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 Definition of infertility Is :

Any woman not being able to get


pregnant after at least one year of
Unprotected Intercourse.
 80% to 90% couples conceive within one
year of their marriage.
 Incidence : 10% to 15% of all couple are
infertile. Incidence varies among
different communities but generally
about 15% of couples need some help to
achieve pregnancy.
 Infertility is a common condition
affecting one in six couples.
 About 80 million couples are affected
world wide.
 It is of two types:
1. Primary Infertility
2. Secondary Infertility
 Pregnancy is a result of complex events
which includes ovulation that is release
of mature egg from the ovary.
 Its transport through the fallopian tubes.
 Availability of healthy sperms that fertilize
the egg.
 The fertilized egg must attaches itself to
uterus.
 So infertility can result from problems that
interfere with any of these steps.
 Infertility is not always women’s
problem.
 Causes of infertility may lie either in male
or female or in both.
 Female Causes ( 40% ), Male causes (
40% ), 20% is a combination of Male &
Female causes.
 UNEXPLAINED ( 28% )
 SPERM PROBLEM ( 21% )
 OVULATORY PROBLEM ( 18 % )
 TUBAL DAMAGE ( 14 % )
 ENDOMETRIOSIS / CERVICAL MUCOUS ( 9
%)
 COITAL PROBLEM ( 5 % )
 OTHER ( 5 % )
 OVULATORY:
- PCOs, Hypotalamic Amenorrhea, Luteal
Phase Deficiency
 TUBAL / PERITONEAL :
- Hydrosalphinx, Tubal Obstruction,
Endometriosis, Adhesion
 UTERINE :
-Synechiae, Fibroids, Anomalies
 CERVICAL
-Mucous, Antisperm antibodies
 OVARIAN RESERVE :
-Ovarian Failure
 Abnormal spermatogenesis
 Impaired sperm transport
 Immunological and infective factor
 Varicoceole
Normal spermatogenesis depends upon
adequate gonadotrophic stimulation of
testes, proper testicular function and
patent seminal duct.
 Orchitis
 Undescended testes
 Past history of mumps
 Chronic renal failure.
 Chronic liver diseases
 Malignancies
 Uncontrol diabetes mellitus
 Multiple scleroses
 Exposure to radiations or Chemotherapy
 Excessive exposure to heat.
 First step in male investigation is Semen
analyses .
-. if this is normal then no other test is
needed.
-. If oligospermia or azoospermia is found
then patients are referred to specialist
fertility clinic for further investigation.
 Ejaculate Volume >2ml
 Sperm Density: >20m/ml
 Motility >50%
 Morphology ≥ 15% normal
 pH 7.5 – 8.5
 At least one-half of male problems can
be treated.
 Treatment in collaboration with urologists
and endocrinologist is essential.
 Treatment options are:
-Drug Therapy
- Surgery
- IUI / ART
 Due to some autoimmune phenomenon.
 Anti-sperm antibodies maybe present in
cervical mucus which neutralize sperms
by clumping them together and
destroying their membrane.
 About 12-15% of unexplained infertility in
women is linked to ASA.
 These include Large fibroids distorting
uterine cavity
 Congenital abnormalities in shape of
uterus.
 Leuteal phase insufficiency, due to
progestrone deficiency which causes
preparation of endometrium for
reception of fertilized ovum.
 Age Stress
 Poor diet
 Smoking
 Alcohol
 STDs
 Overweight/ Underweight
 Caffeine intake
 Too much exercise
 PELVIC ULTRASOUND &
HYSTEROSALPINGOGRAM
 Pelvic Ultrasound : A detailed ultrasound is
important diagnostic tool. It reveals uterine
abnormalities, uterine masses, ovarian size,
presence or absence of follicles, diagnosing
PCO.
 LAPAROSCOPY: It is considered as
investigation of choice. It has advantage of
diagnosing tubal blockage and
simultaneously treating the pathology.
 Treatment should be based on
documentation of abnormality leading
to infertility.
 The first thing to offer a couple is
counseling and reassurance. Because
infertility treatment can be physically
uncomfortable, time consuming, costly
and without guarantee of success.
 Improve general health
 Stop smoking
 Limiting alcohol consumption
 Obtaining standard Weight. Both over
weight and underweight can cause sub
fertility
 Infections are treated with appropriate
antibiotics
 A delicate balance of Estrogen,
Progesterone, FSH, LH is needed for
timely growth and release of egg from
the ovary.
 Even slight irregularity in these hormones
can cause an ovulation.
 Drugs used for induction of ovulation
are: Clomifen citrate ,HMGS, FSHr,
Dopamine Agonists
 Clomiphene is a synthetic weak
estrogen.
 It competes with endogenous estrogen
for estrogen binding sites in the
hypothalamus
 Giving a negative feedback to pitutiary
gland which starts producing large
amounts of FSH which causes growth
and maturity of folical hence ensuring
ovulation.
 HMGS are GlycoProtein Hormones
directly stimulates ovary
 These drugs are prepared from urine of
menopausal women. They are used to
produce super ovulation in ART and in
certain cases where clomiphen citrate
fails to produce ovulation. Progesteron
support is given from 15 to 25th day.
 FSH recombinant is more accepatable
now because it produce not from
human urine and ofcourse it is Halal.
 It works directly to stimulate
folicullogenesis
 All of stimulation ovulation procedure
needs luteal phase support because
usually lack of progesterone
 Bromocriptin is Used when cause of an
ovulation is hyperprolactenemia
 Anti sperm anti bodies are treated with
low dose coticosteroids. Predinsolone 40
– 60 mg is used from day 1 to 10 and
than 20 mg for next 2 days. This therapy is
given for 6 to 9 months.
 IUI
 IVF
 ICSI
 Infertility should be evaluated for couples
after one year of trying pregnant
without contraception.
 History and Physical examination usually
will help to identify the etiology.
 If patients fail the initial therapies then
the proper referral should be made to a
reproductive specialist.
 Optionof adoption is also offered to
infertile couples when all the treatments
are failed