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Subfertility is defined by involuntary failure to conceive after a couple having unprotected intercourse for a year. Infertility can be either primary or secondary. The incidence of primary infertility affected at least 12% of couples. For diagnosis of infertility, coital history is essential and both partners should be investigated. Primary infertility refers to a couple that never become pregnant after a year of unprotected sexual intercourse. Secondary infertility means a couple have been pregnant at least once in their lifetime however have difficulty to become pregnant again. Causes of infertility:Infertility factor Type Percentage
Female factor Tubal problemAnovulationOther 15%20%10%
Male factor Ejaculation and erection dysfunction and reduce sperm quality 40%
Unknown IdiopathicSexual problem 25%5% The total of causes are more than 100% because most of the time there is more than one factor that cause the infertility. Management of infertility is different for each problem. In severe case, assisted reproduction will be necessary. Infertility – female factor Female factor infertility is the inability to conceive or carry a pregnancy to term due to one or more problems specific to females. For example, if a couple is struggling to achieve pregnancy and the male has adequate sperm count, motility, and shape, but the woman has polycystic ovarian syndrome, then their inability to conceive is likely due to female factor infertility. There are several conditions that contribute to female factor infertility, including uterine and pelvic abnormalities, secondary infertility, polycystic ovarian syndrome, and hostile cervical mucus. It is important to understand, however, that infertility, whether male infertility or female infertility, is not the same thing as sterility - conception and successful pregnancy are possible in many cases. Likewise, secondary infertility (the inability of a couple to conceive after having already achieved a successful pregnancy or pregnancies) can often be treated. Infertility – male factor Approximately 15% of couples attempting their first pregnancy meet with failure. Most authorities define these patients as primarily infertile if they have been unable to achieve a pregnancy after one year of unprotected intercourse. Conception normally is achieved within twelve months in 80-85% of couples who use no contraceptive measures, and persons presenting after this time should therefore be regarded as possibly infertile and should be evaluated. Data available over the past twenty years reveal that in approximately 30% of cases pathology is found in the man alone, and in another 20% both the man and woman are abnormal. Therefore, the male factor is at least partly responsible in about 50% of infertile couples.
Important issues related to the evaluation of the male factor include the most appropriate time for the male evaluation, the most efficient format for a comprehensive male exam, and definition of rationale and effective medical and surgical regimens in the treatment of these disorders. It is extremely important in the evaluation of infertility to consider the couple as a unit in evaluation and treatment and to proceed in a parallel investigative manner until a problem is uncovered. It has been shown that the longer a couple remains subfertile, the worse their chance for an effective cure. Many couples experience significant apprehension and anxiety after only a few months of failure to conceive. Unduly prolonged unprotected intercourse should not be advocated before a workup of the man is instituted. Initial screening of the man should be considered whenever the patient presents with the chief complaint of infertility. This initial evaluation should be rapid, non-invasive and cost effective. Of interest is the fact that pregnancy rates of up to 50% have been reported when only the woman has been investigated and treated even when the man was found to have moderately severe abnormalities of semen quality. 2010-08-31
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