Infertility.pdf

Infertility Dr. Ahmed Reda Lecturer in Obstetrics and Gynecology  Definition Infertility is Inability to conceive after one year of: o Regular marital life o Unprotected intercourse Background General incidence of infertile couples is 10 to 15 %. Half of...

Infertility Dr. Ahmed Reda Lecturer in Obstetrics and Gynecology  Definition Infertility is Inability to conceive after one year of: o Regular marital life o Unprotected intercourse Background General incidence of infertile couples is 10 to 15 %. Half of those who do not conceive in the first year will do so in the second year (cumulative pregnancy rate over 90%) The chances of conceiving in any given menstrual cycle is less than 20% Types Primary Secondary a couple a couple who who has has previously never conceived conceived regardless of the pregnancy outcome Causes Sexual problems Sexual problems that may contribute to infertility: Too frequent intercourse produces immature sperms. Infrequent intercourse carries possibility of coitus away from the fertile time. Coital difficulties: impotence, vaginismus, dyspareunia. Vaginal wash after intercourse. Use of lubricants interferes with sperm motion. MALE FACTOR INFERTILITY Causes of Male Infertility Impaired spermatogenesis Anti-sperm antibodies Obstruction of seminal tract Defective delivery of sperm Investigations Semen analysis  Normal Semen Parameters Parameter Normal Value Volume ≥ 1.5 ml PH ≥ 7.2 Sperm count ≥ 15 million per ml Total sperm count ≥ 39 million per ejaculate ≥ 40% total motility, Motility ≥ 32 progressive motility Vitality ≥ 58% live spermatozoa Morphology ≥ 4% normal sperms FEMALE FACTOR INFERTILITY  Causes of Female Infertility Ovulatory Uterine Cervical Polycystic Tubal Pelvic Congenital Anatomical ovary adhesions anomalies abnormaliti syndrome es (PCOS) Pelvic infection Asherman’s Luteal syndrome Chronic phase Pelvic cervicitis defect endometriosis Uterine Myoma Prematur Antisperm e ovarian Chronic antibodies failure Endometritis Resistant ovary syndrome Ovulatory Factor Assessment of ovulation (investigations): History Hormonal profile Ultrasound assessment of ovulation (folliculometry) Data in the history that suggest normal ovulation Regular menstrual cycles. Mid-cycle ovulatory pain (Mittelschmerz pain). Ovulatory discharge: minimal increase of clear watery discharge. Ovulation spotting: Few drops of blood due to transient drop in estrogen level with rupture of the follicle. Premenstrual symptoms: e.g. mastalgia. Spasmodic dysmenorrhea. Tubal Factor Assessment (investigations): Hystero-salpingography (HCG) Laparoscopic Normal HSG Hydro salpinx HSGTubal Block laparoscopy hydro-salpinx Uterine Factor Assessment (investigations): Hystero-salpingography (HCG) Hysteroscopy Hysteroscopy  intrauterine adhesions (= Asherman’s syndrome) Hysteroscopy  intrauterine septum Basic workup for Infertility Detailed history and physical examination. Evidence of ovulation. Semen analysis. Hormonal profile: – Serum FSH – Serum LH – Serum prolactin – Thyroid function tests Trans-vaginal ultrasound and folliculometry Hystro-salpingography (HSG) Further Investigations Laparoscopy Hysteroscopy Treatment Sexual problems Advise and correct AIH Male factor Mild , moderate  medical treatment then AIH Severe  ICSI Ovulatory factor Induction of ovulation IVF / ICSI Tubal factor IVF / ICSI Unexplained infertility Induction of ovulation ± AIH IVF / ICSI Abbreviations ART = assisted reproductive technology AIH = artificial insemination by husband IVF = in vitro fertilization ICSI = intracytoplasmic sperm injection Hope to meet you soon…