INFERTILITY

Definition

Infertility is defined as lack of or inability to achieve conception following 1 year of frequent unprotected intercourse.

Types of infertility

Primary infertility ( a couple that has never conceived)

Secondary infertility ( secondary infertility that occurs after previous pregnancy regardless of out come)

Etiology or causes of male infertility

Male infertility can be caused by disorders of the hypothalamic – pituitary system, disorders of the testes, and abnormalities of the ejaculatory system.

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The physical causes are generally divided into three categories :• Pretesticular• Testicular and• Post Testicular

PRETESYICULAR CAUSES : The Pretesticular or endocrine causes occur only in about 3% of the cases and can generally be treated with medication and surgery.

Testicular problems or disease

Testicular problems make up 50% of the cases. The most common cause of male infertility is a varicocele (enlarged veins in the scrotum)

Others factors that influence the testes include infection (e.g mumps virus, STDs, bacterial infections) congenital anomalies, medications, radiation, substance abuse (alcohol, nicotine, drugs), and environmental hazards

Posttesticular problems

Posttesticular causes causes account for approximately 5%to 7% of the cases, with obstruction, infection, or the result of a surgical procedure being the primary causes. The remaining 40% are classified as idiopathic or of unknown causes.

Other causes including systematic illness (e.g Hypertension, diabetes mellitus)

Assessment and diagnostic findings

History and physical examination a care full health history and examination may

reveal the case of a patient infertility. The history should be include age, occupation, past injury, surgery, or infection to the genital tract, life style issues such as hot tubs, weight training or wearing tight undergarments, sexual practice, frequency of intercourse

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and emotional factors such as stress and the desire for children. The use of drugs such as chemotherapeutic agents, anabolic steroids and any recreational drugs, should be documented because these can reduce sperm count.

The first test in an infertility study is a semen analysis ( quantity, quality, morphology, mortality and density of the sperm).

Additional diagnostic tests include the Etiology include plasma testosterone and serum LH and FSH measurements.

Management of male infertility

Treatment options for the male infertility include • Medications • Life Style changes ( avoidance of scrtoal heat,

substance abuse, high level of stress) • In vitro fertilization techniques and corrective

surgery) • Artificial insemination with donar sperm is often

successful.

Emotional impact: infertility places a great emotional burden on the infertile couple. It is important to address the emotional needs of the patient.

Conclusion

Infertility one of the common problems in world wide. Infertility should be elevated after one year of unprotected intercourse. * History /physical examination and other specific diagnostic tests will help to identify the causes of infertility.