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ADRIUS » en » список статей ЕN » Infertility in marriage

Infertility in marriage

We continue to publish the work of Vladimir Nikolayevich Kosenko, an urologist, a specialist of the highest qualification category and Honoured Doctor of Ukraine.

 

Part IV

 

Most men and women prefer to get married then to be alone. However, the marriage is very fragile thing if the relationship is not based on the friendship and mutual understanding. If your spouse says – “It's none of your business! Go to the kitchen and close the door...", the days of such a family are numbered. If there is no child in the family, then this is not a family, but a utopia.

The diagnosis - INFERTILITY - scares a lot of men and women. We will not talk about the childfree youth movement, where young people deliberately deprive themselves of the opportunity to have children. They want to live for themselves only. This is a dead-end branch of evolution, they are doomed to extinct. But with age, the time will surely come when a sane person will feel an acute shortage of his small copy, but there is no turning back. I am really sorry for these people.    

After all, everything that will remain after us such as wealth, fame, success is nothing compared to the birth of a child. Children are the most important wealth, the greatest joy and our main heritage on the Earth. Even the Bible says that if you lived till the birth of your great-grandson, took part in his upbringing, then a place in heaven is guaranteed for you.

Unfortunately, about 10-15% of marriages are infertile. A marriage is considered sterile if the pregnancy does not occur within 2 years of regular sexual activity without protection. According to medical statistics, up to 20% of women become pregnant in the first month of marriage, up to 60% – in the first year, and 10%.– in the second year. Thus, in the vast majority of marriages, the desired pregnancy occurs in 90% of cases.

There is a primary infertility, when a woman has never been pregnant and a secondary infertility, when conception does not occur after several pregnancies. There is an absolute infertility, when there are some changes in which pregnancy is impossible. Also, there is a relative infertility, when the likelihood of pregnancy is reduced.

Finding the culprit for infertility is always painful in the family. It is believed that the ability to have sexual intercourse is equivalent to the ability to fertilize. On this basis, most men refuse to be examined and refer their wives to a doctor. There is no answer to the question - who is most often to blame for the childlessness in a family.

According to the World Health Organization, about 40% women are to blame for infertility compared to 60% of men in USA, but in the Caucasus – 65% of women compared to 35% of men. Most scientists agree that according to world statistics about 60% of women are to blame for infertility compared to 30% of men. In 10% of cases both spouses are to blame. Therefore, in each individual case, it is necessary to examine both spouses.

People have always been interested in the problem of fertilization. The ancient Greeks called the female genitals “The Shell of Aphrodite”, which symbolized the sacrament of conception. According to myth, Aphrodite was born from sea foam. There are lots of myths about the birth, such as storks bring children, rich people find children in dollar cabbage, happy ones are born in a shirt, and future firefighters are found in stewed cabbage.

Seriously though, a man releases 2-4 ml of ejaculate, consisting of sperm and seminal fluid during the intercourse. Spermatozoa are produced in the testes, but seminal fluid is produced in the prostate gland, which is a glandular stromal organ located at the bladder neck. Previously, it was normal to have a sperm count of up to 60 million per milliliter, but today – about 20 million of spermatozoa with 80% activity are allowed. A woman prepares only one egg, which is matured in the ovary. At this time, millions of spermatozoa, hurrying in front of each other, make their way along the genital tract to the meeting place with the desired egg. Fertilization takes place in the abdominal part of the oviduct when one of the smartest lucky spermatozoa meets an important egg. The fertilized egg, which slowly goes back to the uterus, is introduced into the wall, where the new organism will develop. The rest of the spermatozoa die and dissolve. As you can see, the path to the cherished goal is very difficult. A lot of conditions for conceiving a child are needed. Therefore, the causes of infertility are so varied.

Let's talk about male infertility. There is a joke: – when the husband heard his terrible diagnosis - infertility, he was so confused because he did not know how to tell his pregnant wife about it.

The most common causes of male infertility are impaired sperm production, poor seminal fluid quality and mechanical obstruction of the seminal ducts. Male semen is produced in the testes and must meet several parameters, such as at least 20 million spermatozoa per 1 ml of sperm, movement speed – at least 2-3 mm/min, active mobility – up to 80% (spindle-shaped, rocking, pendulum-like movements are not suitable), up to 70-80% of the form of spermatozoa has no pathological changes in the entire ejaculate. The causes for impaired sperm production are different:

- congenital and acquired testicular pathology (e.g. cryptorchidism, hypogonadism)

- various inflammations and complications (e.g. syphilis, mumps, gonorrhea, etc.);

- metabolic disorders (e.g. diabetes mellitus, obesity);

- hormonal imbalance (e.g. diseases of the thyroid gland, adrenal glands, pituitary hypothalamic insufficiency);

--working with industrial poisons (e.g. lead, gasoline, phosphorus, arsenic, agricultural poisons);

- chronic general diseases (e.g. tuberculosis, radiation sickness).

The likelihood of male infertility increases significantly in those who drink alcohol. Even not frequent consumption of alcohol (drinking alcohol several times a month is still poison for the testicles parenchyma) reduces the likelihood of fertilization by 40%. The same statistics are statistics for drug users and those who have exhausting work and constant stress.

The second group of infertility causes incudes the poor quality of seminal fluid, which is produced by the prostate gland. Figuratively, the main character of the fertilization process is a spermatozoon, but his bodyguard is the seminal fluid. Sperm cells feel comfortable in a slightly alkaline environment, but the vaginal environment is acidic. Without the help of alkaline seminal fluid, sperm cannot survive.

Seminal fluid is like a personal guard, and they are ready to die for their master. This guard boldly rushes into battle, dies, but they alkalize the acidic environment and clear the living space for sperm. Due to such a high demand for prostate products, any problems in the prostate may lead to the infertility.

We will talk about prostate diseases in the following essays, and now we will move on to the third group of possible causes of infertility.

The third cause is mechanical obstruction in the testicles, prostate, uterus or fallopian tubes. Inflammatory diseases, such as gonorrhea, trichomoniasis, chlamydia and similar infections, sexually and household transmitted, may also cause the infertility. These infections lead to the appearance of scars, adhesions, narrowing and obstruction of the ducts. In addition, everything can worsen if the treatment is not carried out by a healthcare professional, but on the advice of friends or, even worse, on the Internet recommendations.

Neuropsychiatric disorders, wherein the semen is not ejected (retrograde ejaculation), are very rare.

Now let's move on to female infertility. Considering that 60% of women are blame for a sterile marriage, they have more cause-and-effect disorders.

Firstly, the primary infertility is caused by the underdevelopment of the reproductive apparatus or malformations of the woman. In this case the medicine is powerless, and the higher mathematics (genetic engineering) is required.

Secondly, the most common cause of female infertility is genital inflammation (e.g. ovaries, fallopian tubes and uterus inflammations). Gonorrheal and trichomonas infections, genital tuberculosis are very dangerous infections.

Thirdly, an induced abortion, even when it is performed by a healthcare professional in a medical institution, is often the cause of infertility, and irregular menstruation (dysmenorrhea) as well.

Fourthly, inflammation may cause the increased aggressiveness of the vaginal environment to sperm, resulting to their premature death on the distant approaches to the desired egg. So, no man can turn such a woman into a mother.

Fifth, there are some cases when a marriage is sterile, but both spouses are absolutely healthy and even have children in previous marriages. This is due to the allergic antagonism between the husband's semen and the wife's egg. A sort of personal idiosyncrasy may say. But, on the plus side, the protection is no longer needed. There is a joke – Dear, I want to please you. Now we don't have to use contraception for whole nine months!

As you can see, there are many causes for infertility in marriage. The most important thing of infertility is its prevention from a very young age. This is especially true of promiscuous sexual relations and self-treatment of sexually transmitted diseases. It is necessary to remember the one important thing – any functional disorders in the overwhelming majority are treatable. So, please, do not hesitate to consult a doctor in a timely manner.

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