a couple is infertile, this means that they have been
unable to conceive a child after 12 months of regular
sexual intercourse without birth control. The term
“Primary infertility” is used medically
to denote for whom they have never had a child and
the term “Secondary infertility” means
that the infertile person has had one or more children
in the past, but a medical problem is impairing fertility.
Multiple body functions must be operating
normally in order to conceive a baby and carry a pregnancy
to term. The man must be producing healthy, motile,
swimming sperm in enough quantities to fertilize an
egg cell. The woman's cervical mucus must be at the
right PH and in consistency to facilitate the sperm's
journey to the reproductive tract; the ovaries must
release healthy eggs; her fallopian tubes must be
free of blockages; the uterine environment must be
suitable for implantation of a fertilized egg; and
all along the way, the endocrine system must be secreting
various reproductive hormones in the right sequence
and at proper levels for the pregnancy to occur.
Every one is curious to locate the problem and find
remedy to it. Every one needs basic knowledge in male
reproduction and female reproduction.
How to confirm infertility?
Medical History and Physical Examination
The first step in any infertility work
up is a complete medical history and physical examination
of both partners. Sexual technique and timing, menstrual
history, lifestyle issues, such as smoking and drugs,
alcohol and caffeine consumption and a profile of
the patient's general medical and emotional health
can help the physician decide on appropriate tests.
The basic test to evaluate a man's
fertility is a semen analysis. To perform this test,
a man collects a sample of his semen in a collection
jar during masturbation either at home or at the laboratory.
A man should abstain from ejaculation for four days
before the test, because each ejaculation can reduce
the number of sperms. A semen analysis should be repeated
at least three times over several months. The analysis
reports on any abnormalities in sperm count, motility
and morphology, as well as any problem in the semen.
A low sperm count should not be viewed
as a definitive diagnosis of infertility but rather
as an indicator of a fertility problem. Counts of
less than 20 million per milliliter are currently
considered strong indicators of infertility, although
pregnancy is sometimes possible even with such low
Motility is the speed and quality of
movement. It is graded on a 1 to 4 ranking system.
Grade 1 sperm wriggles sluggishly and makes little
Grade 2 sperm moves forward, but is either very slow
or does not move in a straight line.
Grade 3 sperm moves in a straight line at a reasonable
speed and can home on an egg accurately.
Grade 4 sperm is as accurate as Grade 3 sperm, but
moves at terrific speed. Sperms that clump together
may indicate that antibodies to the sperm are present.
Morphology is the structure of the
sperm. About 60% of the sperm should be normal in
size and shape for adequate fertility. Determining
the morphology of the sperm is particularly important
for the success of the fertility treatment.
The semen itself is analyzed for abnormalities. Most
men ejaculate 2.5 to 5 cc of semen. Amounts of 2.5
cc may indicate of prostate problems or frequent intercourse.
Normal semen is liquefied within 20 minutes by certain
enzymes. If it remains sticky, fertility may be impaired.
An absence of fructose indicates that an obstruction
has occurred either in the vas defererens or in the
epididymis, since fructose is added to the semen in
the epididymis. Conversely, if there is fructose in
the semen but no sperm, then the channel from the
epididymis is open but there is a defect in sperm
production. Thus infections may be detected.
Blood tests are taken to evaluate hormone
levels. Blood studies include FSH, LH, testosterone,
estrogen and progesterone as prescribed to the appropriate
partners. Blood studies for thyroid function and prolactin
levels are also measured.
The postcoital is designed to evaluate
the effect of a woman's cervical mucus on a man's
sperm. To perform this test, a woman is asked to come
into the physician's Laboratory within two to 24 hours
after intercourse at mid-cycle, when ovulation occurs.
A small sample of cervical mucus is obtained and examined
under a microscope. The problem is detected if the
physician observes no surviving sperm or no sperm
at all. Imaging studies.
Ultrasound is a noninvasive
method for evaluating the uterus and ovaries by using
sound waves rather than by x-rays and should be the
first procedure. A series of ultrasounds may be an
accurate and cost effective method for tracking ovulation.
Fibroid tumors and ovarian cysts can be diagnosed
as well. In males, ultrasonogram is helpful to detect
the tumors varicocele
Hysterosalpingography is performed
for the female partner to discover possible blockage
in the fallopian tubes and abnormalities in the uterus.
To determine this, a tube is inserted into the cervix
through which a dye is injected. The dye passes into
the uterus and up through the fallopian tubes. If
the dye is seen emerging from the end of the tube,
it is proved of no blockage. The procedure may reveal
other conditions, including endometrial polyps, fibroid
tumors or structural abnormalities of the uterus and
tubes. In some cases, it may restore fertility, probably
by clearing away tiny tubal blockages.
Occasionally, a testicle biopsy
may be performed for male partner in which tissue
samples are removed under anesthesia. A biopsy is
most useful for detecting obstruction in the transport
system, when sperm production looks normal, but the
count is low.