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Male
Infertility
Male infertility can be the cause of 40 percent of all infertility
problems.
It can be due to impotence or to defects in the male's sperm
specifically their concentration, shape, motility (ability to swim),
and ability to penetrate the ovum. An infertile male may have too
few sperm (a sperm count of less than 20 million per milliliter is
usually inadequate for fertilization), or he may have too high a
proportion of abnormal or defective sperms. Abnormal sources of heat
or constriction can raise the temperature of the scrotum and thus
damage sperm quality.
Male infertility may also be caused by obstructions in or an absence
of the ducts (usually the epididymis) through which the sperm cells
must pass on their trip from the testicles to the urethra during
ejaculation.
The main causes of male infertility are:
-
Deficiencies of
sperm production.
-
Deficiencies in
maturation of sperms.
-
Mumps, with
destruction of the testes.
-
formation of
antibodies to sperm by the male or the female.
The most important tests
of male infertility are examination of the semen and a specimen of
the tissue of the testes. Evaluation also includes chromatin
analysis and observation of thyroid, adrenal, and pituitary
function.
Female
Infertility
Infertility in the female is related to many factors. Mainly, the
faulty production of ova, or the interference with their union with
spermatozoa.
Failure to ovulate, or produce an ovum (egg), is a common cause of
female infertility and usually results from hormonal imbalances,
particularly the stimulation or suppression of the ovaries by other
glands such as the pituitary, thyroid or adrenals. The result can be
an inadequate production of female hormones, and a consequence
disruption of normal ovulation.
Blockages of or an obstruction within the fallopian tubes in which
an ovum is fertilized by a sperm is also a common cause of
infertility in the female. The tubes may become blocked owing to
endometriosis or inflammations.
Vaginal causes are usually uncommon, but abnormalities of the cervix
are among the most important causes obstructing the passage of
sperm.
The sperm enters the uterus through the cervix and, from the uterus,
move into a uterine or fallopian tube, where fertilization of an
ovum takes place. During the few days prior to ovulation, the cervix
normally secretes thin, warey mucus that is beneficial to sperm
survival and migration.
Various factors, such as infection or estrogen deficiency, may
decrease the quality of the mucus. Or may even be lethal to sperm
because of hormonal abnormalities or unbalanced acid-alkaline
ratios.
Treatment
Treatment methods depend largely on the cause of infertility.
A blockage of the sperm passages in both, male or female can be
treated by surgery.
Treating hormonal imbalance in the female using several drugs has
been very successful.
On the other hand, these fertile drugs increase a woman's chances of
having multiple twins owing to the release of more than one egg at
ovulation under the influence of the drug.
Psychological problems may be a cause of infertility. Normal
fertility may return after psychological counseling.
Artificial insemination:
This method is the most popular
alternative treatment. This is useful in cases which the male has
enough sperms but can not produce pregnancy for some reason or
another. He can donate semen, which then can be concentrated in the
lab. Then injected into the woman's uterus.
Invtro fertilization IVF:
In this method, an ovum is removed from the woman, fertilized by the
sperm in the lab. To form the fertilized egg, which then allowed to
divide in to many embryonic cell. This embryo is then injected into
the woman uterus.
Intracytoplasmic Sperm Injection (ICSI)
Edited by: UCL
This technique involves injecting a single sperm
directly into the centre of an egg and is
performed under a microscope using a very fine
needle. ICSI is used when there is a severe male
factor problem that makes it more difficult for
the sperm to penetrate the outer shell of the egg,
for example sperm with poor movement (motility)
and for example when there is a low sperm count,
thus ensuring that one sperm will penetrate the
egg. ICSI can also be used when for example there
has been poor fertilisation of eggs during
conventional IVF treatment of mixing sperm and
eggs.
There is not yet any clear evidence whether ICSI
results in higher rates of birth defects. The
number of babies reported to have major birth
defects, such as cleft palate, is between 1 and 5%
in both the general population and in babies born
following ICSI. Studies suggest that minor
abnormalities occur in up to 20% of ICSI babies,
compared to up to15% of the population. More
studies are needed in order to gain further
insight into these possible effects.
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