Infertility
Everything you wanted to know about Infertility Infertility implies the failure to conceive. It is termed Primary: when conception has never occurred and Secondary: when the patient fails to conceive after having a child.
How conception occurs?
Conception results from the fertilization of the ovum (female gamete) by the spermatozoa or sperm (male gamete). After ejaculation the sperms migrate towards the fallopian tubes and fertilization takes place in the fallopian tubes. The usual life span of a sperm is estimated to be about 24 hours; while the life span of ovum is estimated at 12 hours. So a coitus to be capable of fertilization, must take place within twelve hours of ovulation (release of ovum from the ovary). That certainly explains why some married couples fail to conceive, though they are potentially fertile. The intercourse should be able to coincide with the short time after ovulation, when the ovum is viable, so that chances of fertilization are there. And even then there are numerous factors like sperm motility, viability of sperms, etc. before fertilization can eventually occur.
When does ovulation occur?
It has been concluded after considerable research that ovulation most commonly occurs fourteen days before the onset of the next menstrual period. For example, ovulation will occur on the 14th or 15th day in a 28 days cycle, and on the 10th day in a 24 days cycle.
Is it always the female’s fault if conception is not occurring?
This is a misconception because conception depends upon the fertility of both the partners. Any fault in either partner can lead to infertility. Studies have shown that 40% of infertility is due to the male partner.
What are the main causes of male infertility?
The commonest reason is a low sperm count, which can be attributed to various causes;
• Idiopathic i.e., when the exact cause is not known.
• Varicocele – It is a swollen varicose vein in the scrotum, most commonly on the left side. Blood accumulated in the swollen testicular veins leads to increased temperature in the testis & damages sperm production.
It can be diagnosed, by asking the patient to stand erect and cough . The cord like structure from which the testis hangs i.e., the spermatic cord, feels like a "bunch of worms", on palpation.
• Duct blockage – Infection like gonorrohea, TB, filariasis; on surgery for hernia/hydrocele may lead to blockage of the passage between the testes and the penis. In this case sperms will be absent from the semen(azoospermia)
• Hormonal imbalance – Hormonal imbalance due to pituitary or adrenal gland can lead to infertility.
• Substance Abuse – Excessive intake of alcohol and/or drugs leads to decrease in liver function and increase in levels of the hormone Estrogen which in turn suppresses sperm production.
• Testicular factors – like twisting of testis leading to compromised blood supply; undescended testes when the testes lie in the abdomen; and damage due to exercise or heat can decrease sperm production. Testes lie outside the body in the scortum because they can produce sperms in a cooler environment. So clothes like tight jeans, nylon briefs, and hot baths/saunas, lead to damage to sperm production.