-- Sterility --

Written by Dr. Sarika Doshi

Sterility is the absolute inability to conceive or to produce any offspring, for one or more reasons. It can be seen in both male and female patients. The woman is however, more often found unproductive; but, in certain cases (about 25%), the male is also defective. If a couple fails to achieve pregnancy after one year of "unprotected" and regular intercourse, it is an indication to investigate the couple.

Physiological sterility is present before puberty and after menopause. Also physiological sterility during pregnancy is due to inhibition of ovulation once conception occurs. Conception depends upon the normal development and the functions of the genitalia and sexual organs of both the female and the male. Any defect, temporary or permanant, in either male or female partner leads to sterility. The examination should be conducted to find out the cause.

Causes in Females:

  • General causes

    1. Debilitating diseases like anaemia, tuberculosis etc. causing amenorrhoea and scanty menstruation.

    2. Endocrinal deficiencies: Obesity due to defective Thyroid secretion.

    3. Incompatibility between husband and wife.

    4. Neurotic: Hysteria, indifferances and other mental conditions.

  • Local causes

    1. Absence of any essential part of genitalia e.g.removal of uterus, tubes or ovaries.

    2. Imperforate hymen.

    3. Pinhole cervical os causing mechanical obstruction to spermatozoa.

    4. Hypertrophy or Atresia of Cervix.

    5. Malformation or destruction of tubes: Due to inflammatory conditions like gonorrhoeal salphingitis, appendicitis etc.

    6. Partial stenosis of tubes: It is associated with imperfectly developed uterus.

    7. Inflammatory conditions like endometritis (inflammation of uterus), endocervicitis (inflammation of uterus and cervix).

    8. Cystic ovaries or tumours of ovaries.

    9. Vaginismus: It means the painful and spasmodic reflex contraction of the muscles surrounding the vaginal ourifice during coitus, and during digital examination. So, intercourse is not possible.
      It may be due to:
      • Nervousness and hysteria.

      • Congenital or aquired Smallness of vulva and vagina.

      • Inflammatory conditions.

    10. Displacement of uterus:
      • Retroversion may cause Sterility by tilting the cervix so far forwards that spermatozoa find it difficult to enter the uterus.

      • Prolapse of uterus may prevent coitus.

      • Chronic inversion: The uterus is inverted from within outwards.

    11. Trauma to the parts: Laceration of cervix.

    12. New growth: Fibroid,cancer etc.

Causes in Males:

  • Impotency.

  • Some developmental defects: e.g. short and curved penis, undesended testes etc.

  • Defective seminal discharges: No sperms or undeveloped sperms or few sperm count, non motile sperms.

Investigation in males:

  • Compatibility of husband and wife.

  • General condition and development of genital organs.

  • Examination of semen for the presence and motility of the sperms.

Investigation in females:

  • General examination

    1. State of menses: Menorrhagia, metrorrhagia, dysmenorrhoea or scanty menstruation.

    2. General state of health: Good or poor, anaemia etc.

    3. Debilitating diseases like tuberculosis.

    4. Veneral diseases like Syphilis,Gonorrhoea.

    5. Urine for albumin and sugar.

  • Local examination

    1. Examination of genitalia to rule out above mentioned causes.