Infertility
 

Infertility means failure to conceive within one or more years of regular unprotected coitus.

Factor responsible for fertility are:-

• Healthy sperm should be deposited high in vagina
• The ovum find into the uterine tube where it can be fertilized.
• Ovum move into the uterus.
   

Causes of infertility:-

1. Infertility occurs prior to puberty and after menopause.
2. Some times girl may be pregnant even before menarche and pregnant within few month of menopause.
3. Fertility rate is lower until 16-17 years and after35 years.
4. Conception is not possible during pregnancy. During lactation ,fertility is possible.
5. Both male and female responsible for infertility.
6. 30%males are directly responsible and in some cases 30% females are directly responsible for infertility.
7. Most of times both male and female are responsible for infertility (30%)
8. In some cases both female and male are fit but remains unexplained in spite of diagnosis and investigation with expert doctor and modern techniques.
    

1.  Defective Spermatogenesis
2.  Unable to deposit sperm high in vagina
3.  Default in seminal fluid (low fructose content)
4. Diabetes

In case of female

1. Tubal Factor: Defective ovum pick up, impaired tubal motility
2. Ovarian Factor: Main is an ovulation possible causes of ovulation are

                 * Obesity
                * psychological disturbances
                * psychotophic drugs
                * oral pill
                * Thyroid (Hypo 0r hyper function)
                * Adrenal (hyperplasia)
                * Premature ovarian failure

Treatment or clinical approach on infertility include:-

•  Investigation on age, duration of marriage, history of pervious marriage if any and proven fertility if any,
• Medical history should be noted for sexually transmitted disease.
• Study on surgery if any herniorrhaphy , operation on testes or surgery in genital area.
• Sexual history so that to know frequency of intercourse, whether partner experiencing discomfort or lack of satisfaction.
• Habit of both female and male about heavy smoking and alcohol.
• To general state of health physical examination should be done, and it also include examination of reproductive system.
• It also include routine urine and blood examination, sugar.
• In male seminal fluid analysis, such as fructose content in the seminal fluid, testicular biopsy, sex chromatin study, immunological test, presence of plenty of pus cell .
•  In case of female of females menstrual history is important, previous obstetric history including number of pregnancies and interval between every pregnancy related complications are to be noted. If someone have a infertility problem during second pregnancy then obstetric study should done.
• Observe sexual problem in female.
•  Whether female use some contraceptive or not
•  The most important factor in female is ovulation. The diagnosis of ovulation should be done as follows:
  . Menstrual history
  . evaluation of peripheral
  . Sonography
  . Laparoscopy
• In most cases couples are psychological disturbed, so that these couples are handle carefully and doctors try to decrease their tension.
• If anyone have minor defect then it should be dected. The defect or some faculty or weak point should be treated simultaneously or not one after other.
• Proper instruction should be given about overweight and underweight of male or female.
• Give instruction about excessive smoking or alcohol consumption.
• Give advice to have intercourse during midcycle.

In case of unexplained infertility those couples who have undergone a complete infertility treatment and not found any abnormalities during investigation are still remain infertile.