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Sterility




Sterility is also called Infertility. Infertility means not being able to become pregnant after a year of trying. If a woman keeps having miscarriages, it is also called infertility. Lots of couples have infertility problems. About a third of the time, infertility can be traced to the woman. In another third of cases, it is because of the man. The rest of the time, it is because of both partners or no cause is found.

If you think you might be infertile, tell your doctor. For a man, a first step is often a sperm test. For women, doctors run tests to see if their ovaries work properly. Women in their 30s who have been trying to get pregnant for six months should consider seeking help. A woman's chances of having a baby drop rapidly every year after age 30.

Drugs or surgery are common treatments. Happily, two-thirds of couples treated for infertility go on to have babies.

Causes

Infertility does not have a single cause because successful pregnancy is a multi-step chain of events. Simply described, pregnancy includes the following steps: A woman’s ovaries must be able to release a viable egg, which then must be able to travel down the fallopian tube. The man must be able to ejaculate, and his sperm must be able to travel to the fallopian tube. The sperm and egg must unite to fertilize the egg. The fertilized egg must attach to the inside of a receptive uterus (or implant) and be nurtured by the body to allow the fetus to develop and grow until it is ready for birth.

Problems with any of these steps can lead to infertility.

The cause of infertility can rest in the woman or the man, or can be from unknown factors or a combination of factors. In some cases, environmental factors can contribute to infertility. In other cases, genetic conditions or other health problems are the main cause of infertility.

Female infertility
As explained above, female fertility requires a variety of conditions to be successful. If even one of these conditions is not met, or is not met for the right amount of time, the pregnancy may either not happen or it may end before birth. Most cases of infertility in women result from problems with ovulation. Some conditions affecting ovulation include premature ovarian failure, in which the ovaries stop functioning before natural menopause, and polycystic ovary syndrome (PCOS), in which the ovaries may not release an egg regularly or may not release a viable, healthy egg. Among women who have PCOS, even when a healthy egg is released and fertilized, the uterus may not be receptive to implantation of a fertilized egg, which results in infertility.

Other causes of infertility might include:
  • Blocked fallopian tubes due to endometriosis, pelvic inflammatory disease, or surgery
  • Physical problems with the uterine wall
  • Uterine fibroids
A woman’s risk for infertility can also be affected by certain lifestyle and environmental factors, including (but not limited to):
  • Age
  • Stress
  • Poor diet
  • Being overweight or underweight
  • Smoking, drugs, and alcohol
  • Medication
  • Environmental toxins
  • Genetic conditions, such as being a carrier of Fragile X syndrome
  • Other health problems, such as sexually transmitted diseases
Male infertility
The male fertility process involves the production of mature sperm and getting the sperm to reach and fertilize the egg. Although it may seem to be a simpler process than female fertility, male fertility also requires many conditions to be met: the ability to have and sustain an erection, having enough sperm, having enough semen to carry the sperm to the egg, and having sperm of the right shape that move in the right way. A problem meeting any of these conditions contributes to infertility.

Like female infertility, male infertility can result from physical problems, such as testes that don’t make enough normal sperm, hormonal problems, and lifestyle or environmental factors, including (but not limited to):
  • Age
  • Stress
  • Exposing the testes to high temperatures, which can affect the ability of the sperm to move and to fertilize an egg. For instance:
    • Cryptorchism is a condition where the testes do not descend into the scrotum. Although it does not usually affect the ability to have and sustain an erection, cryptorchism means that the testes are still inside the body cavity,which has a higher temperature than the external scrotum.
    • Tight underwear-For some men, wearing tight underwear can also increase the temperature of the testes.
  • Smoking, drugs, and alcohol
  • Medications
  • Environmental toxins
  • Genetic conditions, such as Klinefelter syndrome
  • Other health problems
But, in some cases, health care providers cannot determine a cause for infertility in the man or woman. In addition, some known causes of infertility do not have any treatments

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Diagnosis

Although not getting pregnant is an indication of possible infertility, only a health care provider can provide a diagnosis of infertility. Those who suspect they are infertile should see their health care providers, including:
  • Couples who have been trying to conceive for a year without getting pregnant
  • Women who have experienced menstrual irregularities or who have had endometriosis or uterine fibroids
  • Women who have gotten pregnant but who have had more than one miscarriage or stillbirth
  • Men and women with certain genetic conditions
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Treatments

There are a variety of ways to treat infertility, including:
  • Medication
  • Surgery
  • Intrauterine insemination/artificial insemination (woman is injected with carefully prepared sperm from the husband, partner, or a donor)
  • Assisted reproductive technology (ART), such as in vitro fertilization
Most often, health care providers treat infertility with medication or surgical repair of the reproductive organs. In addition, lifestyle changes may also help alleviate infertility, such as reducing stress, diet modification, stopping use of drugs or alcohol, or reducing the temperature around the testes. It is important for the couple to recognize and discuss the emotional impact that infertility has on them as individuals and together and to seek medical advice from their health care provider.

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Prognosis

A cause can be determined for about 85- 90% of infertile couples. Appropriate therapy (not including advanced techniques such as in vitro fertilization) allows pregnancy to occur in 50 - 60% of previously infertile couples. Without any treatment intervention, 15 - 20% of couples previously diagnosed as infertile will eventually become pregnant. Although infertility itself does not cause physical illness, the psychological impact of infertility upon individuals or couples affected by it may be severe. Couples may encounter marital problems, as well as individual depression and anxiety.

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Prevention

Because infertility is frequently caused by sexually transmitted diseases, practicing safer sex behaviors may minimize the risk of future infertility. Gonorrhea and chlamydia are the two most frequent causes of STD-related infertility. STDs are often asymptomatic at first, until PID or salpingitis develops. These inflammatory processes cause scarring of the fallopian tubes and decreased fertility, absolute infertility, or an increased incidence of ectopic pregnancy.

Mumps immunization has been well demonstrated to prevent mumps and its male complication, orchitis. Immunization prevents mumps-related sterility. Some forms of birth control, such as the intrauterine device (IUD), carry a higher risk for future infertility. However, IUDs are not recommended for women who have not previously had a child. Women selecting the IUD must be willing to accept the very slight risk of infertility associated with its use. Careful consideration of this risk, weighed with the potential benefits, should be reviewed and discussed with both partners and the health care provider. Early diagnosis and treatment of endometriosis may decrease the risk of infertility.

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Information obtained from National Institute of Health
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