STERILITY AND INFERTILITY

STERILITY AND INFERTILITY

Ques. 1     What is sterility?

Ans.        It means inability to conceive after one year of normal sexual life when the couple gets worried for baby. So also is term sterility very appropriately applied to women who have a capacity for conception, but who remain childless, either because the fertilizing elements in the male is wanting, or because. If conception does occur, ovum does not mature. In the strict sense of the term such women are barren but not sterile.

It means an incapability for conception, but by common usage it is applied to all women who have never born children, even though it has not been established that the failure to conceive is due to their incapacity.

Ques. 2     What are the causes of sterility or infertility?

Ans.     AETIOLOGY : (a) Primary – Where conception has never occurred. (b) Secondary – Where conception has failed after a period of fertility.

  • Physiological – After menopause. 2. Sometimes during lactation. 3. During pregnancy. 4. Before puberty.
  • Pathological – May be male, female or combined

Ques. 3     Which are the faulty male factors due to which sterility can occur?

Ans.          Faulty Male factors –

  1. Endocrine factors – (a) hyperthyroidism. (b) hypopituitarism, (c) defect in the – hypothalamus or adrenal cortex,
  2. Psychological factors – (a) marital disharmony, (b) ignorance about coitus, (c) premature ejaculation. (d) fear, anxiety, tension,
  3. Environmental factors – (a) prolonged exposure to heat (stuck driver), (b) furnacemen. (c) tight underwear,
  4. Genital factors – (i) undescend testis, (ii) hypospadias, Klinefelter syndrome, (iii) testicular atrophy following mumps, small pox at childhood, varicocele, (iv) huge hydrocele, (v) urethritis, prostatitis, epididymitis (gonococcal), (vi) pinhole meatus, (vii) phimosis etc. (viii) defective spermatogenesis,
  5. Systemic factors – (a) diabetes mellitus, (b) obesity, (c) heavy smoking, (d) chronic alcoholism. (e) Age-over 45 years,

Ques. 4     Which are the faulty female factors due to which sterility can occur?

Ans.          Faulty Female factors –

  1. Endocrine factors – (a) hypopituitarism, (b) hypothyroidism, (c) Stein-Leventhal syndrome (polycystic ovaries). (d) defect in hypothalamus,
  2. Psychological – (a) marital disharmony, (b) ignorance about coitus, frigidity. (c) fear, tension,
  3. Genital
    1. cervical factors – hypoplasia, less mucous secretion, chronic cervicitis, cervical erosion, ecctropion, fibroid/polyp in cervix, carcinoma of cervix,
    2. uterine fibromyoma, uterine hypoplasia, infantile, rudimentary of rarely absence of uterus. Tuberculous endometritis, uterine malformations etc.
  • tubal factors congenital tubal defects, tubal occlusion or peri-tubal adhesions from salpingitits etc.
  1. ovarian factors – anovulary cycles, chronic oophoritis, chocolate cysts and ovarian tumors, Turner’s syndrome or testicular feminization syndrome.
  2. vaginal factors – narrow vaginal introitus, vaginismus, tight hymen, vaginitis, vaginal atresia stenosis, high vaginal acidity, absence of vagina, etc.
  1. Combined Factors – A single factor or multiple factors from either partner.
  2. Systemic – (a) obesity, (b) anaemia, tuberculosis, etc. (c) Age – over 35 years,

 

Ques. 5     How can we investigate the case of sterility?

Ans.          (A) INVESTIGATION   

  1. General – routine systemic examination, obesity, general health, secondary sexual characters, etc.
  2. Genital organs – phimosis, hydrocele, varicocele, conditions of testis, vas deferens, urethral discharge, undescended testes and hypospadias etc.
  3. Blood test – for sugar (diabetes), E.S.R., Hb% etc.
  4. Hormone analysis, testicular biopsy, P.B.I., and B.M.R., for thyroid disorders.
  5. Semen analysis.
  6. Chest X-ray for T.B.
  7. Husband -History of – age, occupation mode of life, smoking, drinking, personal hygiene, past history, family history, history of illness (gonorrhoea, syphilis, T.B., etc.) marital relation, impotency, loss of sex desire etc.

(B) Wife-

  1. Menstrual history – menarche, duration, cycle, amount of loss, dysmenorrhoea etc.
  2. Obstetrical history.
  3. Marital history – data of marriage, frequency and nature of intercourse, dyspareunia, contraceptive measures etc.
  4. Past history- mumps, gonorrhoea, syphilis, appendicitis, tuberculosis, and diabetes mellitus.
  5. Family history.
  6. Personal history – mode of life, domestic work, worry, diet etc.
  7. General – routine systemic examination.
  8. Pelvic examination – Perineum, hymen, Bartholin glands, urethra, vagina, cervix, uterus and adnexae etc.
  9. Tubal patency test, hysteron-salpingography, Culdoscopy of Laparoscopy.
  10. Ovulation tests (Basal body temperature, endometrial histology).
  11. Tests for cervical factors- post-coital test, fern test, cervical mucous, incompatibility test.
  12. Endocrime assays.
  13. Blood test – for sugar, Hb% E.S.R., etc.
  14. X-ray of chest.
  15. Age, occupation.
  16. Present history like menstrual disorders, white discharge, obesity, dyspareunia, urinary troubles etc.

PROGNOSIS – It depends entirely upon our ability to discover and remove the cause, but as a general proposition it may be said that treatment of sterility is decidedly unsatisfactory. In those cases where any of essential organs of reproduction are absent or imperfectly development, and in those where no cause is ascertained, the prognosis is most unfavourable.

Ques. 6     How can a case of sterility be managed?

Ans.          It consists in the removal of the condition, which is causing the sterility, if such a thing be possible. So, after proper investigation in cause is determined guideline of treatment should be chalked out to eradicate the defect.

  • Treatment of husband – 1. Preventive – (a) psychological therapy – knowledge about coitus, confidence to gain for preventing premature ejaculation. (b) advised not to wear tight or nylon underwear, smoke, drink (alcohol); 2. Treatment for – (a) genital – (i) medicinal – hormonal for spermatogenesis. (b) general – diabetes mellitus, hypothyroidism, hypopituitarism (if present). (ii) surgical – for phimosis, varicocele, repair or hydrocele, hypospadies, cryptorchidism,
  • Treatment of wife :
    1. Endocrine – hyperpitutarism or hypothyroidism (by hormone).
    2. Psychological – (i) if the patient is ignorant about the techniques – should be advised accordingly. (ii) the couple is advised to have sexual intercourse frequently and especially during the most fertile period of the cycle (10th to 17th day). The wife is advised to take 10 minutes rest in bed to allow the contact to semen with cervix;
    3. Genital – (i) tubal insufflations, (ii) treatment of – widening vaginal introitus and cervical erosion, (iii) removal of polyp of fibroid, (iv) plastic surgery to reconstruct the tubes, vagina, uterus in development defects. (v) cervical dilatation,
    4. Hormone treatment – (a) gonadotrpophine injection. (b) oestrogen – progesterone preparations,
    5. Artificial insemination – (i) A.I.D. – semen from donor – it has medico legal implications : 10 ml. of semen is injected into the posterior fornix of uterus. (ii) A.I.H. – semen from husband,
    6. General – obesity, anaemia, tuberculosis, etc. are corrected.

Ques. 7     Which are the Homoeopathic medicines that can be useful?

Ans.          Homoeopathic Remedies

  1. Natrum Mur – Menses irregular usually profuse, vagina dry leucorrhoea acrid, watery, bearing down pains in morning. Prolapse uteri with cutting in urethra. Suppressed menses. Craving for salt.
  2. Natrum Phos- Infertility, manses too early, pale, thin, watery, sterility with acid secretion from vagina. Leucorrhoea, discharge creamy or honey coloured of acid and materials. Sour smelling discharge. Morning sickness with sour vomiting.
  3. PLATINA – Ovaries sensitive and burn. Menses too early too profuse, dark clotted. Vaginismus. Nymphomania, excessive sexual development. Melancholia aggravated by sitting and standing and ameliorated by walking.Graphites – Menses to late with constipation, pale and scanty with tearing pain in epigastrium and itching before, cough coryza. Leucorrhoea pale, thin profuse. Decided aversion to coition. Sterility, difficult conception.

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