Escolar Documentos
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Dr Somsubhra De
Assistant Professor Dept of OBG
Definition
Types
Primary infertility
Inability of couples conceiving after staying together and having regular unprotected intercourse for two year
Secondary infertility
Inability of couples conceiving after an initial phase of fertility
Incidence
Causes
Male
40%
Female
40%
Causes in MALE
Causes in MALE
Failure to produce sperms
Incomplete development of testes Late descent/ non descent of testes Previous orchitis due to mumps Damage to testes due to X Ray, trauma Exposure of testes to heat Diseases like TB, diabetes etc
Causes in MALE
Obstructive azoospermia Trauma Surgeries like herniorrhaphy Epididymitis by TB Absence of vas Congenital obstruction of epididymis
Causes in MALE
Failure to deposit Sperms
Causes in FEMALE
Causes in FEMALE
Ovarian factors
Causes in FEMALE
Tuboperitoneal factors
Causes in FEMALE
Other factors Uterine Cervical Vaginal Coital errors Lubricants Anxiety
History
Man and wife questioned separately and then together
Examination
External genitalia of both partners In females in addition: body habitus, breast and thyroid, acne and hirsutism
Clinical
Physical examination as before
Semen Analysis
3 days abstinence Obtained by masturbation into a clean wide mouthed container
Testicular biopsy
WHO criteria Semen Analysis Report Volume: Liquefaction time: Sperm count: Sperm Motility: Morphology: 2 6 ml 30 minutes >20millions/ml >50% motile >30% normal
Clinical
Physical examination as before
USG
Uterus and ovaries, follicular imaging and endometrial thickness (10mm at the time of ovulation)
Hormonal assays
FT4, TSH, PRL, FSH, LH
Laparoscopy
Hysterosalpingography
Procedure
Radio opaque water soluble dye is injected into the cervix and noted
Gives information about each tubes, site of obstruction and also about the uterine cavity and its abnormalities
Within Day 10 of menses
Hysterosalpingography
Dangers
Hysterosalpingography
Contraindications
After curettage
Recent acute salpingitis Suspected TB /lower genital tract infections
Hysterosalpingography
Normal Picture
ARCUATE UTERUS
BICORNUATE UTERUS
Treatment
For Male
Correction of impotence, premature ejaculation Improve the sperm by clomiphene, hCG, hMG and GnRh TESA, MESA Correction of varicocele
Treatment
For Female
Hormone therapy
For ovulation disorders mainly. Clomiphene citrate, gonadotrophins, bromocriptine etc
Operatives
For tubal reconstructions mainly. Laparoscopic ovarian drilling in PCOS improves ovulation
ICSI with ET
IVF with ET