It is known that usually conception is achieved within twelve months in 80-85% of couples who use no contraceptive measures. When couples are not able to achieve a pregnancy after one year of unprotected intercourse, they should be regarded as possible infertile, and should be evaluated. Statistics say that in approximately 30% of cases pathology is found in the man alone, and in 20% of cases, both man and woman are abnormal. |
We can say that in the evaluation of infertility, it is important that the couple to be considered as a unit in evaluation and treatment, and to proceed in parallel investigations, until the problem is found. When the patient complains of infertility, initial screening of the man must be considered, and an interesting fact is that pregnancy rates of up to 50% have been reported when only the woman has been investigated and treated even if the man was discovered to have abnormalities of semen quality.
The hypothalamus regulates the production and secretion of gonadotropin releasing hormone. It receives messages from both the central nervous system and the testes, and it is the integrative center of the reproductive axis. The hypothalamus releases gonadotropin releasing hormone in a pulsatile nature, and it seems that this is essential for stimulating the production and release of both luteinizing hormone and follicule stimulating hormone. An interesting fact is that after the initial stimulation of these gonadotropins, the exposure to constant gonadotropin releasing hormone determines the inhibition of their release. In response to the pulsatile release of gonadotropin releasing hormone, luteinizing hormone and follicle stimulating hormone are produced in the anterior pituitary and are secreted episodically, and they bind to specific receptors on the Leydig cells and Sertoli cells within the testis. The tests produce testosterone, which is a primary inhibitor of luteinizing hormone in males. Testosterone may be metabolized in peripheral tissue to the potent androgen dihydrotestosterone or the potent estrogen estradiol. Inhibin, which is produced by a Sertoli cell, regulates the mechanism of feedback control of the follicle stimulating hormone.It was seen that decreases in spermatogenesis are accompanied by decreased production of inhibin, and this is associated with reciprocal elevation of follicle stimulating hormone levels.It is known that also prolactin has a complex inter-relationship with the gonadotropins, luteinizing hormone and follicule stimulating hormone. In males with hyperprolactinemia, the prolactin tends to inhibit the production of gonadotropin releasing hormone, and also elevated prolactin levels may have a direct effect on the central nervous system.
There are a lot of misconceptions in the world of infertility. A very popular myth is that a couple will be able to conceive after the woman will be treated of infertility.Some time ago, treatment for a severe male factor consisted in inseminations or IVF using donor sperm, but today, there appeared innovative therapeutic options that offer a greatly improved chance to conceive their own biological offspring even to those with no sperm in their ejaculate due to genetic conditions.
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