Primary infertility is defined as inability to conceive after one year of unprotected intercourse. Approximately 30 percent of cases pathology is found in the man alone and in another 20 percent both the man and woman are abnormal.
The causes of infertility can be classified as sperm related, ova related and lastly due to structural defects in the uterus and tubes.
What are the major factors affecting sperm production?
Oligospermia is the term used to describe the condition when the sperm count is low. If there are no sperm at all in the semen sample, the condition is termed azoospermia. Infected semen can be a cause of infertility.
Counts may be low if you have low Androgen from any cause or Pituitary hormones like LH/FSH are less. Injury or infection to Testes can make your count low. Some other common causes are as follows:
- Smoking over 20 cigarettes a day has been shown to reduce both the sperm count and the sperm motility to quite a major degree.
- Excessive alcohol intake will lead to infertility mainly because a man loses both the inclination and the ability to rise to the occasion! Alcohol can also lower the production of sperm and of the male hormone testosterone.
- Varicocele is a term used to describe a condition where there are varicose veins around the testicle and vas deferens. In the case of varicoceles, there is an increase in the blood flow and temperature around the testicle. Even a small varicocele may be significant and affect sperm production.
Male Infertility Investigations
1. Semen Analysis: Should be done 48-72 hours of abstinence. A normal semen analysis will show:
- A volume greater than 2 ml.
- A count of more than 30 million sperm per ml
- A motility greater than 60% within one hour of production
2. Hormonal investigation: LH, Testosterone, Prolactin in addition to an ultrasound of the scrotum
There are many reasons for infertility in women. Some of these are:
- Anovulatory cycles (menstrual cycle without ovulation)
- Amenorrhea (suppression or absence of menstruation)
- Polycystic ovaries (PCO)
- Prolactin levels too high
- Anatomical problems
- Fallopian tube defects from a previous surgery or past pelvic inflammations will prevent the eggs from traveling through the tubes.
- uterine fibroids
Female Infertility Investigations
Hormonal investigations like TSH/ free T4, LH/ FSH, Prolactin, 21-day progesterone, Ultrasound scan might include the baseline workup.