INFERTILITY

    







A  couple is considered to be infertile if after a year of  regular intercourse ,a pregnancy  does not occur. In the past, infertility was always blamed on the woman but today, it is a known fact that in many cases  of infertility, the reason could also lie with the man.

In some cases of infertility, the woman could have a fertility problem. The man could also have a fertility problem in the same proportion or factors that affect them both could be present.
For pregnancy to occur, the man's sperm has to be ejaculated into  the upper vagina. They then wriggle their way through the cervix, swimming up between the seaweed-like strands of mucus which stretch downwards  from the cells which line the cervical canal. They have to negotiate the cavity of the uterus and by the time they have done this, of the millions ejaculated, only hundreds remain active. They  then have to get through the narrow opening joining the cavity of the uterus and the hollow tube of the oviduct. Only a few dozen spermatozoa succeed in doing this.They then swim along the oviduct, against the current as it were to reach the outer portion. If this  occurs just at the time when the egg has been expelled from the ovary, and if  the egg has been taken up  by the fine finger-like  projections at the end of the oviduct, conception may occur. If conception takes place, the fertilized egg has to pass down the oviduct again, spending three days in the process during which time it has divided and the original cell is now a collection of cells, still within the shell of the zona pellucida. The fertilized egg reaches the cavity of the uterus three days or so after conception and implants itself into the soft juicy lining of the  uterine cavity. If  all goes well, it now grows and becomes a baby. If all doesn't go well, an abortion occurs which may or may not be noticed by the woman.
Considering the long journey made  by the sperm to fertilize the egg and the long journey made by the fertilized egg to reach the uterine cavity and implant itself there, it is obvious that some factors could cause infertility.

THE MALE FACTOR
A man may not manufacture any spermatozoa or due to ill-health which may have damaged the tube linking his testicles to the collecting area in his prostate gland, the sperm may fail to reach   the collecting areas.  The spermatozoa may not be many in number or they may be weak in strength in which case they may not be able to swim up  the genital tract of the woman. Finally. the man may not be able to ejaculate. Because of these possibilities, the doctor has to find out if the man had previously had any veneral disease  which may have damaged the testicles or the vas deferens. The doctor may also enquire about the man's habits because excessive smoking and drinking could reduce the sperm production as well as reduce the frequency of intercourse. A specimen of the man's sperm has to be investigated to find out the quality as well as the quantity of the sperm. If the test shows that the man's sperm has poor quality or that the sperm count is low,  this can be corrected with certain treatments.

THE FEMALE FACTOR
 If  the  woman fails to produce an egg, obviously  pregnancy cannot  occur. Before the age of 18 and after the age of 38, ovulation may not be very regular. But  between these years, most women ovulate every month. Most doctors determine if ovulation has occurred  by measuring the level of the hormone progestrone in a blood sample taken a week before menstruation. If lack of ovulation is confirmed over several months, an ovulating drug may be prescribed.

THE OVIDUCTAL FACTOR
The sperm has to pass upwards along the the oviduct to reach the egg., and the fertilized egg has to pass downwards along the oviduct to reach the uterine cavity. If  the oviduct is blocked, these essential events cannot take place.The next step in the investigation of infertility after the man has being found to be normal and the woman to be ovulating is to find out if the oviducts are clear. A test is carried out on the woman which will show if her oviducts are normal and unobstructed so that sperm can wriggle along them to reach the ovum. If the test shows that the oviducts are blocked somewhere along their course, the chances of pregnancy occuring is obviously reduced. If  the oviducts are blocked, it can be corrected by surgery although this must be done by  a specialist in micro surgery.
If a woman's oviduct is so damaged that surgery cannot help,  the couple may be assisted through   IN VITRO- FERTILIZATION. This is a procedure whereby  some of the woman's egg is removed when ovulation is about to take place.The egg is added to a specimen of the husband's sperm .When fertilization takes place, the fertilized egg is  removed from the  test tube and put back into  the woman's uterus where hopefully it develops into a baby.

DONOR INSEMINATION
This is a procedure whereby if the man is found to be sterile, the couple decide to let the wife bear the child of an unknown donor. The procedure is called DONOR INSEMINATION. When the woman is ovulating, the semen from the donor is injected into her cervix and upper  vagina. The procedure is repeated the next day. Two or three inseminations a month are required for three to six months before pregnancy occurs.