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Created Date: پنج شنبه 11 تیر 1392 Visit Count: 3730 Comments: 0 Author: host
The Infertile Couple
Even if medical care of the female suffering from disturbed fertility is much better organized than that of the man, an analysis of the distribution of causes of disturbed fertility shows that in up to half of the couples wishing offspring the male factor is implicated (Figure)

Even if medical care of the female suffering from disturbed fertility is much better organized than that of the man, an analysis of the distribution of causes of disturbed fertility shows that in up to half of the couples wishing offspring the male factor is implicated (Figure). In order to evaluate the effects of limited reproductive functions it is important to know the time span within which a "normal" couple will conceive. If a young couple (< 25 years) plans a pregnancy it will occur within 3 months in 75% of couples. In unselected women attending the delivery ward of a larger German municipal hospital 70% conceived within the first 6 months and 90 % conceived within the first 12 months of unprotected intercourse. However, this rate decreases steadily with the age of the female partner. In women older than 25years pregnancy occurs in 80% of couples only within 20-28 months. In women whose husbands are azoospermic (sperm count zero) and who submitted to donor insemination, a rapid decline of fecundity could be found after the age of 30. Moreover, the frequency of coitus plays an important role. When both semen parameters and female factors are normal, the interval to conception decreases with the frequency of coitus as long as sperm production is not exhausted. Partners complaining of involuntary childlessness of more than 12 months' duration and in whom male factors have been excluded achieve a maximum conception rate when coitus takes place 3-4 times per week. When sperm production is limited, however, this direct relationship is no longer valid. Also the timing of coitus is of great importance. Most conceptions occur on the day of ovulation and the two preceding days, few conceptions, if intercourse takes place on days 3-5 before ovulation, but no conceptions after the day of ovulation. It follows that younger couples should be examined only after they have tried to found a family for at least one year. Should the woman be over 30 years, investigations may be initiated earlier. In industrialized nations married childless couples tend to belong to the latter group as the average age at marriage is increasing. As the reproductive functions in men of good health remain intact to an advanced age, from a physiological point of view increasing age of the male partner alone does not warrant early medical intervention. The interdependencies of male and female reproductive functions described above should provide reason enough to examine both partners simultaneously in the event of involuntary childlessness. Both partners should be examined with the same degree of thoroughness. Good medical practice requires a full anamnesis, careful physical examination followed by all necessary technical and laboratory investigations. The entity represented by the couple with disturbed fertility must not be ignored.
Prevalence of Infertility
Information on the prevalence of infertility indicates great variability. Infertility shows considerable geographic variation; according to World Health Organization (WHO) primary infertility is lowest in the Middle East and highest in Central Africa. Whether the incidence of infertility is increasing is not completely clear. The proportion of couples seeking medical treatment for infertility is estimated at 4-17%. Ultimately 3-4 % of all couples remain involuntarily childless at the end of their reproductive life phase. As male causes for infertility are found in half of involuntarily childless couples, it must be assumed that about 7% of all men are confronted with the problem of disturbed fertility in the course of their lives. This means that the prevalence of infertility in men clearly exceeds that of diabetes mellitus (types I and II), which is often considered almost endemic.

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