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DEFINITION,
CAUSES,
DIAGNOSTIC
PROCEDURES
AND
COUNCELLING
DEFINITION
Infertility
is the lack of conception after 1
year of unprotected sexual intercourse.
(Hughes and Hammond 1990)
Primary infertility: identifies those women
who have never conceived.
Secondary infertility: indicates those women
who have formerly been pregnant but have
not conceived during one or more years of
unprotected intercourse.
FEMALE CAUSES
Ovulation
Hypothyroidism
Hypothalamic anovulation
Hyperprolactinaemia
Luteal phase defect: there is decreased
hormone production by the corpus luteum as
well as decreased level of FSH and LH.
Polycystic ovaries
Excessive male hormone (androgens)
Physical stress, psychological stress and
extreme lifestyle changes.
Conti..
Cervical infertility
Inadequate or inhospitable cervical mucus due
to the presence of local sperm antibodies or
due to low pH of the mucus at midcycle.
Cervical stenosis( tight internal os)
Infections of the cervix with common sexually
transmitted diseases (chlamydia, gonorrhea, or
trichomonas, as well as mycoplasma hominis
and ureaplasma urealyticum)
Loss of mucus due to amputation of the cervix,
cone biopsy or diathermy.
Conti
Pelvic causes
Scar tissue or "adhesions"
Endometriosis
Tubal factor infertility
Pelvic inflammatory disease (PID):
usually caused by invasion of either
gonorrhea or chlamydia from the cervix up
to the uterus and tubes.
Benign tumors (fibroids)
Conti..
Uterine causes
Thin or abnormal uterine lining
Anatomic problems (polyps,abnormal shape
of the uterus, septum within the uterus,
mullerian anomalies, prior exposure to DES
Diethylstilbestrol)
Uterine atrophy, absence
Tuberculous endometritis
Intrauterine adhesions ( Asherman’s
syndrome) due to previous overzealous
curettage or previous surgery on the uterus.
Conti..
Coital errors
Apareunia and Dyspareuni
Frequency and timing of coitus: coitus has to take
place every 48 hours during the fertile period to
offer the optimum chance of conception.
Unexplained Infertility
Difficulty in picking up the egg by fallopian tube
Failure of implantation of the embryo into the
uterus
Failure of the sperm to fertilize the egg when in
contact with each other
MALE CAUSES:
Exposure to hazardous toxins,
chemicals, or radiation
Infections such as mumps, or venereal
diseases
Testicular injury (sports or work injury)
Childhood illness (failure of a testicle to
descend properly)
Immune reaction against sperm
(antisperm antibodies)
conti
Blockage of one of the ducts allowing
flow of sperm from the testicle
Injury, infection or prior vasectomy
Genetic absence of these ducts
(cystic fibrosis)
Testicular failure and other hormonal
problems
Chronic medical illness (thyroid
disease, diabetes, and hypertension)
Spinal cord injuries and paralysis
Varicocele
DIAGNOSTIC
HISTORY AND PROCEDURES
PHYSICAL EXAMINATION:
Ages, occupations, previous marriages
Duration of marriage and the period of time
during which contraception has been
practiced.
Past gynecological, surgical, medical
history.
Exposures to tobacco, alcohol,
environmental toxins
A history of sexually transmitted diseases
A careful menstrual history
Conti.
Spinnbarkeit –
This is the stretchiness
of the cervical mucus.
It should be almost
elastic and may stretch
10 cms or more.
HYSTEROSALPINGOGRAM
It is essentially an x-
ray procedure in
which a dye is injected
through the cervix into
the uterus and
fallopian tubes. The
radio-opaque material
is injected slowly from
a syringe; the amount
required varying from
2-20 ml
BASAL BODY
TEMPERATURE CHARTING
Laparoscopy picture
of a hydrosalpinx,
fallopian tube that is
blocked and dilated with
fluid.This is evidence of PID
TESTS FOR MALE
INFERTILITY
SEMEN ANALYSIS
The specimen is collected after 3 days of
abstinence, masturbating directly into a dry
and clean wide mouthed glass container.
The semen analysis should include basic
parameters such as sperm number, motility,
and morphology (shape) The technician
looks at how well the sperm are moving and
counts the total percentage of motile sperm
moving.
Semen Analysis Parameter Normal Values
pH 7.2-8.0