According to the World Health Organization, infertility is defined as the inability of couples to have children after having had at least one year of sexual intercourse without the use of contraceptives. In the whole world, 10-15% of married couples are infertile, which is about 11% to 13% in our country, that is, one out of every six couples does not own one. About 40 percent of men’s infertility problems are, 40 percent are women and about 10 percent are related to both. About 10% of couples also do not know about infertility. In other words, in these couples, both individuals do not have any problems with existing tests, but they do not have children for unknown reasons. Of course, it should be noted that infertility means not the production of gametes, but the inability to give birth to a live baby. For example, in humans, mild illness can be the cause, or after having a vasectomy produces a potential sperm, but in practice it can not have a baby. The same is true for women who do not have congenital uterus, and after the abortion of fallopian tubes.
Infertility in women- causes
The most common cause of female infertility is abnormal ovulation. This condition may be due to a defect in the functioning of the hypothalamus, resulting in impaired pituitary gland stimulation. In this case, sufficient amounts of LH and FSH are not produced to stimulate the puberty of the follicles in the ovary. Thyroid, diabetes, hyperprolactinemia, adrenal insufficiency and liver disease may interfere with hypothalamic or pituitary functions and prevent follicular growth, ovulation, or the survival of corpus luteum (which is essential for the survival of pregnancy). Also, stress, trauma, weight variations, loss of appetite and excessive exercise may play a role in ovulation.
Disorders of the uterine tubes
In some women, uterine tubes are completely or incompletely closed. As a result, the sperm does not reach the egg. Uterine tubes closure
It can be due to infection, endometriosis or adhesions after surgery. These tubes may also be closed after an ectopic pregnancy.
Endometriosis is a condition in which the uterine lining (endometrium) grows and extends beyond the uterus and covers the uterine tubes and even closes them and in practice ovulation disrupts. About 70% of women with endometriosis are infertile.
Disorder of the uterus or uterus
Cervical abnormalities such as body building problems, uterine infections, or inappropriate quality of the uterine secretions can cause infertility. On the other hand, the malignant tumors of the uterus or some of the wounds in the uterus are responsible for infertility.
Infertility in men- Causes
Most male infertility is due to a decrease in the number of sperm (oligospermia), abnormal sperm (teratosispermia), or impaired spontaneous motor osteonospermia (asthenospermia). In these cases, the chance of fertilization is reduced and the infertile man is considered.
Oligo-spermatogenesis: The number of sperm is less than 20 million per milliliter of semen.
Asthenospermic disorder: Low sperm motility. For a sperm to swallow the fallopian and reach the egg to fertilize it, it needs proper motor power. Asthenospermic disorder, in which less than 40% of sperm can move at right speed in a direct direction, is an infertility disorder.
Teratosulosis disorder: is the sperm motility disorder.
Factors affecting the number, shape and movement of sperm
Some chronic infections such as tuberculosis, gonorrhea and long febrile illness that interfere with testicular function. Infectious diseases with inflammatory conditions such as mumps can cause genital or inflammatory infections, and testicles disappear in the male. About 25% of men who have mumps after puberty become infertile.
Hormone disturbances affect the production of hypothalamus and pituitary or sex hormones on production of testosterone and sperm production, and cause infertility problems in men. The gonadotropin releasing hormone (GnRH) secretes from the hypothalamus and, by acting on the pituitary, stimulates the production and release of LH and FSH hormones. FSH produces sperm production in spermatozoa and LH, stimulating production of testosterone by leydig cells. Disruption of the production and secretion of these hormones may affect the production and quality of sperm.
Immune system disorders:
Immunological disorders are considered as one of the factors of infertility. Anti-sperm antibody is an auto-antibody in some men that reduces sperm movement or binds them together.
Abnormalities related to body building
Varicocele: Abnormal ventricular torsion of the venous vein over the testicles. Varicocele can reduce sperm production or reduce the quality of sperm production, but all sorts of varicocele have no effect on sperm. The cause of this phenomenon is longer venous drainage of the testicles of the left testicles to the renal vein and also the vertical angle of the vertebra to the right.
- Semen Analysis
- Fructose (seminal fluid)
- Seminal Zinc
- Thyroid hormones
- ۱۷- OH progesterone
- Anti Mullerian Hormone (AMH)
Terms of testing:
- The sample should be prepared between 3 and 5 days after the last sexual contact or ejaculation, and a sample that is collected earlier than 2 days or 7 days after the closest proximity is not appropriate for the test.
- The best sample is a sample made by artificial stimulation (without the use of soap, gel, shampoo) with a slightly damp hand and collected in a special container provided by the lab. And no condom should be used to collect the sample.
- It is better to take samples in the lab; otherwise, the lab should be delivered within less than half an hour.
- Inform your laboratory if you are taking any medication during your spermatogonum.