Infertility and Impotence in Humans

Infertility and Impotence in Humans

Infertility and Impotence in Humans

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At least 10 percent of couples experience infertility, and deficiencies of sperm production in the male are the causal factor in about one-third of all cases. The common causes of male infertility are deficiencies in maturation of sperm; orchitis (acute inflammation of the testes often resulting from mumps), with destruction of the testes; obstruction of the passageways for sperm; abnormally low thyroid or high adrenal secretion; varicocele (enlargement of the veins of the spermatic cord); or formation of antibodies to sperm by the male or the female. The most important step in the evaluation of male infertility is examination of the semen.

Infertility in the female is related to the faulty production of ova or to interferences in their union with spermatozoa. Disordered ovulation is responsible for approximately 25 percent of female infertility problems; anovulation (failure to ovulate) and oligoovulation (very irregular ovulatory cycles) are among the most common disorders. Other common causes of infertility are blockages and scarring of the fallopian tubes, which can result from infections of the reproductive tract (e.g., pelvic inflammatory disease), uterine fibroids, or endometriosis.(The sperm normally enter the uterus through the cervix and, from the uterus, move into a fallopian tube, where fertilization of an ovum takes place.)

During the few days prior to ovulationrelease of an ovum from the ovarythe glands within the cervix normally secrete a thin, watery mucus that is beneficial to sperm survival and migration. Various factors, such as infection or estrogen deficiency, may decrease the quality of the mucus. Congenital anomalies of the reproductive organs may also cause infertility. Vaginal causes are usually uncommon, but obstruction may be due to an unruptured hymen or may be functional and arise from enlargement and contraction of the levator ani muscles (these muscles form a supporting sheet under the pelvic cavity, with openings for structures such as the anus and the vagina). Thyroid, pituitary, adrenal, or ovarian disease may interfere with ovulation, as may the presence of large numbers of cysts in the ovaries (the condition known as Stein-Leventhal syndrome). Finally, emotional factors may play a role in causing infertility.

Treatment consists of the use of various hormones, surgical correction of tubal blockage, and psychotherapy.

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