Infertility occurs when couples have had regular unprotected sex, usually greater than 12 months in a bid to conceive but to no success.
Infertility occurs when couples have had regular unprotected sex, usually greater than 12 months in a bid to conceive but to no success. During this period, no partner is usually on any birth control method. Generally, one of the partners is unable to contribute to conception or the female partner is unable to carry a pregnancy to term.
Globally, 8%-12% of the population experience problems regarding fertility. Additionally, 10% of females in the United Nations aged between 15-44 years of age experience problems carrying a pregnancy to term or conception difficulties.
Causes of infertility in men
Infertility in men arises when four basic events happen which include oligospermia-low sperm count, Azoospermia- sperm absenteeism, Asthenozoospermia– low sperm motility and teratozoospermia –defective sperm shape. The above events have a wide spectrum of causes including congenital abnormalities such as Klinefelter’s syndrome, hypogonadism (which can be acquired), a metabolic condition such as Cystic fibrosis, inflammatory diseases conditions such as mumps, overheated testicles due to undescended testicles and varicocele. Other causative ways include continued use of medications such as sulfasalazine, radiotherapy and chemotherapy exposure amongst other causes.
Causes of infertility in females.
Various risk factors are acting as culprits and these include, advanced age, excess smoking and alcohol consumptions, eating disorders that cause overweight or underweight nature of a woman amongst other risk factors. The major causes are attributed to those that induce ovulation disorders or fallopian tube disorders. Ovulation disorders may be due to Polycystic Ovarian Syndrome (PCOS), Hyperprolactinaemia and poor ovum quality. Fallopian tubes on the other hand are caused by pelvic surgery complications, submucosal fibroid fallopian tube occlusion, endometriosis and previous sterilization treatment. Medications such as prolonged use of Non-steroidal anti-inflammatory drugs (NSAIDs), exposure to chemotherapy, radiotherapy and illegal.
Treatment is anchored on the elimination of the causes amongst other factors such as the age of the individual striving to conceive, the general health status of individuals and the period for which the infertility problem has lasted. Investigations are performed by the clinician, a diagnosis reached and treatment initiated.
Investigations that are done for men
- Analysis of semen: a semen sample is taken and investigated for motility, shape, sperm count and sperm presence.
- Blood analysis- hormonal assay is done to detect causes such as hypogonadism and Klinefelter’s syndrome in which hormonal imbalance- testosterone deficiency is the culprit.
- Ultrasound: imaging technique for detection of sperm duct obstruction
- Chlamydia test: the infection may cause genetic damage to the male sperm thus infertility.
Investigations that are done for females
- Blood test: hormonal assay helps detect causative conditions such as PCOS
- Imaging techniques: these include hysterosalpingography and laparoscopy to examine the status of the uterus and fallopian tubes.
Treatment in men
Surgery for a blocked epididymis- epididymis blockage leads to ineffective ejaculation hence infertility.
Erectile dysfunction or premature ejaculation: These involve the use of condoms to reduce the sensitivity of the penis thus reduce premature ejaculation. The use of topical anaesthetics such as creams and creams containing lidocaine, prilocaine and benzocaine thus reduce penile sensitivity. Oral medications such as Anti-depressants including selective serotonin reuptake inhibitors (SSRIs) such as escitalopram, Analgesics such as Tramadol and Phosphodiesterase-5 inhibitors such as Viagra all are helpful. Counselling also helps mitigate stress as a culprit.
In-vitro fertilization (IVF): this is of help I various incidences inclusive of sperm duct blockage and oligoasthenoteratozoospermia.
Treatment in female
Various medications are given to mitigate infertility in females and their main mode of action is the induction of ovulation. Some of the administered medications include Clomifene, Metformin especially in those with PCOS, Human menopausal gonadotropin, Follicle stimulating hormone, Human chorionic gonadotropin which is used in combination with Clomifene, bromocriptine which inhibits prolactin release, Gonadotropin-releasing hormone (Gn-RH) analogues such as goserelin.
- Intrauterine Insemination (IUI): sperms are washed in a fluid to obtain the best specimens, then using a catheter, the specimen is inserted via the cervix and have the sperm placed into the uterus during ovulation. The method is effective in oligoasthenoteratozoospermia or when the man has severe erectile dysfunction.
- In-Vitro fertilization (IVF) – sperm sample is placed together with an ovum sample in a petri dish where fertilization occurs. The embryo is then implanted in the uterus or frozen for future deployment.
- Intracytoplasmic sperm injection (ICSI): During the IVF procedure, a single sperm is injected into an ovum thus fertilization highly improved especially in males with low sperm count.
- Sperm or ovum donation: the IVF procedure is applied on donated ovum and sperms to induce fertilization.
- Assisted hatching: The embryologist makes an opening at the zona pellucida layer of the embryo, the move improves the capacity of the embryo to implant on the uterine wall.
- Electric or vibration technique application to induce ejaculation, the vibratory movement ignites ejaculation which is effective for males with spinal cord injury.
- Surgical sperm aspiration: sperms are aspirated from the vas deferens or epididymis and is effective in males with vas deferens blockage.
Brazier, Y. (n.d.). Infertility: Causes, diagnosis, risks, and treatments. Medical and health information. https://www.medicalnewstoday.com/articles/165748#causes_in_women
Infertility symptoms, causes (Men, women), treatments, statistics. (n.d.). MedicineNet. https://www.medicinenet.com/infertility/article.htm