to produce offspring.
Female infertility: Studies shows approximately
10% to 15% of all couples in the United States cannot conceive after regular
intercourse for at least 1 year without contraception. About 40$
to 50% of all infertility is attributed to the female. After extensive
investigation and treatment, approximately 50% of infertile couples achieve
pregnancy. Of the 50% who don’t, about 10% have no pathologic basis
for infertility; the prognosis for this group becomes extremely poor if
pregnancy is not achieved after 3 years.
Cause: Infertility may be caused by any defect or malfunction
of the hypothalamic pituitary ovarian axis, such as certain neurologic
diseases. Other causes include:
Ovarian factors related to anovulation or oligo ovulation
Uterine abnormalities, which may include congenitally absent, bicornuate,
or double uterus; leiomyomas; or Asherman’s syndrome, in which the anterior
and posterior uterine walls adhere because of scar tissue formation.
Tubal and peritoneal factors, such as tubal loss or impairment secondary
to ectopic pregnancy, or tubal occlusion due to salpingitis or peritubla
adhesions
Cervical factors, such as infection and possibly cervical antibodies
that immobilize sperm
Psychological problems.
Findings:
Diagnosis requires a complete physical examination and health history,
including questions about the patient’s reproductive and sexual function,
past diseases, mental state, previous surgery, types of contraception used
in the past, and family history.
Diagnostic tests:
The doctor may order tests to assess ovulation and the structural integrity
of the fallopian tubes, the ovaries, and the uterus as well as male-female
interaction studies.
Assessing ovulation: Basal body temperature graph shows
a sustained elevation in body temperature after ovulation until just before
the onset of menses, indicating the approximate time of ovulation.
Endometrial biopsy done on or about day 5 after the basal
body temperature rises, provides histologic evidence that ovulation has
occurred.
Progesterone blood levels, measured when they should
be highest, can show a luteal phase deficiency.
Assessing structural integrity of female reproductive organs: Hysterosalpingography
provides radiologic evidence of tubal obstruction and abnormalities of
the uterine cavity after injection of a radiopaque contrast medium through
the cervix.
Endoscopy confirms the results of hysterosalpingography
and visualizes the endometrial cavity by hysteroscopy or explores the posterior
surface of the uterus, fallopian tubes, and ovaries by culdoscopy. Laparoscopy
allows
visualization of the abdominal and pelvic areas.
Male-female interaction studies: The postoital test also
known as Sims test examines the cervical mucus for motile
sperm cells after intercourse that takes place at midcycle (as close to
ovulation as possible).
Immunologic or antibody testing detects
spermicidal antibodies in the sera of the female.
Treatment:
Intervention aims to correct the underlying abnormality or dysfunction
with in the hypothalamic-pituitary-ovarian complex. In cases of hyperactivity
or hypoactivity of the adrenal or thyroid gland, hormone therapy is necessary.
Progesterone deficiency requires progesterone replacement.
Anovulation requires treatment with clomiphene citrate, human menopausal
gonadotropins, or HCG. Ovulation usually occurs several days after
such administration.
Surgical restoration may correct certain anatomic causes of infertility,
such as fallopian tube obstruction.
Surgery may be required to remove tumors located within or near the
hypothalamus or pituitary gland.
Endometriosis requires drug therapy and or the combination of surgical
removal of areas of endometriosis.
* Artificial insemination has proven to be an effective alternative
strategy for dealing with infertility problems.
* In vitro (test tube) fertilization has also been successful.
Male infertility: Studies show approximately
40% to 50% of infertility problems in the US are totally or partially attributed
to the male.
Assessment findings: Clinical features of male infertility
include atrophied testes; empty scrotum; scrotal edema; varicocele or anteversion
of the epididymis; inflamed seminal vesicles; beading or abnormal nodes
on the spermatic cord and vas; penile nodes, warts, plaques, or hypospadias;
and prostatic enlargement, nodules, swelling, or tenderness.
Diagnostic test: Patient history and physical examination.
Most conclusive test for male infertility is semen analysis.
Lab. test such as: gonadotropin assay to determine the integrity
of the pituitary gonadal axis, serum testosterone levels to determine end
organ response to LH, urine 17-ketosteroid levels to measure testicular
function, and testicular biopsy to help clarify unexplained oligospermia
or azoospermia.
Vasography and seminal vesiculography may be necessary.
Cause: Some of the factors that cause male infertility
include:
– Varicocele, a mass of dilated and tortuous varicose veins in the spermatic
cord
-Semen disorders, such as volume of motility disturbances or inadequate
sperm density
-Proliferation of abnormal or immature sperm, with variations in the
size and shape of the head
-Systemic diseases, such as diabetes mellitus, neoplasms, and mumps
orchitis
-Genital infection, such as gonorrhea, tuberculosis, and herpes
-Genetic defects
-Disorders of the testes
-Immunologic disorders
-Endocrine imbalance
-Chemicals and drugs that inhibit gonadotropins or interfere with spermatogenesis,
such as arsenic, methotrexate, some antihypertensives
-Sexual problems, such as errectile dysfunction, low libido
-Other factors: age, occupation, and trauma to the testes.
Treatment:
Aims to correct the underlying problem
Counseling or therapy (on sexual techniques, coital frequency, and reproductive
physiology)
Proper nutrition with vitamin supplements.
Decrease FSH levels may respond to vitamin B therapy
Decreased LH levels, to HCG therapy.
Elevated LH levels require low dosages of testosterone. Decreased
testosterone levels, decreased semen motility, and volume disturbances
may respond to HCG.