| Men's Health>>Infertility |
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Everything you wanted to know about
Infertility
Infertility implies the failure to conceive. It is termed
Primary: when conception has never
occured and
Secondary: when the patient fails to
conceive after having a child. |
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How conception occurs.
Conception results from the fertilisation of the ovum
(female gamete) by the spermatozoa or sperm (male gamete).
After ejaculation the sperms migrate towards the fallopian
tubes and fertilisation takes place in the fallopian
tubes. The usual life span of a sperm is estimated to be
about 24 hours; while the life span of ovum is estimated
at 12 hours. So a coitus to be capable of fertilisation,
must take place within twelve hours of ovulation (release
of ovum from the ovary). That certainly explains why some
married couples fail to conceive, though they are
potentially fertile. The intercourse should be able to
coincide with the short time after ovulation, when the
ovum is viable, so that chances of fertilisation are
there. And even then there are numerous factors like sperm
motility, viability of sperms, etc. before fertilisation
can eventually occur. |
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When does ovulation occur?
It has been concluded after considerable research that
ovulation most commonly occurs fourteen days before the
onset of the next menstrual period. For example, ovulation
will occur on the 14th or 15th day
in a 28 days cycle, and on the 10th day in a 24
days cycle. |
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Is it always the females fault if conception is
not occuring?
This is a misconception because conception depends upon
the fertility of both the partners. Any fault in either
partner can lead to inferetility. Studies have shown that
40% of infertility is due to the male partner. |
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What are the main causes of male infertility?
The commonest reason, is a low sperm count, which can be
attributed to various causes; |
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- Idiopathic i.e., when the exact
cause is not known.
- Varicocele It is a swollen
varicose vein in the scrotum, most commonly on the left
side. Blood accumulated in the swollen testicular veins
leads to increased temperature in the testis & damages
sperm production.
It can be diagnosed, by asking the patient to stand
erect and cough . The cord like structure from which the
testis hangs i.e., the spermatic cord, feels like a
"bunch of worms", on palpation.
- Duct blockage Infection like
gonorrohea, TB, filariasis; on surgery for hernia/hydrocele
may lead to blockage of the passage between the testes
and the penis. In this case sperms will be absent from
the semen(azoospermia)
- Hormonal imbalance Hormonal
imbalance due to pituitary or adrenal gland can lead to
infertility.
- Substance Abuse Exessive intake
of alcohol and/or drugs leads to decrease in liver
function and increase in levels of the hormone Estrogen
which in turn suppresses sperm production.
- Testicular factors like twisting
of testis leading to compromised blood supply;
undescended testes when the testes lie in the abdomen;
and damage due to exercise or heat can decrease sperm
production. Testes lie outside the body in the scortum
because they can produce sperms in a cooler environment.
So clothes like tight jeans, nylon briefs, and hot
baths/saunas, lead to damage to sperm production.
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Effect of long term medication- certain
drugs have an adverse effect on the sperm production. Some
of these are Antihypertensives- like reserpine,
methyldopa, guanethidine & propranolol
Corticosteroids
Anabolic steroids
Antipsychotics
Certain anti-cancer drugs |
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People working with harmful chemicals like lead, nickel,
mercury, anaesthetic gases, insecticides & pesticides and
x-rays, are at increased risk of suffering from decreased
sperm count. |
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Problems with ejaculation- Certain men
have problems with ejaculation like problem having an
erection (impotence) or inadequate erection for vaginal
penetration. |
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Problems with erection can be due to psychological factors
like performance anxiety, inhibitions against sex and due
to physical factors like neurologic defects, diabetes,
inadequate blood flow to the penis, and also to certain
hormonal problems.
Certain tests like monitoring for nocturnal erections and
measuring the blood flow through the penis may need to be
carried out.
A successful alternative that has come up is collections
of sperms by masturbation which later be used for
artificial insemination.
Another problem with ejaculation that some men face is
that the semen goes backwards into the urinary bladder
instead of being ejaculated through the penis. This can
occur in men who have had spinal injury or the ones
suffering from diabetes, causing improper contraction of
urinary bladder sphincter muscle. |
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Infections another common reason for
male infertility are infections like tuberculosis,
chlamydia, gonorrhoea and syphilis. Mumps can lead to
complications like testicular inflammation. Infections can
damage the male reproductive tract leading to duct
obstruction in some cases and decreased sperm production
in others.
These have to be treated by antibiotics and semen culture
can tell whether infection is controlled or not. |
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Can something be done to enhance fertility?
- Smoking & excessive alcohol intake is associated
with low sperm counts. These habits should be
discontinued.
- Stop using drugs such as body-building steroids &
illicit drugs. Other medication such as
antihypertensives should also be reviewed in the light
of effect on sperm count.
- Most importantly the frequency of intercourse should
be increased, so that chances of conception increase.
- Men should wear loose fitting underwear and cool
clothes and avoid high temperature baths like saunas
etc.
- It is advisable that when the couple is planning
pregnancy, intercourse is done in a proper position and
using proper technique. Lubricants such petroleum jelly
etc. should be avoided.
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Are there any investigations, which can help to
judge fertility status of a man?
A simple test is Semen Analysis. The
pre-requisites are
Abstinence from sex or masturbation for 4-5 days prior to
the day of test.
The sample given should not be more than half hour old
It should be collected in a wide-mouthed, clean jar by
masturbation.
The sample is to be kept at room temperature.
Other sophisticated tests like sperm viability test, sperm
penetration assay, antisperm antibodies test may be
required in certain cases.
Testicular function can be assessed by male hormone levels
in blood of the male, or by testicular biopsy. |
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Disclaimer - The contents of this site are
for informational purposes only. Always seek the
advice of a qualified physician for any doubts. |
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