Sterility
Sterility

Anatomy

The reproductive tract of the woman responsible for the production of eggs, the implantation of the fertilized egg and the developing embryo and fetus until birth. The main bodies involved in these phenomena are the vagina , uterus, fallopian tubes and ovaries.

THE OVARIAN

The ovaries are the female sex glands. Small , about the size of an almond , they are located in the pelvis on each side of the abdominal cavity. They are connected to the uterus and fallopian tubes by the utero-ovarian ligaments and have two main functions: the production of egg and hormone secretion .

The ovaries contain many follicles predetermined amount from birth , called De Graaf follicles , each containing an egg during maturation . The follicle ruptures at the surface of the ovary releases an egg in it, it’s ovulation. The egg then enters the fallopian tube. If fertilization, De Graaf follicle becomes the corpus luteum. Otherwise , the follicle atrophy and leaves a white scar. During each menstrual cycle, the egg leaves the ovary , through a tube and reaches the uterus. If it is fertilized by a sperm , it was the beginning of pregnancy , if the cycle ends with the onset of menstruation .

The egg is smaller than the head of a pin female, single cell . Since its birth, the ovaries of a little girl already contain the eggs she will produce during her lifetime. This is from puberty, once a month an egg matures and is released from the ovary .

The ovaries secrete estrogen and progesterone. They play a critical role both in the development of secondary sexual characteristics , such as breasts and the feminine aspect of the figure, in the menstrual cycle and fertilization. These are their variations during the cycle that affect ovulation as well as the arrival of the rules. Their dosage gives a fairly accurate idea of ​​the ovarian reserve .

UTERUS

The uterus muscle is a hollow pink pear shaped weighing about 100g . It is lined by endometrial mucosa whose thickness varies over the cycle . Its lower part and narrower is called cervix . In the middle, the neck is provided with an opening communicating the uterine cavity with the vagina . Cervical canal that follows the uterine cavity is lined with a mucous membrane rich in the mucus secreting glands that facilitates sperm mounted at the time of ovulation .

VAGINA

The vagina is a channel for communicating with the internal genitalia vulva, external genitalia . Long centimeters from July to October , its muscle and fibrous walls are able to expand significantly during childbirth.

Causes

Modern life

You should know that food dieting and eating disorders have a negative impact on the quality of ovulation. Alcohol and tobacco are also not good press.
Professional reasons and constraints of modern life are also a significant cause . If contraception has the last 30 years to split the desire and fertility, many women continue to think they can have a child when they want what age do sometimes leave the ravages of the ovaries especially after 35 years or fertility drops significantly . As a child is when you can .

Abnormalities of ovulation

They are the most common cause of infertility . When ovulation does not exist , it is called anovulation. If it exists but poor quality , it is called dysovulation . Oocytes are in this case little or no fertilized . In these cases one finds many abnormalities associated with a dysfunction of the pituitary or hypothalamus . But the most common of them are the poly cystic ovaries or ovarian dystrophies representing Morocco in the first cause of anovulation dysovulation see . It is a pathology or woman often has a widely spaced rules ( spaniomenorrhea ) see no periods (amenorrhea ) with a tendency to obesity and excess hair (hyper trichose ) . Sometimes symptoms are gathered separately.

Abnormalities of the fallopian tubes

They are responsible for about 30 % of female infertility and are often related to infectious causes have sometimes evolved low noise. They can also be the cause of ectopic pregnancy . However, it only takes one wrong good for a pregnancy can occur spontaneously.

Endometriosis

Defined by the presence of fragments of uterine lining outside their place of origin . This lining can be placed in the ovary, fallopian , peritoneal cavity , etc. . It can block the fallopian tubes or shrink as it can give ovarian cysts or adhesions. 50-60 % of women with endometriosis have difficulty conceiving .

The cervical

Sometimes the collar instead of opening during the period of ovulation, it is closed either congenitally ( malformation ) or the result of trauma ( curettage , aspiration, birth trauma ..) preventing the ascent of sperm , thus creating a barrier or mechanical ( synechiae or adhesions ) is related to an abnormal cervical mucus normally under the influence of hormones during ovulation becomes fluid and permeable to facilitate the passage of sperm into the uterus . This anomaly can be quantitative (decrease ) or qualitative (infection, presence of anti sperm antibodies).

The uterus

It can be challenged by the presence of improper lining for implantation , including the presence of synechiae ( adhesions between the two walls of the cavity ), or infection ( chronic endometritis ) .

Immune factors

Their role in infertility is often cited but remains uncertain. In any case, their detection is difficult at this day.

Idiopathic infertility

It is defined by the absence of obvious causes despite the performance of any battery of additional tests . Their number is reduced day by day , however we know that we must be more aggressive in their care .

Explorations

You should know that the panel explorations of infertility is quite large and should be undertaken in a systematic taking into account the medical history of the couple, the length of infertility , age of the patient and the suspected cause the questioning and examination .

a – The temperature curve

It is to ask the woman to take her temperature every morning before waking up, and annotate on a curve issued by the doctor by scoring all intercurrent events ( fever, flu , day rules ..) for a period average of 3 months .

This curve can give us some information on the existence of ovulation , duration of heat plateau after ovulation and the day of ovulation possible . However, this method is quite restrictive and is often biased by events that come distort the result and make its interpretation difficult .

b – Hysterosalpingography

It is an essential radiological examination to visualize the inside of the uterine cavity and especially to verify the integrity of the tubes granny that gives an idea of ​​the possible existence of adhesions distorting the anatomical relationships pelvis.

Why ?
It can discover :

– A malformation of the uterus with fibroids ;

– A synechia is a joining of the fibrous wall of the uterus , usually observed after infection or curettage ;

– A gaping neck can cause miscarriages or otherwise blocked by a large polyp or synechia ;

– Abnormalities of the fallopian tubes blocked, an altered mucosal , or endometriosis ;

– The review can turn into care. It happens that the pressure exerted by the rise of radio -opaque liquid opens a trunk .

c – The hysteroscopy

It is an exploration of the uterine cavity . This test is often used in addition to hysterosalpingography .

Why ?
– This exam will take biopsies in lesions , especially if there is a chronic infection.
– Hysteroscopy is also used for curative purposes . It is used to remove a small polyp or synechiae .

d – Hormone assays

They fall within the broad field of endocrinology . The assays are performed on samples of blood and urine study hormone production of the ovaries , pituitary , hypothalamus and thyroid .

Why ?
They are often required when there is an ovulation disorder visible on the temperature curve , and to place the responsibility of disorder or abnormality on ultrasound including small ovaries or ovarian appearance of polypeptide

e – The karyotype

It is the study of abnormalities on the number and structure of chromosomes located in the nucleus of cells .

Why ?
The woman may be unknowingly carrying a genetic defect that would lead to sterility.

f – The ultrasound

It is a simple painless test , widely used in gynecology.

Why ?
– It reveals a uterine or ovarian abnormality ( fibroid polyp) .
– It determines the size and number of ovarian follicles and the appearance of the endometrium.
– It is used both for diagnosis and for monitoring the effectiveness of certain treatments.
As we will see later , ultrasound is essential in the induction of ovulation treatment, and at the time of egg retrieval for IVF -ETE .

g – Endometrial biopsy

The endometrial lining of the uterus , the structure varies according to the portion of the cycle and hormonal impregnation

Why ?
– The biopsy to assess the hormonal impregnation and quality of ovulation.
– It allows the other to make a bacteriological analysis in search of a latent infection.

h – Laparoscopy

Laparoscopy occurs when problems are obvious mistake . It allows you to decide whether to move to in vitro fertilization or when a disease such as endometriosis is suspected.
This examination is carried out as a last resort because it is a surgical procedure . Laparoscopy can be both diagnostic and curative action .

Why ?
To see perfectly the uterus, ovaries, fallopian tubes and the peritoneal cavity an accurate diagnosis .
But also to check tubal patency , that is to say, make sure the tube is able to drag , move the egg properly and at the right speed .

Anatomy

The organs of the male reproductive system involved in the development of the various components of the sperm and its transmission are multiple: the tests, epididymis, vas deferens, seminal vesicles, ejaculatory ducts, prostate and penis.

THE PENIS OR VERGE

The penis is genital human characteristic . It consists of two corpora cavernosa and the corpus spongiosum before back. This sponge body is penetrated through the urethra , which channel is used both for the passage of urine and semen .

TESTIS

Two in number , variable in size , they are the site of sperm production . They are located within the exchanges, known as scrotum. The sperm is a tiny cell that can move. It consists of three parts: the head , the body and the flagellum. The head contains the acrosome , a reserve of enzymes that can penetrate the wall of the oocyte nucleus and containing all genetic information , the body contains the useful energy to the displacement . As the flagellum , he waves to move better .

EPIDIDYMIS AND VAS DEFERENS

These channels allow the ejaculate contains sperm from the testicle to pass the region of the prostate. They allow the sperm to complete their maturation by providing various biochemical constituents that increase their ability to fertilize.

PROSTATE AND SEMINAL VESICLES

When the sperm reaches the prostate , there come the end of the seminal vesicles during his career, he was charged with additional components from the prostate (citrate , acid phosphatase , zinc) and seminal vesicles (fructose ) involved them also the quality of the final sperm fertilizing

URETHRA

This channel through the penis and allows the transport of sperm in the prostate terminal orifice of the penis, called meatus , which is located at the tip of the glans .

Causes

Man today shares the same responsibility as the woman in the causes of infertility.

In all cases regardless of the “responsible” , the role of two partners is imperative to the success of their expectations.

 a – Azoospermia :

It is defined by the absence of sperm in the ejaculate . Under these conditions, it is best to have the same results on two different samples because of the large variations in human semen during his lifetime. In these cases there are two cases:

– It is no secret ion sperm , causing an inability to procreate. This may be due to the destruction of their testicles not descending at birth or by trauma or disease. In these cases infertility is often permanent because the chances of finding sperm are exceptional. Sometimes it is a hormonal problem, which means that the pituitary gland stimulates the testicles. In these cases hormone therapy can be effective .

– Sperm are produced, but stuck in the excretory ducts (excretory azoospermia). This can be linked to a sequel of genital infection untreated or after surgery of urogenital area .

b – Oligo-asthenospermies :

From far the most common , and include different aspects.

– The Teratospermia : defined by the presence of too many abnormal sperm. These abnormalities are often due to a dysfunction of spermatogenesis and can cover all parts of the sperm. For a sperm to be fertile, it takes 20  to 50%  ‘good’ sperm. The necrospermie it is defined by more than 50% often died from infections sperm.

– Oligospermia : if in general there are 20 to 100 million sperm per milliliter of semen, by their number is less than 20 million.

– The asthenospermia : This is a mobility problem. In general more than 50 % of sperm are moving after an hour of ejaculation, below this threshold we talk about asthenospermia. In these cases the varicocele is often responsible (abnormal dilation of the veins scholarships in the form of varicose veins that are palpable).

– The environment : stress , alcohol , tobacco , certain medications can affect the sperm . As high fever, severe illness as well as being overweight increase the risk of infertility.

Explorations

You should know that the panel explorations of infertility is quite large and should be undertaken in a systematic taking into account the medical history of the couple, the length of infertility , age of the patient and the suspected cause the questioning and examination .

a – The sperm

The semen analysis sperm quality . This is probably the most requested review and the most important search for causes of male infertility .

Why ?

To count the number of sperm to assess the proportion of those who move (mobility) , for their ability to move forward and quantify the proportion of normal spermatozoa.

Consistency and the total volume of ejaculation is measured as an abnormally low volume suggests a predisposition to infertility.

A dosage of sugar in semen is made because the sperm are big energy consumers.

If the sperm appears infected, a semen culture will be asked to identify the infection.

b – The hormone assays

Assays will be prescribed if the semen analysis is unsatisfactory.

Why ?

As for the woman , and the purpose to study the different stages of endocrinological male fertility. Testosterone is the hormone that stimulates the development of male characteristics and , as in women , the hormones of the pituitary and the hypothalamus will be determined.

 c – The karyotype

The karyotype is used to study anomalies in the number and structure of chromosomes, genetic capital located in the cell nucleus.

d – The testicular biopsy

Rarely required , it is done only to know whether treatment is reasonable to consider .

e – Doppler and thermography

Both tests exploring the circulation of blood.

– Doppler to measure the speed of blood flow to highlight a narrowing or abnormal dilation of blood vessels .

– A thermography can dilate slow blood flow plates of liquid crystal varies depending on the color temperature of the skin , which is then hot or no blood flows . .

f – The ultrasound

With this painless examination , a search effusions or obstacles in the excretory tract . It explores the testes , prostate, blood vessels.

g – Deferentography

This is an X-ray performed under general anesthesia , which studies the excretory ducts to repair any obstacle and make a surgical decision .

The list of tests is probably not exhaustive, this is the most requested . In all cases , only your medical team is able to prescribe a balance when it considers it appropriate , when it is needed, it is necessary only to you and only you .