Infertility

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How prevalent is infertility?

Infertility is the inability of a couple to conceive after one year of unprotected intercourse. This condition affects about twenty percent (1 in 5) couples in the United States. Its escalating incidence reflects today's intentional delay in marriage and in having the first child.

What causes infertility?

The factors leading to infertility are sperm disorders (35%), ovulatory disorders (20%), female tubal dysfunction (30%), abnormal cervical mucus (5%), and unidentified factors (10%).

Is infertility more common among females?

It appears that is the case, in the approximate ratio of about 55 to 35, female to male.

Does fever affect sperm production?

Spermatogenesis (sperm production) is continuous and requires about 72 to 74 days for maturation. Production is most efficient at 34 degrees centigrade (93.2 degrees Fahrenheit), so exposure to excessive heat or prolonged fever within 2 to 3 months of sperm analysis can adversely affect sperm count, motility and morphology (size, shape).

What are the sperm disorders?

The most common disorders are varicocele (abnormal dilatation of the veins of the testicles), which has about 25% incidence; azoospermia (no sperm in semen); retrograde (reverse) ejaculation into the bladder; and, endocrine (hormonal) disorders.

Do mumps cause male infertility?

Only if the mumps are associated with orchitis (inflammation of the testicles). Fortunately, most cases of mumps are not associated with orchitis. Also, not all with mumps orchitis develop infertility. If orchitis develops, it leads to abnormal, poor or absence of sperm production.

What is ovulatory dysfunction?

This is a condition where a woman is unable to ovulate (produce viable eggs for fertilization), as in Polycystic Ovary Syndrome or Chronic Anovulation, Luteal Phase Deficiency, and Hypothalamic Amenorrhea. The other causes of infertility in the females are tubal dysfunction (associated with past event of pelvic inflammatory diseases), abnormal cervical mucus (normal cervical mucus acts as a biologic filter to prevent influx of vaginal bacteria that could kill the sperm), and some are due to unknown causes.

What are the diagnostic tests for male infertility?

History and physical examination is essential to help the physician in deciding what tests to order. The usual diagnostic aids are semen analysis (the major test), performed after 2-3 days of sexual abstinence; immuno bead test for antisperm antibodies; hemizona assay; sperm penetration assay; and, rarely, testicular biopsy.

How about tests for female infertility?

Ovulation Monitoring (daily measurements of basal body temperature), which is not very accurate. More reliable are: Pelvic Ultrasound Monitoring of ovarian follicle diameter; and endometrial biopsy. To detect ovulation, there are now predictor kits available that detect an increase in the urinary luteinizing hromone (LH) excretion 24 to 36 hours before ovulation. Other biochemical parameters can be used by the physician to determine if ovulation has taken place.

How successful are the current treatments for infertility?

More than ever before, the success rate today, especially among females, is better, depending on the underlying cause of the infertility. In general, the rate of success among males are much lower, depending on the underlying factor. For more detailed information, consult your Family Physician, Urologist or Gynecologist.

What is Assisted Reproduction?

This is the science of helping women have a successful pregnancy. One technique is In Vitro Fertilization, used among patients with tubal disease, endometriosis, husband with oligospermia (low count) and/or sperm antibodies, and unexplained infertility. The procedure involves drug stimulation of the ovaries to produce oocytes (eggs), retrieval of the oocyte by Ultrasound-guided needle biopsy of the follicle transvaginally, fertilization of the oocyte in the "test tube" with washed sperm, culturing the embryos for about 40 hours, after which 3 to 4 embryos are transferred to the uterine cavity (womb). The rest of the embryos may be frozen in liquid nitrogen for future transfer in subsequent natural cycle, if needed.

What is the success rate of this technique?

Although multiple embryos are transferred into the uterus, the average term pregnancy with In Vitro Fertilization is only about one in five (20%) to one in four (25%) at best per attempt.

What are the other "surgical" assisted means?

GIFT or Gamete Intra Fallopian Tube transfer , where the in vitro fertilized embryos are transferred to the distal fallopian tubes laparoscopically or transvaginally guided by Ultrasound. When other techniques have not succeeded, Intracytoplasmic Sperm Injection is done , where the sperm is injected directly to the oocyte, to ensure sperm penetration and attachment.

If all these, and hormonal treatment, fail, then what?

The procedures described above are obviously emotionally taxing, very expensive and many times unsuccessful. The option left is not only a practical one but a very noble and very humane one: adoption. With millions and millions of unwanted babies and uncared for children and orphans in our own country (and in the whole world), adoption could satisfy the motherly and parental desires of childless couples, at the same time doing a most admirable act. Adopting children is today considered all over the world as an honorable and dignified way of having and caring for children. After all, being parents in today's modern society no longer means "contributors of sperms and eggs," but rather being benefactors and providers of genuine love and family to children. It is good parenting, and not conceiving and giving birth to a child, that makes a couple real parents.

©2003Raoul R. Diez, M.A.O.D.