Download Production

AZRA NAHEED MEDICAL COLLEGE
DEPARTMENT OF PHYSIOLOGY
MALE AND FEMALE INFERTILITY
• Infertility is “inability to conceive after one year
of conjugal life without use of contraceptive
methods.”
• The term "primary infertility" is applied to “the
couple who has never achieved a pregnancy.”
• "secondary infertility" implies that “at least one
previous conception has taken place.”
ORIGIN OF PROBLEM :
• 35% female
• 35% male
• 20% both partners
• 10% unexplained
MALE EITIOLOGY
•
•
•
•
•
•
•
Idiopathic
Infection – genito-urinary tract,mumps
Genetic/systemic disease
Endocrine
Immunologic
Obstruction
Developmental
FEMALE ETIOLOGY
• Unexplained
• DEVELOPMENT
• Cervical
• Endometrial/uterine
• Pelvic
• Tubal
• Genetic
APPROACH TO INFERTILITY
• Production
• Storage
• Delivery
MALE INFERTILITY
Production:
• Hypothalamus
• Anterior Pituitary
• Testes
HYPOTHALAMIC-PITUITARY-GONADAL
AXIS
HYPOTHALAMUS
• 1Congenital abnormalities of hypothalamus e.g.
Kallman’s syndrome
• Starvation, stress or severe illness
• Tumors (craniopharyngioma, metastatic tumor)
• Head injury
• Inflammation
• Infection
• XRT
• Drugs: marijuana,
PITUITARY
•
.
Endocrine: prolactin
• Tumors
• Inflammation: meningitis
• Trauma/XRT
• Drugs: anabolic steroids
TESTES
• Congenital: Klinefelters (XYY),
developmental disorders
• Infection: chlamydia, prostatitis.
• Autoimmune
• Tumors; chemo/XRT
2.STORAGE
• Temperature
• Rise in scrotal temperature
• Varicocoele
. DELIVERY:
 Impotence/Ejaculation
○Neurogenic: medications (α-blockers,
methyldopa)
○Congenital: absence vas deferens (CF)
○Genetic
○Vasectomy
HISTORY
 Infections: prostatitis, STD
 Trauma to testicles
 Surgery to testicles or hernia
 Chemo or Radio therapy
 Ethanol or Smoking
 Medication
 Previous investigations
INVESTIGATIONS
• semen analysis
• At least 2 samples over different period of
time
• If abnormal:
• Blood work: testosterone
• Testicular U/S
• Chromosomal analysis
SEMEN ANALYSIS (WHO)
• Volume
> 2.0 mL
• Sperm
> 20 million/mL
• Motility
> 50% forward progression or
> 25% rapid progression within
60 min
• Morphology
> 30% normal forms
FEMALE INFERTILITY
• Production
• Storage
• Delivery
PRODUCTION
• Hypothalamus
• Pituitary
• Ovary
HYPO-PITUITARY GONADAL AXIS
HYPOTHALAMUS
•
Stress
• Congenital/genetic
• Tumors (craniopharyngioma, metastatic
tumor)
• Head injury
• Infection
• XRT
• Drugs
PITUITARY
 Tumors: Pituitary adenoma, metastatic
 Inappropriate gonadal feedback
○estrogen excess: obesity/ tumors
○estrogen deficiency
OVARY
• XRT / Chemo for childhood malignancies
• Premature ovarian failure
STORAGE
• Uterine abnormalities
• Leiomyoma
• Luteal phase deficiency
DELIVERY
• Uterine abnormalities
• Tubal Disease
• Infections/ STD/PID
HISTORY
 Age
 Regulation of period
 Infections, Surgeries
 Medication, Smoking, Ethanol
 Medical history
 Previous investigations
EXAMINATION
• Abdomen (masses, scars)
• Vaginal (abnormalities)
• Bimanual (Uterus, masses)
Blood work:
 FSH
 LH
 Luteal phase Progesterone
Imaging:
 Pelvic Ultrasound (to ensure presence of
organs)
 HSG (hysterosalpingography)
Diagnostic
 Laparoscopy (later)