Infertility
Infertility
No sperm: - Absence of sperms in semen.
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Low sperm motility: -
•Sperms are immotile, can not swim.
•Abnormal sperms: (Unusual shape , more difficult to move and fertilize
egg) it caused by:
Testicular infections.
Testicular cancer.
Testicular surgery.
Continued….
• Overheating testicles.
• Ejaculation disorders (Retrograde ejaculation).
• Variocele (includes varicose vein in scrotum).
• Undescended testicles.
• Hypogonadism (testosterone deficiency).
• Genetic abnormality.
• Mumps (testicular inflammation).
• Hypospadiasis.
• Chlamydia infection
Cont….(Causes/risk factor of Infertility)
In Women
•Premature ovarian failure (before age of 40)
•Polycystic ovary syndrome.
•Hyper-prolactinemia (in non pregnant state)
• Poor egg quality.
•Problems in uterus & fallopian tubes
•Surgery.
•Sub-mucosal fibroids.
•Endometriosis.
•Previous sterilization treatment.
Requirement of normal pregnancy and delivery of a viable fetus
1. Normal health reproductive organs
2. Discharge of a healthy ovum from the ovary
3. The ovum find its way into fallopian within a few hours
4. Insemination occurs and the spermatozoa migrate to the tubes
5. Fertilization of ovum in ampulla
6. Fertilized ovum implanted and develops in a favorable site in the
endometrial
7. Maturation proceeds normally until delivery
Etiology of female infertility
Smoking
• Irregular periods: Some women with PCOS get fewer than eight
periods a year
• Heavy bleeding: The uterine lining builds up for a longer period
of time, so the periods you do get can be heavier than normal.
• Hair growth: More than 70 percent of women with this
condition grow hair on their face and body is called hirsutism.
• Acne: the skin oilier than usual.
• Weight gain: Up to 80 percent of women with PCOS are
overweight or obese .
• Darkening of the skin: Dark patches of skin can form in body
creases like those on the neck, in the groin, and under the
breasts.
Anovulation
Symptoms Evaluation*
• Irregular menstrual • Follicle stimulating
cycles hormone
• Amenorrhea • Lutenizing hormone
• Hirsutism • Thyroid stimulating
hormone
• Acne
• Prolactin hormone
• Galactorrhea
• Androstenedione hormone
• Increased vaginal
(oestrogen &testosterone )
secretions
B-Tubal factor infertility:
It caused by:
1-Completely blocked fallopian tubes.
-If the fallopian tubes are open the dye flows into the tubes
and then spills out to the abdominal cavity.
Investigated by (Hysteroscopy)
Uterine Polyps
Investigation for infertility females:
1. Medical treatment
2. Correction of coital Difficulties
3. Improve vaginal and\or cervical secretion through:
a. treatment of infected cervical erosion
b. improve deficient or viscous cervical secretion by
administration of estrogen in the first 10 days of cycle
4. Correction of any lesion in the uterine body
5. Correction of the lesion of the tube
6. Stimulation of ovulation:
Before start the treatment, you must do hormonal assay to
assess the prolactine, estrogen, FSH,LH, and progesterone
A. If prolactine level is high this will lead to decrease level of
estrogen , and progesterone and prevent ovulation. After
exclusion of pituitary tumor, high level prolactin is treated
by parlodel
B. If an ovulation occurring due to FSH, and LH she is treated
by clomid as the following
1. 50 mg\day start from the 3rd day of menstrual cycle
2. treatment is given for 3 month . Ovulation should occur
around day 12-16 and intercourse advice each other day
from 10-18 day
Causes of male infertility
Disruption of testicular or ejaculatory function
•Varicocele: a condition in which the veins within a man’s
testicle are enlarged. Although there are often no
symptoms, varicoceles may affect the number or shape of
the sperm and decreased sperm quality, which can cause
infertility.
•Trauma to the testes may affect sperm production and
result in lower number of sperm.
•Hormonal disorders: Improper function of the
hypothalamus or pituitary glands. The hypothalamus and
pituitary glands in the brain produce hormones that
maintain normal testicular function
Causes of male infertility …
(Cont.)
• Heavy alcohol use, smoking, anabolic steroid
use, and illicit drug use.
• Cancer treatment involving certain types of
chemotherapy, radiation, or surgery to remove
one or both testicles.
• Medical conditions such as diabetes, cystic
fibrosis, certain types of autoimmune
disorders, and certain types of infections may
cause testicular failure.
• Obesity
• Psychological problem and stress.
Treatment of the husband:
Medical:
Good diet , vitamins and attention to
causative habits as smoking, alcohol and
drug addiction
Treatment of diabetes.
Treatment of specific & nonspecific
infection.
Hormonal agents as testosterone to improve
spermatogenesis.
Cortisone in cases with circulating antisperm
antibodies.
Surgical treatment
Prevention of infertility:
some but not all of infertility causes are
preventable as:
- general advices female marriage and
childbearing should be planned earlier rather
than in the latter fertile years. An advice to
complete family before 35 years female age.
- Prevention and control of genital infection:
1- Sexually transmitted diseases especially
gonorrhea, chlamydia and mycoplasma.
2- Control of non venereal disease as T.B.
3- Immunization of children against Mumps.
4- Prevention & treatment of puerperal & post
abortive infections
5- Treatment of appendicitis which lead to
pelvic adhesions.
Avoidance of unnecessary pelvic operations:
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