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Infertility: Etiology, Diagnostic

Evaluation, Management, Prognosis

Michaella Almirah T. Mujaddid

Causes of Infertility

Collins reported that among 14,141 couples in

21 publications, ovulatory disorders occurred
27% of the time:
• male factors, 25%;
• tubal disorders, 22%;
• endometriosis, 5%;
• other, 4%;
• and unexplained factors, 17%
Diagnostic Evaluation

Probability of conception on
specific days near the day of
ovulation. The bars represent
probabilities calculated from data
on 129 menstrual cycles in which
sexual intercourse was recorded
to have occurred on only a single
day during the 6-day interval
ending on the day of ovulation
(day 0). The solid line shows daily
probabilities based on all 625
cycles, as estimated by the
statistical model.
• Use of Ultrasound in the Diagnostic Evaluation

It is most common to carry out a pelvic ultrasound evaluation as part of

the investigation. By so doing, significant pathology such as fibroids,
endometriosis, and other pathology can be uncovered. In addition
polycystic ovaries, which are prevalent, can be appreciated; and finally
an antral follicle count (AFC) can be obtained, which is similar in value
to the measurement of AMH, in the assessment of ovarian reserve. An
age-related nomogram for AFCs has also been reported. For
standardization it has been suggested that the AFC be obtained on
cycle days 2 to 4
Age-related nomogram for antral follicle count depicted by various
percentiles showing a biphasic decline and with a poor antral follicle count
defined by a value under eight.
• Other Blood Testing

Some specialists obtain antibody titers for Chlamydia trachomatis , which if

elevated may signify the possibility of tubal disease. It has been suggested that if
the immunoglobulin G (IgG) antibody titer is greater than 1:32, 35% of patients
have evidence of tubal damage. Whether this type of evaluation is routinely
warranted as a focus for the infertility investigation continues to be debated.
• Hysterosalpingography

Representative hysterosalpingograms showing a normal study (A), normal

ampullary folds (B), bilateral salpingitis isthmica nodosa (proximal disease) (C),
and bilateral hydrosalpinges (distal disease) (D).
Technique of tubal cannulation using a vacuum cup on the cervix, the
introduction of a 5.5-French catheter into the tubal ostium under fluoroscopy;
followed by a 0.015-inch guidewire into the fallopian tube for dislodgement of
debris ( A ). B shows injection of contrast through a 3-French catheter into the
tube confirming successful cannulation and a normal-appearing patent tube.
Treatment of the Causes Of Infertility

• Clomiphene Citrate
• Metformin and Other Insulin Sensitizers