FERTILITY

FERTILITY derived from fertilization is the ability of the woman to conceive. Oocyte (egg) of the wife is fertilized by the sperm of the husband in the oviducts. Fertilization requires efficient Male and Female factors. Male factors are Testicular (good quality semen), Coital (ability of deposing semen in vagina). In woman Ovarian, Tubal, Peritoneal, Uterine and Cervical factors play their roles. These can be detected by appropriately applying modern methods to the individual couple’s needs. Husband only provides the sperm. All the other events take place in wife. The egg once ripe is released from the ovary when its follicle ruptures. The eggs are picked up by free fimbrial end of the oviduct.

The sperms after deposition in vagina during sexual intercourse swim up through cervix and body of the uterus to reach the oviducts. There the sperm if finds the locus penetrates the ovum and the nuclei of the two join to form the embryo. One egg is fertilized by only one sperm. The embryo is not motile and is pushed by oviducts into the uterus, where it implants, becomes fetus and grows to maturity to be delivered as a baby.

The ovum and the sperm are the basic need to have a child. A place to host them for fertilization is equally important. In natural course of events this environment is provided by the fallopian tubes where the sperm, the oocyte and if fertilization succeeds, the embryo are harbored for 5 to 7 days. It is temporary but an important home for them. In IVF (In vitro fertilization), generally known as Test Tube Baby, this temporary shelter is provided in the laboratory by the Co 2 incubator.

In wife, it is not only important that she ovulates which is the first and the basic requirement but it is also important that she has a normal, functional uterus and oviducts. All the generative organs of male & female play an important role then all the body systems of the female facilitate the outcome.

The testes, the ovaries and the uterus are the main players to own a child, of which there is no replacement. The other factors in fertility are conducive to facilitate the sperm ovum meeting. A successful pregnancy is achieved by efficient and coordinated events of ovarian, tubal, cervical, uterine, pelvic and male factors. Fertilization, implantation and maintenance of pregnancy rely on the following events:

Ovarian Factor: The wife’s ovaries function efficiently

Ovulation must be taking place;
Sufficient estrogen must be secreted in preovulatory phase to make the cervical glands produce fertile type of mucus to facilitate sperm ascent;
Sufficient Progesterone in luteal phase to affect the endometrium for implantation.

Male Factor: The husband’s role is to:

Produces adequate number of progressively motile spermatozoa,
Ejaculate semen in vagina at ovulation time by sexual intercourse.

Cervical Factor: Quality and the quantity of the cervical mucus facilitate passage of sperms.
Tubal factor: Oviducts must be normal in morphology and function.

To be patent to allow the passage of sperm and the ovum to be together;
Endothelium to allow fertilization & host fertilized ovum;
Be sufficiently mobile to pick up the ova & then push embryo to uterus.

Uterine Factor: The uterus must be capable.

First to let the sperm ascent through it.
Support the implantation of the embryo.
And then support the fetal growth to the birth at term.

Pelvic Factor: Pelvis to be free of adhesions, endometriosis & inflammatory disease.

Fertilizing receptivity of the egg after coming out of follicle is 18-36 hrs after which it looses its fertilizing receptivity. Sperms can survive after entering woman’s body at fertile period for 48-72 hours. There is possibility of conceiving if the wife & husband have sexual intercourse during this fertile period.

Sperm and ovum are single cells. The creation of baby with so many multicellular organs by the union of two single cells can not be so simple. Expecting that every time sperms and ovum come to gather, baby will be achieved is asking for moon. It is a blessing that so many have children.