
INFERTILITY
MEN
Infertility in men is defined as the inability to impregnate a woman after one year of regular sexual intercourse due to a number of reasons including spermatogenesis abnormalities.
Sperm is produced in the seminiferous tubules of the testicles. Like tadpoles, the spermatozoon moves by propulsion or the thrusting movement of the tail. The young sperm passes through a convoluted tube called epididymis towards the vas deferens where it matures. It has a life span of about three weeks. A normal semen analysis should contain more than 20 million sperm per ml with a motility rate of greater than 75%. Usually, a sperm count or rate of motility that falls below these parameters results in failed pregnancies.
- EPIDIDYMIS
- SEMINIFEROUS TUBULES
- TESTICLE
- SPERM
- VAS DEFERENS
As the spermatozoa enter the vaginal canal, it proceeds to the uterine cavity through the cervical canal and must reach the ovum in the fallopian tubes where fertilization of the egg occurs. Any disruption in these events may result in infertility.
Infections – A Cause of Infertility
Infections can cause abnormalities in the production of sperm, or cause an obstruction in the passageway, or affect the sperm itself.
Alexander and Berger wrote: “The belief that inflammation and infection in the male genital tract can adversely affect fertility is widely held.” A trend towards a decreasing sperm count in men has been observed from 1934 and may be related to the increasing incidence of these infections in men.
For example, Gonorrhea and Chlamydia, silent as they are, can trigger a potentially sterilizing infection of the testicles and epididymis, and rarely, the vas deferens. Other bacteria such as the Chlamydia trachomatis, Ureaplasma urealyticum and Mycoplasma hominis may colonize the tail of the sperm; or some coliforms and even the fungus called Candida Albicans may cause agglutination of sperm, reducing its motility and killing them (Colleen and Mardh).
Additionally, Brown observed phagocytosis (ingestion) of sperm by Trichomonas vaginalis (a protozoan) and other investigators (Krieger) have noted that sperm mobility is decreased in the presence of large numbers of Trichomonas vaginalis in vitro.
Investigation
The examination of infertile men begins with complete laboratory tests for genitourinary tract infections whether or not they are symptomatic. Sperm analysis is also done.
A most important point is to educate the partners on all aspects of infertility to ensure their cooperation. Instruction materials are presented to encourage doctor-and-patient interaction.
After the infection is treated or ruled out as the cause of infertility and the sperm count and/or motility persist to be abnormal, hormonal studies are also done, including biopsy of the testicles, to determine if the problem is in the production of sperm. The patency of the fallopian tubes are also ascertained.
WOMEN....
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