Infertility in both men and women
Infertility could be defined as the inability of a couple to achieve conception after a one year period of regular, unprotected intercourse. It is believed that about a third of infertility problems are due to female infertility, and another third are due to male infertility. In other cases, infertility affects both partners or the cause is unclear. In order to ascertain the cause of infertility in a couple, it is important for both partners to be tested at the same time. In both men and women the fertility process is usually complex. The process of fertilization usually depends on factors such as:
- A healthy hormonal environment of the woman.
- Healthy sperm ejaculated by the man
- The release of sufficient sperm by the man
- Healthy eggs produced by the woman
- Healthy and unblocked fallopian tubes that allow the sperm to reach the egg
- The ability of the sperm to fertilize the egg at connection point
- The ability of the fertilized egg (embryo) to become implanted in the woman’s uterus
- The ability of the lining of the uterus to allow implantation
- Sufficient embryo quality
- A healthy embryo
It is important that both partners take responsibility for Infertility challenges since it is usually a responsibility of both partners, sometime 1 out of 3 cases of infertility are associated with the man’s problems and same with the woman in order cases and in 1 out of 3 cases both are responsible. In about 15% of infertility cases no cause is found (unexplained Infertility).
Factors that cause infertility in both man and woman
The most common male infertility factors say 90% are as a result of the man having very few sperm a situation known as oligospermia, this is when a man is said to have a low sperm count or no sperm azoospermia, and malformed sperm cells while remaining 10% infertility cases in men can be caused by a genetic disease/ defects, anatomical problems and hormonal imbalance.
Risk factors for male infertility include:
- Varicocele: This is an abnormal enlargement of the pampiniform venous plexus in the scrotum. When this happens, the valves within the veins malfunctions. This leads into decreased sperm production and quality while hindering the free flow of blood though the veins.
- Sexually transmitted diseases (infections), can cause scarring(a lingering sign of damage or injury) in the male reproductive system or damage sperm function
- Aging (40 years and above) This can reduce sperm counts and motility and decline the genetic quality of sperm
- Toxicity: This is a Long-term or excessive exposure to certain harmful chemicals, toxins, or medications
- Unwholesome Lifestyle factors such as smoking (passive/active) and substance abuse
- Certain working conditions that tend to expose a man to intense heat or harmful rays and emissions.
To diagnose the cause of male infertility, these tests and procedures are carried out
- Analysis of the medical history including family history for any inherited conditions, chronic illnesses, injuries or surgeries that could lead to infertility, sexual habits and development, then general physical examinations of the genitals
- Semen Analysis: Laboratory analysis of the Semen for the evaluation of the quantity and quality of the sperm against any abnormality
- Hormone testing: Blood samples are tested to evaluate testosterone levels and other hormones
- Post-ejaculation urinalysis: presence of sperm in the urine indicates a retrograded ejaculation
- Scrotal ultrasound: Imaging tests using high frequency sound waves to look for structural problems like varicocele or any testicle problems
- Genetic testing to identify sperm DNA fragmentation, chromosomal defects, or genetic diseases (congenital)
- Testicular biopsy: the removal of samples from the testicles with a needle to determine sperm production condition. This is rarely done.
- Transrectal ultrasound: inserting a lubricated wand into the rectum to check for prostate and blockages of the tube (ejaculatory ducts and seminal vesicles).
- Other specialized tests to check sperm survival after ejaculation, egg penetration and attachment.
Firstly, treatment for male infertility is started by addressing any underlying medical conditions that could contribute to fertility issues like infections and sexual intercourse problems, etc. The use of Drug therapy may be applied to treat hormonal disorders. Other times, Surgery may be carried out to repair varicoceles and correct any obstructions in the reproductive tract.
Sometimes, when fertility issues persist, intracytoplasmic sperm injection (ICSI) is frequently used in combination with in vitro fertilization (IVF) to achieve pregnancy if male infertility is a factor. ICSI involves injecting a single sperm into an egg obtained through IVF. The fertilized egg is then implanted back into the woman. Pregnancy success rates depend on many different factors.
It is perceived that about 10% of women ages 15 – 44, or about 6.1 million women, have difficulty getting pregnant or carrying a baby to term.
Risk factors for female infertility include:
Female Infertility may be caused by fundamental medical condition that damages the fallopian tubes, affects the ovulation, or causes hormonal impairments among other factors;
- Ovulation disorder, which is either the absence of ovulation, random ovulation or poor quality eggs.
- Other causes of female infertility include blocked fallopian tubes, which can occur when a woman has had abdominal surgery
- Pelvic inflammatory disease (PID) or endometriosis.
- A woman’s age is a major factor because the number and quality of the eggs decline as a woman gets older starting at age 30.
- fallopian tube failure (endometriosis, scarring, or other problems),
- Polycystic ovary syndrome (PCOS): causes hormonal imbalance
- uterine fibroid and
- Cervical issues.
If a couple has been unable to conceive after 1 year of consistent unprotected sex, then fertility evaluation should be carried out especially if the woman is over 35 years old or if either partner has known risk factors for infertility. It is advised to first of all do a semen analysis for the man before the female partner undertakes any intensive testing.
Treatment for infertility should first address any underlying medical condition that may be contributing to fertility problems. If this step does not restore fertility, there are several treatment approaches:
- Lifestyle measures (such as maintaining a healthy weight, quitting smoking, timing sexual activity with regard to the ovulation cycle)
- Drugs to induce ovulation, such as clomiphene and gonadotrophins
- Assisted reproductive technologies (ART), such as in vitro fertilization (IVF)