Subfertility PDF

In(sub)fertility  Inability of a couple to conceive after 12 Infertility/ months of regular intercourse without use of contraception in women less than 35 Subfertility years of age, and 6 months in women 35 years and older. ...

In(sub)fertility  Inability of a couple to conceive after 12 Infertility/ months of regular intercourse without use of contraception in women less than 35 Subfertility years of age, and 6 months in women 35 years and older.  Probability of achieving a pregnancy in Fecundability one menstrual cycle 199 95 - je ovulation Fecundability of normal population 20% 85% of couples achieve a pregnancy within one year 95% of couples achieve a pregnancy within 2 years  Primary: never achieved Primary pregnancy before versus secondary Secondary: has achieved Subfertility pregnancy before regardless of outcome Causes of Subfertility 1/3 MALE FACTOR 1/3 FEMALE FACTOR 1/3 UNEXPLAINED OR COMBINED FACTORS Female Subfertility TUBAL/PELVIC UTERINE OVARIAN ENDOMETRIOSIS CERVICAL This Photo by Unknown Author is licensed under CC BY-SA  Ovulatory dysfunction: oligoovulation, anovulation Ovarian Subfertility Oocyte aging Ovulatory Disorders WHO WHO Class I: Hypogonadotropic Hypogonadal Classification of Anovulation anovulation: WHO Class II: Normogonadotropic Normoestrogenic Anovulation WHO Class III: Hypergonadotropic Hypoestrogenic Anovulation Hyperprolactinemic Anovulation  PID Adhesions from previous surgery and nontubal infections Tubal/Pelvic Severe endometriosis Subfertility Pelvic TB Pseudo-obstruction: mucous plug, tubal spasm  Fibroids: only those with a submucosal or intracavitary component Uterine Uterine anomalies: Mullerian anomalies, endometrial polyps Subfertility Intrauterine adhesions Cervical Congenital malformations Factors Cervical injury  Causes: Anatomic distortion Damage to ovarian Endometriosis tissue Production of inflammatory substances Controversies Immune Luteal phase Thrombophilia Ovarian cysts factors defect Male Subfertility Pre- Post- Testicular testicular testicular  Congenital hypogonadotropic hypogonadism Acquired hypogonadotropic Pre- hypogonadism testicular Factors Drugs Systemic diseases  Idiopathic dysspermatogenesis Genetic causes Testicular Factors Congenital and developmental disorders Acuired testicular disorders  Abnormalities of the epididymis, vas deferens, ejaculatory duct, seminal Post- vesicles, and prostate. testicular Factors Sexual dysfunction  Timing is important Evaluation of Always evaluate as a couple the Infertile Couple Take psychology into consideration Complete history and physical examination  Male: SFA semen fluid andysis Female: Assessment of ovulation Investigations Assessment of ovarian reserve Assessment of genital tract anatomy Assessment of tubal patency Thyroid function Hormone profile  Volume Concentration Total count SFA pH Motility Morphology Midluteal Progesterone Level This Photo by Unknown Author is licensed under CC BY-SA AMH Arein hormone Released from granulosa cells of antral follicles Declines with age Marker of ovarian reserve Predictor for response to ovarian stimulation This Photo by Unknown Author is licensed under CC BY-SA Antral Follicle Count This Photo by Unknown Author is licensed under CC BY-SA Pelvic Ultrasound This Photo by Unknown Author is licensed under CC BY-SA-NC This Photo by Unknown Author is licensed under CC BY-SA-NC hysterosalpingogram This Photo by Unknown Author is licensed under CC BY-SA-NC This Photo by Unknown Author is licensed under CC BY-SA-NC  Correct reversible causes Treatment Overcome irreversible factors  Ovulatory disorders >>> correct underlying cause if possible, ovulation induction with or without ART, oocyte donation Uterine anomalies >>> surgical, surrogacy, uterine transplant Tubal factors >>> IVF Treatment Endometriosis >>> IVF, surgical Cervical factors >>> surgical, some are difficult to treat Male factor >>> ICSI, sperm donation Unexplained >>> IVF THE END