WHAT IS INFERTILITY?
The basic definition of infertility is the inability of a couple to achieve pregnancy following a defined period of unprotected intercourse – usually one year for the younger couples and six months for the older couples or the inability of the woman to carry a pregnancy through to life birth. Hence a woman who has had only miscarriages may be considered infertile.

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WHAT IS Primary Infertility?
This means that the woman has never been pregnant since her birth. The man can also be classified in this category if he has an absolute factor precluding formation of sperm.

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What is Secondary Infertility
This means that one or more previous pregnancies have occurred in the woman, and that she is now finding it difficult to become pregnant or she is having difficulty carrying the pregnancy. The man can also be classified as secondary infertility if he has fathered a child before, but has some factors now that make it impossible for him to father more children. Such condition can be caused by infections, surgery of the reproductive tract or illness.

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What is Sterility?
When a woman or man is said to be sterile, it implies that some absolute factors preclude conception. This could be temporary - (as in some reversible conditions like: the use of contraceptives tubal ligation to postpone pregnancy), or permanent factors like male testicular castration or removal of the woman's womb (hysterectomy) and her two ovaries (oophorectomy). There may be a genetic lack of the afore-mentioned organs either in the male or female.

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What is the difference between infertility and sterility?
Infertility has a less ominous connotation than sterility. infertility can be treated successfully when the factors have been identified, but it is not the same for sterility which denotes factors that cannot be corrected as some of them may be genetic in origin. Even when one partner is sterile, current assisted conception technology has made it possible for the couple to have children with at least one partner's gamete implanted into a surrogate mother if the female has the problem or by the use of donor sperm if the man has the problem.

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When will a couple be considered infertile?
A couple is considered infertile if pregnancy has not occurred after one year of regular unprotected intercourse.

NOTE: Normally, 75% of couples will conceive within six months of trying to conceive without medical help, and 85% will achieve pregnancy by one year. For the remaining unfortunate couples, the dream of becoming parents through unassisted conception become elusive. If a young couple has been trying to conceive for twelve to eighteen months without success, it will be prudent for them to seek medical help and undergo complete evaluation of both husband and wife.

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When will a young couple seek for medical help and undergo complete evaluation?
If the young couple has been trying to conceive for twelve to eighteen months without success.

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When will an older couple seek for medical help and undergo complete evaluation?
After six months of trying to conceive naturally without success.

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What is the principal reason for this decline of fertility in older woman?
It is because of diminished ovarian reserve. Theoretically, the follicles in any woman is as old as the woman herself. All the follicles a woman possesses are present at her birth. As the woman grows older, her follicles undergo cyclic atresia.

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How is diminished ovarian reserve characterized?
This is characterized by shortened cycle intervals and irregular cycles; elevated FSH , low Estradiol and a low Inhibin B in early follicular phase of her cycle.

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When is the age range for maximal fertility in a woman?
when a woman is about 20-24 years and it is the best time to get married and plan a family.

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What is the probable chance of a woman experiencing a miscarriage during her reproductive years?
The woman's chance of miscarriage increases with age. For example, a 20 year old pregnant woman has a 12% chance of miscarriage; a 35 year old woman has an 18% chance of miscarriage; a 40 year old woman has a 33% chance of miscarriage. Women who are older than 44 years who become pregnant have a 53 % chance of miscarriage.

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What is the advice you will give to a lady that feel reluctant over marriage but cares about having children?

1. Do not postpone marriage until your late thirties or early forties.
2. Do not postpone marriage until you get all your education
3. Do not postpone marriage until you get all your economically stable
4. Do not postpone marriage until you attain all other life objectives and aspirations

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Apart from medical problems, can other things possibly cause couple's infertility?

1. The couple's lifestyles and work schedules don't allow correct timing of intercourse during the woman's ovulation period.
2. The man’s work location may be hundreds of kilometers away from the wife’s place of work and they only meet on weekends or public holidays which may not correspond with the woman’s ovulation time.
3. Sometimes the living conditions such as living with parents, relatives or house helps denies the couple the privacy and relaxation they need to cultivate good sexual relationship.
4. Sometimes, mere ignorance of both the female and male anatomy of the reproductive system and the couple's individual expectations of one another may contribute to their inability to become pregnant.
5. D&C (dilatation and curettage) done to procure illegal or legal abortion by unskilled individual
6. Fibroid operation often called myomectomy by untrainned specialists

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What are the basic pre-requisites for achieving normal conception?

1. The husband's gonads (testes) must be normal to produce sperm of reasonable quantity and quality.
2. There must not be any form of obstruction or difficulty in producing the sperm as in the case of erectile dysfunction and depositing it into the wife's vagina.
3. The sperm must have access into the cervical canal. It is from here that the sperm can ascend into the uterus (womb), and then to the fallopian tubes where union of the sperm and egg usually occur.
4. The endocervical mucus and the vaginal environment of the woman must not be hostile but favourable for sperm survival.
5. The fallopian tubes must be patent and free of infection to allow for ascent of the sperm, fertilization of the egg, and descent of the fertilized egg into the endometrial cavity of the uterus for implantation of the blastocyst.
6. The ovaries must produce and release normal eggs.
7. There must be no obstruction between the ovaries and the fimbriated end of the fallopian tubes to allow easy access and pick up of the released eggs following ovulatioin.
8. The endometrium of the womb must be physiologically capable of permitting normal implantation of the fertilized egg and the continued embryonic growth.
9. The genetic make up of both the sperm and the egg must be reasonably normal to allow fetal growth to viability and lessen the incidence of early miscarriages and having a genetically deformed or abnormal child.

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What factors can cause male infertility?

1. Sexual Dysfunction and habits.
2. Immunological causes
3. Anatomic abnormalities: hypospadias, retrograde ejaculation, obstruction of the vas deferens, presence of varicocele.
4. Genetic causes: Oligospermic males have a high prevalence of Y chromosome submicroscopic deletions
5. Azoospermic males have mutations in the LH-beta subunit and FSH receptor.
6. History of testicular injury: surgery, torsion and mumps.
7. Severe allergic reaction.
8. Exposure to environmental toxins and excessive heat.
9. Use of medications especially local herbs, which can depress sperm count and quality. Other drugs to be avoided that cause sperm problems include but not limited to Cimetidine, spironolactone, nitrofurantin, sulfasalazine, erythromycin, tetracycline, steroids, chemotherapy drugs, methyl-dopa to mention a few.
10. Coital frequency: too frequent and too infrequent.
11. Androgen as well as estrogen
12. Many other drugs and local herbal medicines too numerous to mention here have been implicated in male infertility.
    

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    What are some possible causes of female infertility?
    

    1. Ovulation disturbances - which include hormonal imbalance.
    2. Tubal problems- PID, Tubal blockade, Pelvic adhesions.
    3. Uterine and endometrial factors- Fibroids, malformations
    4. Cervical factors-Stenosis.
    5. Nutritional deficiencies.
    6. Genetic factors.
    7. Aging of the reproductive system.
    8. Immunologic factors
       

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       What is the primary function of the male’s reproductive system?
       The male reproductive system has many functions-production of sperm and its ability to effect fertilization when in contact with the woman’s egg, hormones that the man's body needs to function well etc.
       

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       How do you perform initial evaluation for the male partner?
       

       1. Detailed personal history.
       2. Complete physcial examination.
       3. Appropriate investigations and laboratory studies including sperm studies.
       
       

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       When interviewing an infertility man, what are the likely questions to ask?
       

       1. Previous marriage or relationship; if married before, did he ever father a child? Has he legitimately or illegitimately pregnanted a woman before?
       2. Previous medical tests or treatments for infertility. These will include the use of local herbs and other self medications.
       3. Previous surgical procedures: such as hernia repair, hydrocele, or genitial injuries. A history of a hernia or hydrocele repair as an infant or child should raise the suspicion that the vas deferens may have been compromised or destroyed during such an operation, with resulting unilateral or bilateral obstruction. Unskilled surgeon can also compromise the blood supplies to the testes during a hernia repair. This may affect sperm production resulting in low sperm count.
       4. Abnormalities. Venereal disease-exposure, swelling of testes, exposure to other infectious diseases, chronic illness, obesity, allergies, current or past medications or recent fever. The pathologic sequlae of mumps orchitis, acute testicular injury, or inflammation due to various infectious agents may lead to the destruction and sclerosis of the seminiferous tubules or obstruction of the efferent ductal system. A history of recurrent urinary tract infections, prostatitis or hemospermia should be noted, since leukocytes and bacteria may adversely affect sperm function. All these may lead to various abnormalities in the sperm of the male, making it impossible for effective fertilization of egg and eventual development of the baby.
       5. Various occupations may interfere with production of good quality sperm. These include, but not limited to: Exposure to X-ray and chemicals such as those in painting and printing. Excessive heat to the scrotum – as experienced by some drivers or bakers and those working in certain industries; prolonged and frequent hot baths and wearing of very tight pants. Extreme stress can also have deleterious effect on male fertility and can be a cause for sexual dysfunction.
          

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          What diseases that can cause low sperm count?
          

          1. Sexually Transmitted Diseases (STD)
          2. Viral Diseases
          
          

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          What is (are) the types of STD?
          

          1. Chlamydia
          2. Gonorrhea
          3. HIV (the virus that causes AIDS)
          4. Syhillis
       
       

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       Name some of the viral Diseases that can cause infertility.
       

       1. mononucleosis
       2. Hepatitis.
       
       

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       Is Staphlococus an STD?
       No. It is not a Sexually Transmitted Diseases and it is not in any real sense a cause of infertility.
       

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       What is Staphlococus?
       Staphlococus is a Gram positive cocci, facultatively anaerobic bacteria that is a part of normal human flora. Therefore every person has it and most of the time, it does not cause any illness to humans except under certain conditions.
       

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       What are the three species of staphlococus bacteria that are of medical importance to man and which can cause different kinds of illnesses to man under certain conditions?
       

       4. Staphlococus Aureus cause cutaneous infections, osteomyelitis, septicemia and endocarditis, Pneumonia, food poisoning (enterotoxin B)
       5. Staphlococus Epidermidis causes endocarditis, intravenous catheter infections, urinary tract infections, and ocular infections following eye surgeries.
       6. Staphlococus Saprophyticus causes urinary tract infections in young sexually active females.
       
       

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       Is Staphlococus the cause of low sperm count?
       Staphlococus is not the cause of low sperm count in most men.
       

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       What is Epididymitis?
       Epididymitis can be defined as the inflammation of that part of the testes where the sperm are stored.
       

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       Can Epididymitis cause severe depression in sperm count?
       Epididymitis cause severe depression in sperm count.
       

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       What are some of the infections that are notorious for rendering men infertile?
       

       1. mumps
       2. tuberculosis.
       
       

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       What damages do STD infections cause in female?
       pelvic infections, adhesions and blockade of tubes.
       

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       Is it advisable for men to abstain from sexual intercourse for a prolonged period?
       No. it is not good because prolonged abstinence will have a tendency to increase the volume of sperm but with a corresponding decrease in sperm concentration and motility.
       

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       Is it good to use jelly to facilitate easy penetration of penis into the vagina if you are having challenges with conception?
       Not advisable as some of these jellies, creams, and lotions may be harmful to the sperm including the ordinary petroleum jelly (Vaseline), which is toxic to the sperm cell.
       

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       What are the organic causes of a man's impotence?
       Diabetes, prostatitis, alcoholism, and drug addiction.
       

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       Can you list some drugs that can cause a man to be impotent?
       They are

       • tranquilizers
       • anti-hypertensive drugs
         1. guanethidine
       • antacids
         1. cimethidine ( H2-receptor antagonist).
       • Various drugs used in the treatment of cancer
       • Cyclophosphamide for treatment of kidney disease
       • The tranquilization produced by high doses or long term use of the phenothiazines
       
       

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