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FCPS Notes

Primary subfertility can be caused by female or male factors. Common female factors include ovulatory dysfunction, tubal damage from infections or other causes, uterine fibroids or polyps, PCOS, thyroid issues, or congenital defects. Male factors include age, environmental or occupational exposures, surgery, genetic conditions, infections, obesity, smoking, or erectile dysfunction. Treatment depends on the underlying cause but may include lifestyle changes, medication, surgery, IUI, IVF, donor gametes, adoption or remaining childfree. The goal is to address any identifiable medical issues and improve chances of natural or assisted conception.

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FA Khan
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222 views

FCPS Notes

Primary subfertility can be caused by female or male factors. Common female factors include ovulatory dysfunction, tubal damage from infections or other causes, uterine fibroids or polyps, PCOS, thyroid issues, or congenital defects. Male factors include age, environmental or occupational exposures, surgery, genetic conditions, infections, obesity, smoking, or erectile dysfunction. Treatment depends on the underlying cause but may include lifestyle changes, medication, surgery, IUI, IVF, donor gametes, adoption or remaining childfree. The goal is to address any identifiable medical issues and improve chances of natural or assisted conception.

Uploaded by

FA Khan
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PDF, TXT or read online on Scribd
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PRIMARY SUBFERTILITY SHORT KEY

CAUSES:
FEMALE FACTORS:
Ovulatory dysfunction cyclic irreg ( HMB, Anovulation)
Tubal factor  endometriosis , PID , fibroid blocking tubes, STD (multiple
Partners, unprotected coitus, perineal lesions)
Non-STD ( prev c.sec, D& C IUCD Purperial pyrexia –)
Pelvic TB.
Uterine Uterine fibroids/ endometrial polyp/ IUCD / asherman’s synd/
Endometritis/ anatomical defects
Ovarian PCOs / chemo / radio / hormones
Endocrine abnThyroid dysfunction  hyper/ hypo
Hypothalamic dysfunction  hypothalamic hypogonadism( kallman’s),
POF
Pituitary disease  Hyper prolactinemia prolactinomas/ drugs ( antipsychotic /
anti depressants)
Congenital defects turner / MRKH , AIS
MALE FACTORS:
Age/ profession ( hot environment)/ chemical industry (lead, paints, pesticides)/
radiation/ surgery/trauma/ch.uncorected inguinal hernia/ Prostate surgery
retrograde ejaculation
Primary testicular failurech disorders, maldecendant, microdeletion of genes at
y chromosomes Abn semen analysis  oligo/Azoospermia/ Aspermia/
uncorrected maldecendant testes torsion
Drugs alcohol, smoking, anabolic steroids, anti hypertensive, sedatives,
antipsychotic, antidepressants
Endocrinologicalhypogonadotrophic hypogonadism , hyperprolactinemia
Testicular failure, genital infections (polygamy), diabetes.
Obstructive causescongenital/ inflammatory/ iatrogenic/ cystic fibrosis
Other Infections epididymo-orchitis
Autoimmune antisperm antibodies
PhysiologicalErectile/ ejaculatory dysfunction
Congenital abn Klinifelters synd , sweyer syndrome
MANAGEMENT:
FEMALE FACTOR TREATMENT:
Conditions Treatment
Unexplained infertility Re-assure
1st line cc
2nd line aromataze inhibitors(
letrozole)
3rd line IUI/ IVF
4th (donor/ surrogacy/ not in
PK)Adoption

PID: a.Tubes patent:


treat PID
ovulation induction
IUI
IVF
adoption

b: tubes not patent:


IVF
Adoption
Stage I and II  ov induction
Endometriosis: Better result with ablation/ excision
Stage II & IV surgery for symptomatic
Rx
IVF

TB: Treat TB / IVF/ adoption

PCOS: Weight reduction


Ov induction
By cc/ letrozole/ GnRh
/IUI/IVF/Adoption

Hyperprolactinemia: Dopamine agonists  bromocriptine/


cabargoline

Fibroid: Symptomatic:
a. <3cm fl up/medical Rx
b. >3cm ---< 5cm sub/m 
hysteroscopic resection
c. > 5cm sub/m , intra/m
myomectomy
/dye test
Asymptomatic:
a. <3 yrs infertility with patent
tubes fl up / reassurance
b. >3 yrs infertility with patent tubes/
and b/l blocked tubes
myomectomy , dye test

Polyp: small vaginal avulsion/ thick pedicle


hysteroscopic resection

MALE FACTOR Rx:


Improve Nutrition
Ensure Cf 2—3 / week
Life style/ job /duty adjustment to less hazard environment
Correct deformity
Diabetes control
Quit smoking
If Congenital absence of Vas def/ cystic fibrosis / obstructive causes  surgical
sperm retrieval f/b IVF & ICSI
Hyperprolactinemia impotence  erectile dysfunction phosphodiestrase
type 5 inhibitors / intracavernosal inj of alprostadil
Klinifelters/ sweyer syndrome donor sperms

Dr. Shamim

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