Infertility cannot be accurately defined because there are varying degrees. To a lay man, infertility is the inability of a couple to have a child within a period of years, but an average fertile couple have a 15 – 30 per cent chances of conceiving every month, if no contraception is used. Therefore, a useful definition of infertility is the failure of a couple to achieve pregnancy after regular, unprotected coitus for a period of 12 months of living together. This could either be primary or secondary.
For pregnancy to occur in a female, the major organs involved are: the ovaries, the uterine tubes, the uterus, the vagina, the external genitalia, the greater vestibular glands and the mammary glands.
In male infertility, an autoimmune reaction is suggested by the demonstration of sperm agglutinins in the serum. About 8 – 15 per cent of infertility shows this. 3-15 per cent of infertile males have agglutinating antibody in their serum or seminal fluid, while control samples from fertile males do not show these agglutinins. Patients with obstructive traumatic, or inflammatory disease of the genital tract are considered. In a haemagglutination test with the supernatant of freeze-thawed spermatozoa, there is greater proportion of positive reactions, laboratory research shows.
About 50 per cent of vasectomised men develop antibodies to sperm, as demonstrated by agglutination or immobilisation techniques. The immunologic response is presumably due to continuous absorption of sperm, especially through the epididymis, and this indicates that extravasated sperm or their fragments are antigenic. The normal way of removing excess sperm is phagocytosis within the lumen of the epididymis, which does not induce an immunological response. In 85 per cent cases of infertile males, the fructose level is between 30 – 40per cent, compared to a normal fertile male whose fructose level is about 80– 90 per cent.
Malnutrition, alcoholism and the action of certain drugs lead to alterations in spermatogonia, with a resulting decrease in production of spermatozoa. X-irradiation and cadmium salts are quite toxic to cells of the spermatogenic lineage, causing the death of those cells and sterility.
The drug, busulfan, acts on the germinal cells. When administered to pregnant female rats, it promotes the death of the germinal cells of their offspring. The offspring are therefore sterile, and their seminiferous tubules contain only Sertoli cells.
Laboratory Diagnosis
In the laboratory, apart from semen analysis, other tests carried out to diagnose infertility are: Follicular stimulating and luteinizing hormones, progesterone, prolactin, testosterone, oestradiol, oestriol e.t.c.
Causes of Male Infertility:
• Azoospermia (absence of sperm): Blockage between the testes and seminal vesicles, due to injury or scarring of infections like Gonorrhoeae and Tuberculosis (TB), and can also be congenital.
• Oligospermia (low sperm count): Due to infection of the genital tract (prostate gland), drugs like marijuana, antidepressants, antihypertensives as well as stress, hormones, obesity, smoking, alcoholism etc.
• Abnormal sperm: High percentage of abnormalities in shape and size, due to hormonal problems or infections.
•Autoimmunity: Antibodies are made which attack the sperm and reduce the living sperm count.
• Premature ejaculation.
• Impotence.
Causes of Female Infertility:
1. Failure to ovulate, which may either be hormonal origin or adverse effect of drugs, which might have effect on follicular stimulating hormone (FSH) and luteinizing hormone (LH) surge.
2. Damage to the oviduct, cervix and uterus, due to infections like STIs, PID/IUD, adverse effects of drugs and probably as a result of abortion and miscarriage.
3. Antibody to sperm: This can be found in the cervix, uterus and oviducts.
Treatment
Use of hormonal/fertility drugs (HCG, clomiphene, tamoxifen), antibiotics, surgical operation, In Vitro Fertilisation (IVF), Gamete Intra-Fallopian Transfer (GIFT), Zygote Intra-Fallopian Transfer (ZIFT), Donor Insemination (DI) or Artificial Insemination by Donor (AID), Artificial Insemination by Husband or Partner (AIH), Egg Donation, Surrogacy and Sub-zonal Insemination (SUZI) or Micro-insemination Sperm Transfer (MIST).
Ige Ilesanmi Paul Bolarinwa wrote from Achievers University, Owo, Ondo State
Reference:
• General Hospital, Ile-Oluji; Laboratory Report (2009-2011).
• Basic Anatomy, By Katmore (New Edition).
• Biological Science, By D.J. Taylor, N.P.O. Green & G.W. Stout, (3rd Edition).
• Basic and Clinical Immunology, By H.H. Fudenberg, D.P. Stites, J.L. Caldwell, & J.V. wells, (2nd Edition).
