2. Introduction
• Infertility primarily refers to the biological inability of a person to
contribute to conception.
• Women who are fertile experience a natural period of fertility
before and during ovulation, and they are naturally infertile during
the rest of the menstrual cycle.
• Infertility in a couple can be due to either the woman or the man,
not necessarily both.
3. General objectives
At the end the lesson students should be able to acquire
knowlegde and understanding on infertility.
4. Specific objectives
At the end of the lesson students should be able to;
• Define infertility
• State the risk factors/ cause of infertility
• Outline the classifications of infertility
• State the sign and symptoms of infertility
5. Definition of infertility
• Infertility is the inability of a couple to obtain a clinically
recognizable pregnancy after 12 months of regular unprotected
sexual intercourse.
• Infertility is the inability to conceive after one year of unprotected
sexual intercourse of average frequency 3 times a week.
6. DEFINITION OF TERMS
• Sterility: The total inability to conceive.
• Fecundity: The capacity to participate in the production of a child.
INCIDENCE
• Generally, worldwide it is estimated that one in seven couples
have problems of conceiving.
7. Classification of infertility
Primary infertility
• A couple who have never achieved to have a pregnancy.
Secondary infertility
• Infertility that occurs after previous pregnancy with regular
unprotected sexual intercourse
8. VARIABLES INVOLVED IN
INFERTILITY
1. Age
• Females maximum fertility potential is in early twenties with a
slight fall at age 35 and a rapid decline thereafter
• Male fertilization curve is maximum at 24 years after which it falls
slightly and remains constant throughout the remainder of life
9. VARIABLES INVOLVED IN INFERTILITY
CONT’D
2. Coital exposure (frequency):
• maximum fertility is achieved with 4 to 6 sexual time of exposure:
3. Time of exposure:
• 85% of couples will achieve a pregnancy within 12 months of
unprotected coitus.
• The chance of pregnancy in any one cycle is about 15-25% even if
the couple is perfectly fertile and is having intercourse at the right
time. Best chances is at ovulation time.
10. Risk factors of infertility
In Male
• Defective sperm production and Insemination difficulties 30-40%
In Female
• Ovulation factors 5-25%
• Tubal or uterine factors 15-25%
• Cervical /immunological factors 5-10%
11. Male infertility
Male infertility is due to low sperm production, misshapen or
immobile sperm, or blockages that prevent the delivery of sperm.
Illnesses, injuries, chronic health problems, lifestyle choices and
other factors can play a role in causing male infertility.
12. Causes of male infertility
The causes fall into 3 main categories namely:
1.Hormonal problems or imbalance
2. Physical problems
3. Psychological/behavioural problems
13. Hormonal Problems
Hyperprolactinemia: Elevated prolactin- A hormone associated with
nursing mothers, it is also found in 10 to 40 percent of infertile males.
Mild elevation of prolactin levels produces no symptoms, but a
greater elevation of the hormone reduces sperm production, reduces
libido and may cause impotence.
14. Hormonal Problems
Hypothyroidism: Low thyroid hormone levels-can cause poor
semen quality, poor testicular function and may disturb libido. This
condition may be caused by a diet high in iodine. Reducing iodine
intake or beginning thyroid hormone replacement therapy can
elevate sperm count. This condition is found in only 1 percent of
infertile men.
15. Hormonal Problems
Congenital Adrenal Hyperplasia: Occurs when the pituitary is
suppressed by increased levels of adrenal androgens. Symptoms
include low sperm count, an increased number of immature sperm
cells, and low sperm cell motility. This disorder is treated with
cortisone replacement therapy. This condition is found in only 1
percent of infertile men.
16. Hormonal Problems
Hypogonadotropic Hypopituitarism: Low pituitary gland output of
LH and FSH. This condition arrests sperm development and causes
the progressive loss of germ cells from the testes and causes the
seminiferous tubules and Leydig (testosterone producing) cells to
deteriorate. This condition may be treated with the drug Serophene.
However, if all germ cells are destroyed before treatment
commences, the male may be permanently infertile.
17. Hormonal Problems
Panhypopituitarism: Complete pituitary gland failure-lowers
growth hormone, thyroid_x0002_stimulating hormone, and LH and
FSH levels. Symptoms include: lethargy, impotence, decreased
libido, loss of secondary sex characteristics, and normal or
undersized testicles. Supplementing the missing pituitary hormones
may restore vigor and a hormone called hCG may stimulate
testosterone and sperm production
18. Physical Problems
A variety of physical problems can cause male infertility. These
problems either interfere with the sperm production process or
disrupt the pathway down which sperm travel from the testes to the
tip of the penis. These problems are usually characterized by a low
sperm count and/or abnormal sperm morphology.
19. Physical Problems
Varicocele: A Varicocele is an enlargement of the internal spermatic
veins that drain blood from the testicle to the abdomen (back to the
heart) and are present in 15% of the general male population and
40% of infertile men. A Varicocele may cause reduced sperm count
and abnormal sperm morphology which cause infertility.
20. Physical Problems
Damaged Sperm Ducts: 7% of infertile men cannot transport sperm
from their testicles to out of their penis. This pathway may be
blocked by a number of conditions: ·
• A genetic or developmental mistake may block or cause the
absence of one or both tubes .
• Scarring from tuberculosis or some STDs may block the
epididymis or tubes.
21. Physical Problems
Torsion: Is a common problem affecting fertility that is caused by a
supportive tissue abnormality which allows the testes to twist inside
the scrotum which is characterized by extreme swelling. Torsion
pinches the blood vessels that feed the testes shut which causes
testicular damage. If emergency surgery is not performed to untwist
the testes, torsion can seriously impair fertility and cause permanent
infertility if both testes twist
22. Infection and Disease
Mumps, tuberculosis, brucellosis, gonorrhea, typhoid, influenza,
smallpox, and syphilis can cause testicular atrophy. A low sperm
count and low sperm motility are indicators of this condition. Also,
elevated FSH levels and other hormonal problems are indicative of
testicular damage.Some STDs like gonorrhea and Chlamydia
cancause infertility by blocking the epididymis or tubes. These
conditions are usually treated by hormonal replacement therapy and
surgery in the case of tubular blockage.
23. Environmental causes
Overexposure to certain environmental elements such as heat, toxins
and chemicals can reduce sperm production or sperm function.
Specific causes include:
• Heavy metal exposure. Exposure to lead or other heavy metals
also may cause infertility.
• Radiation or X-rays. Exposure to radiation can reduce sperm
production, though it will often eventually return to normal.
24. Psychological/Physical/Behavioural Problems
Several sexual problems exist that can affect male fertility. These
problems are most often both psychological and physical in nature:
Erectile Dysfunction (ED): Also known as impotence, this
condition is common and ED is the result of a single, or more
commonly a combination of multiple factors.
25. Psychological/Physical/Behavioural Problems
Other common causes of impotence include: diabetes, high blood
pressure, heart and vascular disease, stress, hormone problems,
pelvic surgery, trauma, venous leak, and the side effects of
frequently prescribed medications.However, most men who suffer
from ED have a secondary psychological problem that can worsen
the situation like performance anxiety, guilt, and low self-esteem.
26. Psychological/Physical/Behavioural Problems
Premature Ejaculation: Premature ejaculation is defined as an
inability to control the ejaculatory response for at least thirty
seconds following penetration. Premature ejaculation becomes a
fertility problem when ejaculation occurs before a man is able to
fully insert his penis into his partner’s vagina.
27. Psychological/Physical/Behavioural Problems
Ejaculatory Incompetence: This rare psychological condition
prevents men from ejaculating during sexual intercourse even
though they can ejaculate normally through masturbation. This
condition sometimes responds well to behavioral therapy; if this
technique does not work, artificial insemination can be employed
using an ejaculate from masturbation.
29. Other causes
Health, lifestyle and other causes of male infertility include: Illegal
drug use: Anabolic steroids taken to stimulate muscle strength and
growth can cause the testicles to shrink and sperm production to
decrease.
Use of cocaine or marijuana may temporarily reduce the number
and quality of the sperm as well.
30. Cont...
Alcohol use: Drinking alcohol can lower testosterone levels, cause
erectile dysfunction and decrease sperm production. Liver disease
caused by excessive drinking also may lead to fertility problems.
Tobacco smoking. Men who smoke may have a lower sperm count
than do those who don't smoke. Weight. Obesity can cause hormone
changes thatreduce male fertility
31. Symptoms Of Male Infertility
The main sign of male infertility is the inability to conceive a
child. There may be no other obvious signs or symptoms. However
there other problems with sexual function:
Difficulty with ejaculation or difficulty maintaining an erection
(erectile dysfunction).
Having a lower than total sperm count of less than 40 million per
ejaculate. Pain, swelling or a lump in the testicle area.
32. Management for male infertility
Investigations
1. History taking: This will reveal unprotected sexual intercose
2. On possible predisposing factor will reveal
Sexual behaviour such as frequency of sexual intercourse
Inherited conditions, chronic health problems, illnesses, injuries
or surgeries that could affect fertility
33. Cont...
3.General physical examination - includes examining the man’s
genitals .
4.Semen analysis-Semen is generally obtained by masturbating and
ejaculating into a special container. This reveals low sperm count
and abnormalities in the shape (morphology) and movement
(motility) of the sperm
34. Cont...
Often sperm counts fluctuate from one specimen to the next. In
most cases, several semen analysis tests are done over a period of
time to ensure accurate results. If the sperm analysis is normal, the
doctor will recommend thorough testing of the female partner
before conducting any more male infertility tests
35. Cont...
Additional tests to help identify the cause of your infertility. These
can include:
1. Testosterone level
2. Scrotal ultrasound.
3. Trans rectal ultrasound.
4. Post-ejaculation urinalysis.
5. Testicular biopsy.
36. Treatments
1. Surgery. For example, a Varicocele can often be surgically
corrected or an obstructed vas deferens repaired.
2. Treating infections. Antibiotic treatment may cure an infection of
the reproductive tract, but doesn't always restore fertility.
3. Oligocare tablets for sperm maturation, sperm count and motility
37. Cont...
3. Hormone treatments and medications. replacement or
medications in cases where infertility is caused by high or low
levels of certain hormones or problems with the way the body uses
hormones.
4. Clomiphene citrate is occasionally used for induction of
spermatogenesis
38. CAUSES OF INFERTILITY IN FEMALE
• For a woman to conceive, certain things have to happen:
intercourse must take place around the time when an egg is
released from her ovary; the systems that produce eggs and sperm
have to be working at optimum levels; and her hormones must be
balanced.
39. SPECIFIC FEMALE CAUSES
1. Ovulation problems
• Disruption in the part of the brain that regulates ovulation can
cause low levels of luteinizing hormone (LH) and follicles
timulating hormone (FSH).
• Even slight irregularities in the hormone system can prevent the
ovaries from releasing eggs (anovulation).
40. SPECIFIC FEMALE CAUSES CONT’D
Specific causes of hypothalamic -pituitary disorders that can
result in anovulation include injury, tumors, excessive exercise and
starvation, Some medications and Severe stress may also affect
female ovulation.
2. Elevated prolactin
The hormone prolactin stimulates breast milk production.
High levels in women who aren't pregnant or nursing may affect
ovulation.
41. SPECIFIC FEMALE CAUSES CONT’D
• An elevation in prolactin levels may also indicate the presence of a
pituitary tumor.
• Some drugs can elevate levels of prolactin.
3. Early menopause (premature ovarian failure).
• Early menopause is the absence of menstruation and the early
depletion of ovarian follicles before age 40.
42. SPECIFIC FEMALE CAUSES CONT’D
• Certain conditions are associated with early menopause, including
immune system diseases, radiation or chemotherapy treatment, and
smoking.
4 Poor ovum (egg) quality
• Eggs that become damaged or develop chromosomal abnormalities
cannot sustain a pregnancy.
• This problem is usually age-related - egg quality declines
significantly in the late 30s and early 40s.
43. SPECIFIC FEMALE CAUSES CONT’D
5. Polycystic ovary syndrome (PCOS ).
• Patients whose ovaries contain many small cysts have hormone
imbalances and do not ovulate regularly.
• In PCOS, the body produces too much androgen hormone, which
affects ovulation.
• PCOS is also associated with insulin resistance and obesity
44. SPECIFIC FEMALE CAUSES CONT’D
6. Uterine fibroids
• Fibroids are benign tumors in the wall of the uterus.
• They may cause infertility by blocking the fallopian tubes.
• More often, fibroids interfere with proper implantation of the
fertilized egg.
45. SPECIFIC FEMALE CAUSES CONT’D
7. Fallopian tube damage or blockage
• Fallopian tube damage usually results from inflammation of the
fallopian tube (Salpingitis) which reduces and damages the ciliary
epithelium lining of the tube, also healing by fibrosis narrows the
tube or closes it.
• Also pelvic adhesions which interfere with the passage of ova
from ovary to tube.
46. SPECIFIC FEMALE CAUSES CONT’D
8. Pelvic adhesions
• Pelvic adhesions are bands of scar tissue that bind organs after
pelvic infection, appendicitis, abdominal or pelvic surgery.
• This scar tissue formation interfere with the passage of ova from
ovary to tube.
9. Thyroid problems.
• Disorders of the thyroid gland, either too much thyroid hormone
(hyperthyroidism) or too little (hypothyroidism), can interrupt the
menstrual cycle and cause infertility
47. SPECIFIC FEMALE CAUSES CONT’D
10. Cancer and its treatment
• Certain cancers particularly female reproductive cancers — often
severely impair female fertility.
• Both radiation and chemotherapy may affect a woman's ability to
reproduce.
11. Other medical conditions.
• Medical conditions associated with delayed puberty or
amenorrhea, such as Cushing's disease, sickle cell disease, kidney
disease and diabetes, can affect a woman's fertility.
48. SPECIFIC FEMALE CAUSES CONT’D
12. Cervix and vagina diseases may alter the reaction of secretions.
• Spermatozoa can survive only in an alkaline media and can only
pass through cervical mucus of the right consistency.
13. Caffeine intake.
• Excessive caffeine consumption can reduce fertility in women.
49. SPECIFIC FEMALE CAUSES CONT’D
14. Psychological factors
• such as anxiety and tension where ovulation is suppressed.
15. Nutrition and general health of the couple.
• Poor health and malnutrition is associated with infertility.
16. Coital errors due to ignorance
Some penetration of the vagina has never occurred (apareunia),
infrequent coitus and not occurring during the fertile period can lead
to infertility
50. SPECIFIC FEMALE CAUSES CONT’D
17. Congenital malformation
e.g. absence of the vagina, tubes or ovaries
51. ADVICE
1. If the cause is fibroids -myomectomy
2. If the cause is PID- treat
3. In alcoholism-reduce alcohol consumption
4. If fear refer to psychosexual counselor
5. To have sex while ovulating
6. To be relaxed when having sex
7. STI treated promptly
8. No tight pants/not to wear pants
52. ADVICE CONT’D
9. No very hot baths
10. If working in furnance, change occupation
11. Relieve tension /avoid anxiety
12. Reduce obesity
13. Reduce coitus
14. If untreated possibility of adoption
15. Artificial insemination
16. Egg donation or surrogacy
