Infertility/Fertility

What is infertility?
Infertility is the term health care providers use for women who are unable to get pregnant, and for men who are unable to impregnate a woman, after at least one year of trying. In women, the term is used to describe those who are of normal childbearing age, not those who cant get pregnant because they are near or past menopause. Women who are able to get pregnant but who cannot carry a pregnancy to term (birth) may also be considered infertile.

What causes infertility?

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 womans 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, andpolycystic 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 womans risk for infertility can also be affected by cer tain 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 dont 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: o 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. o Tight underwearFor 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

How is infertility diagnosed?

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

What are the treatments for infertility?

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

The purpose of the organs of the male reproductive system is to perform the following functions:

To produce, maintain, and transport sperm (the male reproductive cells) and protective fluid (semen) To discharge sperm within the female reproductive tract during sex To produce and secrete male sex hormones responsible for maintaining the male reproductive system
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.

Penis: This is the male organ used in sexual intercourse. It has three parts: the root, which attaches to the wall of the abdomen; the body, or shaft; and the glans, which is the cone-shaped part at the end of the penis. The glans, also called the head of the penis, is covered with a loose layer of skin called foreskin. This skin is sometimes removed in a procedure called circumcision. The opening of the urethra, the tube that transports semen and urine, is at the tip of the penis. The penis also contains a number of sensitive nerve endings. The body of the penis is cylindrical in shape and consists of three circular shaped chambers. These chambers are made up of special, sponge-like tissue. This tissue contains thousands of large spaces that fill with blood when the man is sexually aroused. As the penis fills with blood, it becomes rigid and erect, which allows for penetration during sexual intercourse. The skin of the penis is loose and elastic to accommodate changes in penis size during an erection. Semen, which contains sperm (reproductive cells), is expelled (ejaculated) through the end of the penis when the man reaches sexual climax (orgasm). When the penis is erect, the flow of urine is blocked from the urethra, allowing only semen to be ejaculated at orgasm.

Scrotum: This is the loose pouch-like sac of skin that hangs behind and below the penis. It contains the testicles (also called testes), as well as many nerves and blood vessels. The scrotum acts as a "climate control system" for the testes. For normal sperm development, the testes must be at a temperature slightly cooler than body temperature. Special muscles in the wall of the scrotum allow it to contract and relax, moving the testicles closer to the body for warmth or farther away from the body to cool the temperature. Testicles (testes): These are oval organs about the size of large olives that lie in the scrotum, secured at either end by a structure called the spermatic cord. Most men have two testes. The testes are responsible for making testosterone, the primary male sex hormone, and for generating sperm. Within the testes are coiled masses of tubes called seminiferous tubules. These tubes are responsible for producing sperm cells.

The internal organs of the male reproductive system, also called accessory organs, include the following:

Epididymis: The epididymis is a long, coiled tube that rests on the backside of each testicle. It transports and stores sperm cells that are produced in the testes. It also is the job of the epididymis to bring the sperm to maturity, since the sperm that emerge from the testes are immature and incapable of fertilization. During sexual arousal, contractions force the sperm into the vas deferens. Vas deferens: The vas deferens is a long, muscular tube that travels from the epididymis into the pelvic cavity, to just behind the bladder. The vas deferens transports mature sperm to the urethra, the tube that carries urine or sperm to outside of the body, in preparation for ejaculation. Ejaculatory ducts: These are formed by the fusion of the vas deferens and the seminal vesicles (see below). The ejaculatory ducts empty into the urethra. Urethra: The urethra is the tube that carries urine from the bladder to outside of the body. In males, it has the additional function of ejaculating semen when the man reaches orgasm. When the penis is erect during sex, the flow of urine is blocked from the urethra, allowing only semen to be ejaculated at orgasm. Seminal vesicles: The seminal vesicles are sac-like pouches that attach to the vas deferens near the base of the bladder. The seminal vesicles produce a sugar-rich fluid (fructose) that provides sperm with a source of energy to help them move. The fluid of the seminal vesicles makes up most of the volume of a man's ejaculatory fluid, or ejaculate. Prostate gland: The prostate gland is a walnut-sized structure that is located below the urinary bladder in front of the rectum. The prostate gland contributes additional fluid to the ejaculate. Prostate fluids also help to nourish the sperm. The urethra, which carries the ejaculate to be expelled during orgasm, runs through the center of the prostate gland. Bulbourethral glands: Also called Cowper's glands, these are pea-sized structures located on the sides of the urethra just below the prostate gland. These glands produce a clear, slippery fluid that empties directly into the urethra. This fluid serves to lubricate the urethra and to neutralize any acidity that may be present due to residual drops of urine in the urethra.

The female reproductive system is designed to carry out several functions. It produces the female egg cells necessary for reproduction, called the ova or oocytes. The system is designed to transport the ova to the site of fertilization.Conception, the fertilization of an egg by a sperm, normally occurs in the fallopian tubes. The next step for the fertilized egg is to implant into the walls of the uterus, beginning the initial stages of pregnancy. If fertilization and/or implantation does not take place, the system is designed to menstruate (the monthly shedding of the uterine lining). In addition, the female reproductive system produces female sex hormones that maintain the reproductive cycle.

The function of the external female reproductive structures (the genitals) is twofold: To enable sperm to enter the body and to protect the internal genital organs from infectious organisms. The main external structures of the female reproductive system include:

Labia majora: The labia majora enclose and protect the other external reproductive organs. Literally translated as "large lips," the labia majora are relatively large and fleshy, and are comparable to the scrotum in males. The labia majora contain sweat and oil-secreting glands. After puberty, the labia majora are covered with hair. Labia minora: Literally translated as "small lips," the labia minora can be very small or up to 2 inches wide. They lie just inside the labia majora, and surround the openings to the vagina (the canal that joins the lower part of the uterus to the outside of the body) and urethra (the tube that carries urine from the bladder to the outside of the body). Bartholin's glands: These glands are located beside the vaginal opening and produce a fluid (mucus) secretion. Clitoris: The two labia minora meet at the clitoris, a small, sensitive protrusion that is comparable to the penis in males. The clitoris is covered by a fold of skin, called the prepuce, which is similar to the foreskin at the end of the penis. Like the penis, the clitoris is very sensitive to stimulation and can become erect. The internal reproductive organs in the female include:

Vagina: The vagina is a canal that joins the cervix (the lower part of uterus) to the outside of the body. It also is known as the birth canal. Uterus (womb): The uterus is a hollow, pear-shaped organ that is the home to adeveloping fetus. The uterus is divided into two parts: the cervix, which is the lower part that opens into the vagina, and the main body of the uterus, called the corpus. The corpus can easily expand to hold a developing baby. A channel through the cervix allows sperm to enter and menstrual blood to exit. Ovaries: The ovaries are small, oval-shaped glands that are located on either side of the uterus. The ovaries produce eggs and hormones. Fallopian tubes: These are narrow tubes that are attached to the upper part of the uterus and serve as tunnels for the ova (egg cells) to travel from the ovaries to the uterus. Conception, the fertilization of an egg by a sperm, normally occurs in the fallopian tubes. The fertilized egg then moves to the uterus, where it implants into the lining of the uterine wall.