ch. 13 Infertility

Posted: May 17, 2012 in Gynocology

Infertility means She/He cannot make a baby (conceive).

Types :

  • Primary infertility refers to couples who have not become pregnant after at least 1 year of unprotected sex (intercourse).
  • Secondary infertility refers to couples who have been pregnant at least once, but never again.
Requirements for Normal Reproduction :
1)Release of a normal preovulatory oocyte.
2)Production of adequate spermatozoa.
3)Normal transport of the gametes to the ampullary portion of the fallopian tube (where fertilization occurs).
4)Subsequent transport of the cleaving embryo into the endometrial cavity for implantation and development.

Etiology :

Female infertility :

  1. A fertilized egg or embryo does not survive once it sticks to the lining of the womb (uterus)
  2. The fertilized egg does not attach to the lining of the uterus
  3. The eggs cannot move from the ovaries to the womb
  4. The ovaries have problems producing eggs

Female infertility may be caused by:

  1. Autoimmune disorders, such as antiphospholipid syndrome (APS)
  2. Cancer or tumor
  3. Clotting disorders
  4. Diabetes
  5. Growths (such as fibroids or polyps) in the uterus and cervix
  6. Birth defects that affect the reproductive tract
  7. Excessive exercising
  8. Eating disorders or poor nutrition
  9. Use of certain medications, including chemotherapy drugs
  10. Drinking too much alcohol
  11. Obesity
  12. Older age
  13. Ovarian cysts and polycystic ovary syndrome (PCOS)
  14. Pelvic infection or pelvic inflammatory disease (PID)
  15. Scarring from sexually transmitted infection or endometriosis
  16. Thyroid disease
  17. Too little or too much hormones
Male infertility :
  1. A decrease in sperm count
  2. Sperm being blocked from being released
  3. Sperm that do not work properly

Male infertility can be caused by:

  1. Environmental pollutants
  2. Being in high heat for prolonged periods
  3. Birth defects
  4. Heavy use of alcohol, marijuana, or cocaine
  5. Too little or too much hormones
  6. Impotence
  7. Infection
  8. Older age
  9. Cancer treatments, including chemotherapy and radiation
  10. Scarring from sexually transmitted diseases, injury, or surgery
  11. Retrograde ejaculation
  12. Smoking
  13. Use of certain drugs, such as cimetidine, spironolactone, and nitrofurantoin

 Tests for diagnosis Female Infertility :

  1. Transvaginal Ultrasonography (TVUS)
  2. Hysterosalpingography (HSG)
  3. Hysteroscopy
  4. Laparoscopy
  5. History of Past Diseases

Tests for diagnosis Male Infertility :

  1. Scrotal Ultrasonography
  2. Transrectal Ultrasonography (TRUS)
  3. Complete Blood Count (CBC)
  4. FSH, Testosterone
  5. GC/Chlam, UA
  6. Renal and Liver Function
  7. Semen analysis
  8. Postejaculatory urinalysis
  9. Past sexually transmitted infection (STI).
  10. Varicocele  (widening of the Varicose veins along the cord that holds up a man’s testicles)
  11. Hernia
  12. History of Past Diseases

Infertility Treatment :

  • Treatment of infertility depends on the cause, diagnosis, duration of infertility, age of the partners and many personal preferences.
  • Some causes of infertility cannot be corrected.
  • A woman can still become pregnant with assisted reproductive technology or other procedures to restore fertility.
Increase frequency of intercourse: Two to three times a week of intercourse may improve fertility.

Sperm survive in the female reproductive tract for up to 72 hours, and an egg can be fertilized for up to 24 hours after ovulation.

General sexual problems:  Addressing impotence or premature ejaculation can improve fertility.
Treatment for these problems often is with medication or behavioral approaches.

 Lack of sperm: surgery or hormones to correct the problem or use of assisted reproductive technology is sometimes possible.

Varicocele can often be surgically corrected.

Stimulating ovulation with fertility drugs: Fertility drugs are the main treatment for women who are infertile due to ovulation disorders.These medications regulate or induce ovulation, and work like natural hormones to trigger ovulation such as: Follicle-stimulating hormone (FSH) and Luteinizing hormone (LH).

Commonly used fertility drugs include:

  1.  Clomiphene citrate
  2. Human menopausal gonadotropin, or hMG (Repronex)
  3. Follicle-stimulating hormone, or FSH (Gonal-F, Follistim, Bravelle)
  4. Human chorionic gonadotropin, or HCG (Ovidrel, Pregnyl)
  5. Gonadotropin-releasing hormone (Gn-RH) analogs
  6. Letrozole (Femara)
 
In Vitro Fertilization
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