Male and Female Sterility and Infertility

CMR Torino Male and Female Sterility and Infertility

When a man and/or a woman are unable to contribute to conception irreversibly, it is referred to as sterility; when we talk about infertility, we mean the inability of a couple to conceive in the absence of irreversible sterility factors.

Often, even in the medical field, the two terms are confused.

The International Council on Infertility Information Dissemination (INCIID) defines a sterile couple as one that does not achieve conception after one year of attempts (reduced to 6 months for a woman over thirty-seven).

Male and female sterility can be defined as primary when referring to individuals who have never been able to conceive, while secondary sterility refers to the inability to conceive a second or further child after having conceived and/or carried a normal pregnancy to term.

Female fertility peaks around 23 years, gradually decreasing until 30, then rapidly declining from 30 to 35, and progressively dropping until 45.

According to the Italian National Institute of Health, in a report on Medically Assisted Procreation from April 2017, the following infertility factors are identified:

FEMALE STERILITY/INFERTILITY IN ITALY

    From a medical standpoint (in order of frequency), female sterility/infertility can be distinguished into the following forms:

  • Endocrine sterility/infertility
    Represents about 6% of female sterility/infertility cases and means that the woman has alterations in the ovulatory cycle.
  • Tubal sterility/infertility
    Represents about 9% of all female causes of sterility/infertility and relates to the lack of anatomical and/or functional integrity of the tube, an essential requirement for its proper functioning. This case represents one of the main indications for in vitro fertilization (IVF).
  • Cervical sterility/infertility
    Related to poor quality of cervical mucus, which should be permeable to sperm just before ovulation, acting, conversely, as a barrier to their passage and to germs outside the ovulatory period. A possible solution is intrauterine insemination (IUI).
  • Uterine sterility/infertility
    Represents about 5% - 10% of cases. These consist of congenital anomalies, adhesions from previous curettages, growth of fibroids or polyps, and more rarely infections.
  • Vaginal sterility/infertility
      Depends on alterations at the vaginal level and essentially recognizes three causes:
    • Malformations
    • Dyspareunia
    • Psychogenic vaginismus
    • In these particular cases, it is essentially due to a hindered sexual relationship or an abnormal deposition of sperm in the vagina.
  • Immunological sterility/infertility
    This is determined by the presence of anti-sperm antibodies that can interfere with fertility by immobilizing sperm and preventing their ascent in the cervical canal. A solution to this problem may be intrauterine insemination (IUI).

MALE STERILITY/INFERTILITY IN ITALY

    Male sterility is discussed when the semen is unable to fertilize the ovum; it can be subdivided into three categories:

  • Pre-testicular
    These mainly concern pathologies affecting the hypothalamus and pituitary gland, leading to a deficit in the secretion of gonadotropins, resulting in a lack of development of sexual characteristics. If this occurs after puberty, testicular hypotrophy may ensue.
      Pre-testicular causes include:
    • Endocrine problems, e.g., diabetes mellitus, Cushing's syndrome, thyroid disorders
    • Hypothalamic disorders, e.g., Kallmann syndrome
    • Hyperprolactinemia
    • Hypopituitarism
    • Hypogonadism of various types
    • Cryptorchidism
    • Psychological causes
    • Intoxication from drugs, alcohol, chemicals, use of certain medications (SSRIs, antipsychotics...)
    • Avitaminosis (particularly folic acid deficiency)
    • Irradiation with X-rays or gamma rays
    • Heat sources that constantly and continuously elevate testicular temperature
  • Testicular
    These are congenital or acquired pathologies affecting the testicles and relate to sperm production within the testicles.
      Testicular damage can be caused by:
    • Varicocele
    • Cryptorchidism
    • Orchitis
    • Torsions of the spermatic cord
    • Genetic anomalies
    • Testicular cancer
    • Environmental factors
    • Aplasia of germ cells
    • Lifestyle
  • Post-testicular and penile
    These include acquired or congenital malformations of the seminal pathways and accessory glands and relate to the transport of sperm from the testicles to the outside.
      Post-testicular and penile causes include:
    • Obstruction of the vas deferens
    • Infection, e.g., prostatitis
    • Retrograde ejaculation
    • Hypospadias
    • Impotentia coeundi
    • Dysfunction or malformations of the penis

The main examination to perform is the semen analysis.
This analysis mainly includes the sperm count, the measurement of their motility, and their morphology under the microscope.

A production of few sperm is called oligospermia, while the absence of sperm is referred to as azoospermia.

A quantitatively sufficient production but with poor motility is called asthenozoospermia.

A production of sperm with morphological characteristics below normal is called teratozoospermia.

Impotentia generandi refers to the inability to procreate while being able to have normal sexual intercourse, while impotentia coeundi refers to the inability to complete the act of intercourse.
In this case, the man is still capable of generating through assisted reproductive techniques.

The C.M.R. Turin Team

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