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Infertility Fertility Sub fertility Sterility Infertility: Diminished capacity to conceive and bear a child Sterility: Absolute and irreversible inability to conceive Clinically: Involuntary failure to conceive after 12 months of unprotected frequent intercourse. Primary: No previous pregnancy Secondary: Previous pregnancies what ever the outcome. Prevalence: 10-15% 1/3 In the Female 1/3 in the male 1/3 in the couple combined FACTORS AFFECTING FERTILITY: Age Psychological Health General Health DISORDERS: 1. Involving each of the major physical events that are necessary to produce a pregnancy. 2. Production of a healthy eggs. 3. Production of a healthy sperm. 4. Transportation of the sperm to the site of fertilization. 5. Transportation of the egg and zygote to the uterus for implantation. 6. Successful implantation in a receptive endometrium 7. Presence of other factors. No OOCYTES production and OOCYTES abnormalities: Failure to ovulate The disorders are grouped into three general categories: Hypothalamus] Pituitary ] Ovarian ] Dysfunction HYPOTHALAMUS = Abnormalities of weight, body composition. Strenuous Ex. Stress, travel PITUITARY: Hyperprolactinaemia Hypothyroidism OVARIAN: failure PCOS Premature ovarian ANATOMIC ABNORMALITIES: TUBAL FACTOR: 20% Pelvic Infection adhesion Rupture appendicitis Septic abortion Previous surgery IUCD Ectopic Pregnancy UTERINE FIBROID: ENDOMETRIOSIS : Ectopic Endometrium Presence of tissue that resembles endometrium outside its normal positon. Glands and stroma = responsive to gonadal hormone. Increase in prostaglandin inflammatory response fibrosis and scarring. MALE INFERTILITY TESTES: Under GnRH 1 - Steroidogenesis Leydig cells between seminiferous tubule Testesterone – (LH) 2 – Spermatogenesis Sertoli cells (inhibin) – (FSH) Both lead to production of healthy spermatozoa. Cryptoorchidism: Infection – orchitis – mumps Occupation – excess heat, radiation, toxic Lifestyle – smoking, alcohol Drugs salfasalyasin Ejaculation – disorders – Retrograde Premature Ejeculation - Impotence Congenital abnormalities Chromosomal anomalies Traumatic causes Coital Abnormalities Vascular Hormonal Inflammatory Immunological Environmental EXAMINATION: General Health Presence of 20 sexual characteristics Genital Examination Epididymis Testes INVESTIGATION: Hormonal Testesterone FSH Chromosome Karyotype Semen Analysis Volume 2 – 6ml Liquefa within 30 min. Density 20-250 million/ml Motility > 50% progressive movement AZOOSPERMIA Obstructive Non obstructive PRINCIPLE OF MANAGEMENT Deal with the couple together AIM OF INVESTIGATION: To give an explanation of the cause To form basis for treatment. Prognosis IN THE FEMALE: Rubella status Check for ovulation ● Basal body temperature chart ● Serum progesterone D21-22 (28 day cycle) ● LH Surge ● Ultrasound (TVU) S. Prolactin LH / FSH ratio Thyroid function test Endometrial biopsy EVALUATION OF FALLOPIAN TUBE Chlamydia titre Laparoscopy Hysteroscopy Hysterosalpigography (HSG) Tubal insufflation – CO2 POST COITAL TEST Once evaluation is complete, treatment of infertile couple is directed by the findings. WOMEN = Anovulatory cycles Correct underlying cause/ Weight Hyperprolactinaemia Hypothyroidism Ovulation Induction Clomaphine citrate……Multiple ? Gonadotrophine, injection…OHSS ? Surgery: Tubal Endometriosis Assisted Conception AIH ZIFT GIFT IVF ICSI IUI A.R.T