Infertility: causes and its investigations

  Infertility:  Causes and its Investigations



Infertility is an inability to conceive in spite of having regular unprotected sex of over 12 months.
In 40-50% cases female is responsible in 20% cases male is responsible and in about 30 to 40% cases both partners are equally responsible for infertility. There may be a single cause in one of the partner or it may be a result of combined causes.

 Infertility may be- primary or secondary
1.  Primary infertility- it is an infertility in which a couple never had a child.
2.  Secondary infertility- in this there is failure to conceive in spite of previous pregnancy.

 it may be-
1. Physiological - prior to puberty, after Menopause and during lactation.
2.  Pathological- infertility due to some medical reasons.
 

 Causes of infertility

To have a child both partners are to be healthy. Problem in any one of the partner or of both can result in infertility.
Therefore causes may be classified as-
1. General (pertaining to both partners) 
2. Females
3. Males

 General cause of infertility

Factor affecting both male and female partner
  • Genetic
  • DNA damage
  • Diabetes mellitus
  • Thyroid disorders, Hypeprolactinemia, Hypopituitarism. 
  • Environmental factors-chemical dust,  pesticides, tobacco smoking. 
  • Sexually transmitted infections- e.g. Chlamydia trachomatis,  Neisseria gonorrhea. 
  • Advanced age
  • Anxiety 
  • Lack of knowledge in coital technique 
  • Obesity

Causes of infertility in females 

1. Ovarian causes-

  • Anovulation or oligoovulation
  • Polycystic ovarian syndrome 

2. Tubal causes (Fallopian tube) 

  • Tubal blockage
  • Tubal ligation 
  • Tubal endometriosis
  • Impaired tubal motility 
  • Peritubal adhesion

3. Pelvic factors-

  • Endometriosis
  • Adhesions
  • Pelvic inflammatory disease-tuberculosis.

4. Uterine factors-

  • Uterine hypoplasia
  • Fibroid uterus
  • Inadequate secretory endometrium
  • Congenital defect

5. Immune infertility - 

  • Antisperm Antibody. 

Causes of infertility in males-

  1.  Defective spermatogenesis- congenital, thermal factor. 
  2. Cydtic fibrosis
  3. Testicular malformations, undescended testicles, vericocele. 
  4. Hormonal imbalance
  5. Obstruction of efferent duct system,  Vasectomy. 
  6. Infection - mumps,  orchitis. 
  7. Smoking
  8. Impotency
  9. Ejaculatory defect,  Retrograde ejaculation.
  10. Error in seminal fluid/sperm-
  • High or low volume of ejaculate. 
  • Low sperm count- Azoospermia,  oligozoospermia. 
  • Disorder of sperm motility
  • Morphological abnormalities of sperm
  • Low fructose content
  • High prostaglandin content
  • High viscosity. 
Unexplained infetility:
The cause of infertility is unknown.

Lab investigations-

Females:

  1. USG 
  2. Laproscopy
  3. Hysterosalpingography
  4. Thyroid function test
  5. Hormonal essay-FSH, LH
  6. Routine- Hb, TLC,  DLC

Males:

  1. Semen analysis 
  2. Routine: Blood,  urine,  blood sugar test
  3. Serum: TSH,  LH,  testosterone. 
  4. Immunological test. 

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