
-Acquired (varicocele, tight clothing)
-Cancer treatment
2) DEFECTIVE TRANSPORT
a) Obstruction or absence of seminal ducts
-Infection
-Congenital anomalies
-Trauma
b)Impaired Secretion from prostrate or seminal vesicles
-Infection
-Metabolic disorders
3) INEFFECTIVE DELIVERY
a)Psychosexual problems (impotence)
b)Drug induced (ejaculatory dysfunction)
c)Physical disability
d)Physical anomalies
-Hypospadias (opening of the urethra on the posterior part of the penis)
-Epispadias (opening of the urethra on the anterior part of the penis)
-Retrograde ejaculation (into the bladder)
a) Endocrine disorders
-Dysfunction of hypothalamus, pituitary, adrenals and thyroid glands.
-systematic diseases e.g. diabetes, mellitus coeliac diseases, renal failure.
b) PHYSICAL DISORDERS
-Obesity
-Anorexia nervosa or strict dieting.
-Exercise
c) Ovarian disorders
-Hormonal (either deficient or excess)
-Ovarian cysts or tumors
-Polycystic ovary disease
-Ovarian endometriosis
A) Ovum
a) Tubal obstruction
-Infections (gonorrhea, peritonitis, pelvic, inflammatory disease)
-Previous tubal surgery
b) Fimbrial adhesions due to
-previous surgery
-endometriosis
B) Sperm
a) Vagina
-psychosexual problems (“vaginismus” which is painful muscular spasm of the vaginal walls resulting in dyspareunia or painful sex)
-Infection (causing dyspareunia)
-congenital anomaly
b) Cervix
-cervical trauma or surgery
-Infection
-hormonal (hostile mucus)
-antisperm antibodies in mucus
a) Hormonal imbalance
b) Congenital anomalies
c) Fibroid
d) Infection
Treatment depends on the causes of infertility but may include counseling. Fertility treatment which include in vitro fertilisation. Treatment methods of infertility may be grouped as medical or complementary and alternative treatments. Some of the methods may be used in concert with other methods. Drugs used for women include clomiphene citrate, human menopausal gonadotropin, follicle stimulating hormone, human chorionic gonadotropin, releasing hormone analogs, aromatase inhibitor, and metformin.
In 2007, the FDA cleared the first at home tier one medical conceptive device to aid in conception. The key to the kit are cervical caps for conception. This at home (cervical cap) insemination method allows all the semen to be placed up against the cervical as for six hours allowing all available sperm to be placed directly on the cervical “OS”. For low sperm count, low sperm motility or a tilted cervix using a cervical cap will aid in conception. This is a prescriptive medical device, but not commonly prescribed by the physicians.
However, Medical treatment of infertility generally involves the use of fertility medication, medical device, surgery or combination of them. If the sperm are of good quality and the mechanics of the woman’s reproductive structure are good (patent fallopian tubes, no adhesion or scarring). Physicians may start by prescribing a course of ovarian stimulating medication. Hence the physician may also suggest using a conception cap (cervical cap). The one the patient uses at home also by placing the sperm inside the cap and putting the conception device on the cervix or intrauterine insemination (IUI). Hence, the doctor introduces sperm into the uterus during ovulation via a catheter. In these methods, fertilisation occurs inside the body.
However, conservative medical treatments fail to achieve a full-term pregnancy, the physician may suggest the patient undergo In Vitro Fertilisation (IVF). IVF and related techniques (Intra Cytoplasmic Sperm Injection (ICSI), Zygote Intra Fallopian Transfer (ZIFT), Gamete Intra Fallopian Transfer (GIFT) are all called Assisted Reproductive Technology (ART) techniques.
furthermore, “ART” techniques generally start with stimulating the ovaries to increase egg production. After stimulation, the physician surgically extracts one or more eggs from the ovary and unites them with sperm in a laboratory setting. With the intent of producing one or more embryos. Fertilisation takes place outside the body. And the fertilised egg is reinserted into the woman’s reproductive tract. In a procedure called embryo transfer. Other medical techniques include tuboplasty, assisted hatching, preimplantation genetic diagnosis and surrogacy,