Infertility - PDF

infertility ALZAEIM ALAZHARY SARAH ISMAT definition  Infertility is defined as a failure to conceive within one or more years of regular unprotected intercourse. Types of infertility There are two types of infertility.  1. Primary infertility: Primary infertility denotes couples...

infertility ALZAEIM ALAZHARY SARAH ISMAT definition  Infertility is defined as a failure to conceive within one or more years of regular unprotected intercourse. Types of infertility There are two types of infertility.  1. Primary infertility: Primary infertility denotes couples who have never been able to conceive.  2. Secondary infertility: Secondary infertility indicates difficulty in conceiving after already having conceived. Causes of infertility ❑ Male factor ❑ Female factor 5% 30% ❑ Both 25% ❑ Unexplained 30% male factor female factor both unexplained Female subfertility Ovulatory uterine disorders tubal damage disorders polycystic ovary pelvic inflammatory fibroids syndrome (PCOS) disease (PID) Endometrial polyps Hypothalamic disorders endometriosis. Endometrial scarring pituitary disease abdominal surgery (Asherman’s syndrome) Causes of infertility Causes of male infertility Male factor Compromised sperm  –reversible conditions (varicocele, number or quality is an obstructive azoospermia) important contributor to  –not reversible, but viable sperm subfertility available (ejaculatory dysfunction,  Oligospermia reduce number inoperative obstructive azoospermia)  Azoospermia no sperm  –not reversible, no viable sperm  Teratospermia..abnormal shape (hypogonadism)  –genetic abnormalities  –testicular or pituitary cancer History General history  − occupation and background  − use of tobacco, alcohol and drugs  − history of abdominal surgery and earlier diseases/infections Sexual history  − sexual disturbances or dysfunction such as vaginismus, dyspareunia or erectile dysfunction  − sexually transmitted infections history Obstetric and Gynecological History :  Reproductive history  Gynecological history  Age at menarche  Menstrual periods: duration and intervals  Previous contraceptive use  Previous testing and treatment for infertility General and Gynecological Examination Visual evaluation and pelvic exam for Visual evaluation and penile exam women to rule out: for men to rule out:  Endocrinopathy  Hypogonadism  Congenital anomalies  Tumors Epididymal cysts  Uterine hypoplasia  Cryptorchidism  Cervical lesion  Hydrocele  Dyspareunia  Varicocele Investigation Male Partner: Semen Analysis Semen is studied for a number of factors including: ▪ Volume (1.5 cc to 5.0 cc) ▪ Number of sperm present (> 15 million/ml) ▪ Sperm progression motility (> 32%) ▪ Morphology (> 4 % normal forms) Investigation Female investigation : Confirm ovulation  FSH,LH cycle day 2or3  AMH (antimularian hormone} ovarian reserve  Luteal phase progesterone day 21  Transvaginal ultrasound (TVUSS) to see antral follicle count (AFC) Investigation Female investigation : Tubal assessment  hysterosalpingography (HSG) using X-ray  hysterocontrast synography (HyCoSy) using ultrasound  laparoscopy and hysteroscopy Treatment Treatment of female infertility consists of  fertility restoration drugs,  fertility restoration surgeries,  Assisted reproductive technologies( ART). Management {medical} Ovulation IUI {Intrauterine IVF/ICSI induction insemination} {In-vitrofertilization },{intracytoplasmic sperm injection} PCOS ovulatory Mild male factor problems Cervical mucus Male factor Unexplained problems Tubal pathology infertility Unexplained Unexplained infertility infertility Management {surgical} ❑ minimal access surgery (MAS) ; ▪ laparoscopic ablation of endometriosis ▪ ,adhesion , ▪ ovarian drilling for PCO. ❑ laparotomy approach for the use of myomectomy ART(assisted reproductive technologies) ART involves removing of eggs from a woman body and mixing with sperm in the laboratory. Common ART methods  1. Intrauterine insemination.  2. Invitro fertilization.  3. Zygote intrafallopian transfer( ZIFT).  4. Gamete intrafallopian transfer( GIFT).  5. Intracytoplasmic sperm injection( ICSI). Thanks ….any question …