The reproductive function is provided by male and female reproductive organ interaction. Several actions are required to become pregnant – ovulation releasing a mature egg, quantitative and qualitative sperm release, good sperm motility, egg ability to penetrate the fallopian tube, successful transport of the fertilized embryo into the uterine cavity and implantation in the endometrium.
Infertility may be due to female, male or both factors. Both the female and male factor is present in approximately 35% of cases. About 20% have more than one cause or a combination of factors. On average in 10% of cases, the cause is unexplained.
The frequency of infertility-causing factors is related to the couple’s age. Ovulatory dysfunction as a cause of infertility is more common in younger couples, the fallopian tubes and peritoneal (pelvic peritoneum) factors are observed at different ages, but the male factor and unexplained infertility is observed in older couples.
The average duration of infertility in couples who recourse to the family doctor or gynaecologist is 21 months. The average time of infertility in specialized centres is 42 months.
The human fertilization process is very complex. To facilitate the further examination of the couple, it is appropriate to divide this process into the five following events:
Semen is introduced into the vagina at the cervix around the time of ovulation or exactly during ovulation. The sperm must be able to cross the cervix, swim to the fallopian tubes and fertilize the egg – these functions are provided by sperm or the male factor.
During ovulation, a mature oocyte is released (ideally, if the cycle is regular, namely, 28 days and ovulation can be expected) – this function is provided by the ovaries or ovulatory factor.
The cervix captures, filters and helps the sperm to penetrate the uterine cavity and fallopian tubes – it is supported by the cervix or cervical factor.
The tubal distal end (fimbria) grips the oocyte (immature egg) and pushes it into the fallopian tube, as well as helps the sperm reach the egg. After fertilization it helps to deliver the embryo back into the uterine cavity. This function is provided by the fallopian tubes or tubal factor.
The uterus provides the normal process of implantation and embryo-endometrium interaction – this is a factor of the uterus, or embryo-endometrial factor.
An infertility examination is based on these five (female/male) factors!