INFERTILITY BRIEFLY EXPLAINED

Infertility is defined as 1 year of unprotected intercourse without pregnancy.

Classified as primary or secondary infertility

FECUNDABILITY; probability of achieving pregnancy within a single menstrual cycle

FECUNDITY: probability of achieving a life birth within a single menstrual cycle

FECUNDABILITY  of normal couple is estimated at 20 – 25%

Time of evaluation of infertility is after 1 year

Exceptions are;

1.women above 35 years

2.couples with obvious pathology that is associated with infertility.

At age 35years and above , fertility decreases due to:

•       Decrease in number of ovarian follicle, which becomes rapid after 36 years
• .     Ovarian follicles become less sensitive to GNT stimulation
•       Rate of estradiol rise and peak concentration  is low

Infertility affects 10-15% of couples in the U.S and 20-30% in Nigeria

Couples who have conceived before have a better prognosis

CAUSES

Infrequent coitus due to separation, erectile dysfunction, dyspareunia

Age. Female- as stated above

        Male- Semen volume, sperm motility, and percentage of normal sperm gradually decreases with ageespeciallyy from 45-50years.

MALE;

1.      Abnormality of sperm production e.g klinefelter syndrome, Y-Chromosome microdeletion, damage to the testis anatomy like in cases of cryptorchidism,varicocele, infections like viral and bacterial orchitis,gonadotoxins like lead, agricultural spray,x-ray,radioactive substance,heat,febrile illness, tight nylon under wear, smoking, alcoholand drugs like cimetidine, nitrofurantoin and tetracycline.

2.      Inadequate GNT stimulation from genetic causes like isolated GNT deficiency and direct and indirect effect of hypothalamic/ pituitary tumour.

Exogenous androgen use,abnormality of sperm function, obstruction in the ductal system and idiopathic causes.

FEMALE;

1.      Ovarian- PCOS, hyperprolactinemia, hypothyroidism, hyperthyroidism, over weight, underweight, kallaman syndrome

2.      Tubo-peritoneal- PID, post abortal sepsis,puerperal sepsis, endo metriosis

3.      Uterine- fibroid, endometritis, asherman syndrome, adenomyosis,congenital uterine abnormality

4.      Cervical/Immunological- anti-sperm antibody, hostile cervical mucus, abnormality of the cervix

5.      Systemic conditions- chronic infections, chronic diseases including auto-immune conditions

UNEXPLAINED INFERTILITY

Applies to couples that have failed to establish a pregnancy despite evaluation uncovering no obvious cause of infertility OR after correction of identified causes responsible for infertility.

PREVALENCE OF INFERTILITY

Male factor – 25-40%

Male and female – 10%

Feamle factor – 40-50%

Unexplained – 10%

Author: Medrockets