|
|
| Reproduction is the fundamental property
of every living organism aimed at the propagation of its
species. Human Reproduction involves many complex changes
and mechanisms which ultimately lead to conception. The
Human Reproductive potential ( fecundity ) is one of the
lowest in the animal world at about 25% per cycle i.e.
every egg carries a chance of 1 in 4 of getting fertilized
in each menstrual cycle. |
 |
|
|
|
:: Infertility
or Childlessness :: |
|
|
Infertility is defined as a failure of conception even
after an active married or sexual life for a continuous
12 months.
Infertility, a condition that affects about one in a five
couples at some stage in their Reproductive life, carries
enormous social stigma and immense psychological trauma
with it. It is our belief that Health Education , good
understanding and use of appropriate technology can bring
joy to many a couple that is longing to cuddle an offspring.
Infertility or childlessness is a common problem of mankind,
from ancient times. The present figures suggest that one
in five couple experience infertility at some stage in
their reproductive life. There is enough evidence to indicate
that the incidence in fertility is on the rise. While
the exact reason for this rise is not clear, the modern
life style, late marriage, substance abuse, environmental
degradation etc. appear to be affecting human fertility.
The Problem:
The causes of infertility vary from marital discontent
to psychological and pathological conditions. A large
number of these problems can be corrected by simple medicines
and operations. Remaining few need certain highly specialized
treatments which are collectively called Assisted Reproductive
techniques. |
|
|
|
:: Factors affecting
fertility: :: |
|
|
 |
a) Age :
Fertility is closely linked to the age of both male and
female partners, more so in the female, as shown in the
graph. Late attempts at having a family can result in
difficulties.
b) Coital Frequency :
Couple having thrice weekly or more frequent intercourse
have better chance of achieving a pregnancy. This is because
lesser frequency of intercourse may miss the 'fertile
window' of the female menstrual cycle.
c) Environmental factors :
The importance of these is harder to estimate. Smoking,
drugs, alcohol, industrial pollution , occupation, dress,
hot bath etc are known to depress sperm function. . |
|
|
|
|
 |
| Main Organ |
Defect |
| Hypothalamus & Pituitary |
Unknown
Hypogonadotrophic Hypogonadism
Delayed puberty
Tumours, trauma, irradiation, surgery, drugs
Hyperprolactinaemia |
| Testis |
Unknown(most common)
Varicocele
Orchitis
Cryptorchism, Anorchism
Systemic disease affecting spermatogenesis
Testicular tumours
Radiation, chemotherapy, Drugs, toxins |
| Seminal ducts/glands |
Obstruction
Vasa aplasia
Vasectomy
Cystic fibrosis
Autoimmunity |
| Coital problems |
Epispadias / hypospadias
Phimosis
Retrograde ejaculation
Erectile difficulty; impotence |
| Androgen insensitivity |
Testicular feminization |
|
| Causes |
Approximate Frequency
(%) |
| Unknown |
30
|
| Varicocele |
15
|
| Endocrine |
10
|
| Infection |
09
|
| Maldescended testicle |
08
|
| Psychosexual dysfunction |
06
|
| Systemic disease |
05
|
| Sperm antibodies |
04
|
| Others |
13
|
|
|
|
|
:: Causes
in the Female :: |
|
|
 |
|
Common causes of defective ovulation |
| Ovarian failure |
- Genetic
- Radiotherapy and chemotherapy
- Autoimmune
- Idiopathic premature menopause
- Surgical ablation, endometriosi
|
| Disorders
of gonadotrophin regulation |
- Hyperprolactinaemia
- Kallmann's syndrome
- Suprapituitary tumours
- Weight loss and exercise
- Unknow
|
| Gonadotrophin
deficiency |
- Pituitary tumours
- Destructive pituitary lesions
- Pituitary ablatio
|
| Ovarian dysfunction |
|
|
|
|
|
:: Both
male and female causes :: |
|
|
In some couple one or more cause may be found
in both partners.
Unexplained infertility:
There are few couple who do not show any of the above
causes in either partners and this group is called 'unexplained
infertility' |
|
:: When to ask for help? :: |
|
|
| In young couple it may be reasonable to wait
two years but in older couple it is wise to start tests
after about 12 months of trying. Earlier investigation
are also better in those with clear history of menstrual
irregularity, hair growth, pelvic infections or male problem
such as undescended testis, adult mumps etc. |
|
|
