Infertility is defined as the failure to conceive after one or more years of regular unprotected coitus.
- Primary Infertility: The patient has never conceived.
- Secondary Infertility: The patient has had a previous pregnancy but fails to conceive subsequently.
Essential Factors for Conception
- Healthy Spermatozoa
- Ovulation (Ovarian Factors)
- Patent Fallopian Tubes (for sperm-egg interaction at the ampulla)
- Healthy Uterus for Implantation
Causes of Infertility
1. Male Factors
- Genetic Disorders:
- Klinefelter Syndrome (XXY)
- Undescended Testes (Cryptorchidism)
- Testicular Disorders:
- Varicocele → Increased temperature affects spermatogenesis
- Testicular Failure due to gonadotropin deficiency
- Idiopathic Testicular Failure (Sertoli-cell-only syndrome)
- Hormonal Imbalances:
- Hyperprolactinemia (linked to impotence)
- Hypogonadism (Low testosterone, LH, FSH)
- Obstruction of Sperm Transport:
- Vas deferens obstruction
- Epididymal obstruction
- Immunological Factors:
- Antisperm Antibodies affecting sperm function
- Lifestyle Factors:
- Heavy smoking & alcohol
- Nutritional deficiencies
- Radiation exposure
- Use of antihypertensives, anticonvulsants, antiandrogens
2. Female Factors
a) Ovulatory Dysfunction
- Anovulation / Oligo-ovulation
- Decreased ovarian reserve (DOR)
- Luteal phase defect (LPD)
- Polycystic Ovary Syndrome (PCOS)
b) Tubal Factors
- Tubal Blockage (Salpingitis, Endometriosis)
- Impaired Tubal Motility (Damaged ciliary movement)
- Tubal Adhesions (Post-infection, post-surgery)
c) Uterine Factors
- Chronic Endometritis
- Fibroids & Synechiae (Asherman’s Syndrome)
- Congenital Malformations (Septate Uterus, Bicornuate Uterus)
d) Cervical Factors
- Congenital Cervical Anomalies
- Chronic Cervicitis
- Cervical Polyp
e) Vaginal Factors
- Vaginal Atresia
- Transverse Vaginal Septum
- Narrow Introitus
- Dyspareunia (Painful intercourse)
f) Peritoneal Factors
- Peritoneal Adhesions
- Pelvic Endometriosis
g) Age-Related Factors
- Advanced age (>35 years) leading to decreased ovarian reserve
h) Coital Factors
- Inadequate coital frequency or improper technique
- Anxiety, Dyspareunia, Vaginismus
- Use of lubricants affecting sperm viability
Investigations for Infertility
Male Investigations
- Semen Analysis:
- Sperm Count, Motility, Morphology
- Non-motile vs. motile sperm ratio
- Hormonal Assays:
- FSH, LH, Testosterone, Prolactin
- Testicular Biopsy:
- For Azoospermia (Absence of sperm in semen)
- Chromosomal Studies:
- Karyotyping for genetic abnormalities
Female Investigations
- Menstrual History & Ovulation Monitoring
- Hormonal Assays:
- FSH, LH, Estradiol, Progesterone, Prolactin, Thyroid Function Tests
- Endometrial Biopsy:
- For luteal phase defect
- Ultrasound (USG):
- Ovarian Follicular Study
- Hysterosalpingography (HSG):
- Evaluates tubal patency
- Laparoscopy & Hysteroscopy:
- Detects pelvic adhesions, endometriosis, tubal pathology
- Post-Coital Test (PCT):
- Evaluates sperm survival in cervical mucus
Treatment & Management
1. General Measures
- Psychological counseling & stress reduction
- Smoking & alcohol cessation
- Nutritional supplementation (Vitamin B, C, E)
2. Male Infertility Treatment
- Lifestyle modifications
- Testosterone therapy (for hypogonadism)
- Antibiotics for infections
- Surgical correction:
- Varicocele ligation
- Vasovasostomy (for vas deferens blockage)
- Assisted Reproductive Techniques (ART):
- Intracytoplasmic Sperm Injection (ICSI)
- Testicular Sperm Aspiration (TESA)
3. Female Infertility Treatment
a) Ovulatory Dysfunction
- Ovulation Induction:
- Clomiphene Citrate (50–100 mg/day)
- hCG injections
- Gonadotropins (FSH, hMG therapy)
b) Tubal & Uterine Factors
- Tuboplasty (for tubal block correction)
- Salpingostomy (for distal tubal obstruction)
- Myomectomy (for fibroids removal)
c) Cervical & Vaginal Factors
- Cervical mucus enhancement therapy
- Surgical correction of septa or stenosis
4. Assisted Reproductive Techniques (ART)
- Artificial Insemination (AI)
- Intrauterine Insemination (IUI)
- In Vitro Fertilization (IVF)
- Gamete Intrafallopian Transfer (GIFT)
- Zygote Intrafallopian Transfer (ZIFT)
