Inability to conceive despite trying and having regular intercourse for one year. The causes could be due to female factors or male factors

Causes In Women Cervical Tubal Uterine Ovarian Endometriosis Unexplained Age

 Laser conization- low secretion of mucous  Anti-Sperm Antibodies  Closed Cervix  Blockage of the vagina  Imperforate hymen  Extremely narrow vagina  Painful infections in the vagina

Uterine Causes of Infertility in Women  Congenital  Asherman Syndrome  Fibroids  Fibrosis  Endometrial Polyps  Adenomyosis

Treatment: Hysteroscopic resection of these adhesions can be done but it may need multiple sessions, in addition to giving steroids with estrogen for three weeks after surgery to avoid recurrence. Asherman Syndrome:  Intra uterine adhesion (srepeated curettage, severe endometritis, scars of uterine surgery).  Decreased amount of blood loss during menstruation.  Can be diagnosed easily using hysterosalpingogram.

Fibroids: Benign uterine tumor. “ Adenomyosis They usually do not cause infertility unless it affects the intrauterine cavity in an obvious way, but if no other reason for infertility can be found, it is better to do myomectomy (excision of the fibroid ) and restore the intrauterine cavity. Myomectomy can be done either by Hysteroscopic resection or by laparotomy ‘’

Fibrosis may happen after Endometritis and can be diagnosed using HSG, hysteroscopy can help in treatment.

Endometrial polyp: Its presence mimics IUCD, polyps can be diagnosed by HSG, ultrasound or hysteroscopy then polypectomy (removing the polyp) can be done easily. Adenomyosis: Symptoms include secondary dysmenorrhea, some hormonal treatments could be helpful e.g. GNRH analogues, or Danazol, the decision for this treatment should be taken by the treating physician.

Chronic Pelvic Infections Fimbral End Destruction Adhesions Short tubes Tubal Tumors Tubal Cause Of Infertility

Chronic Pelvic Infections:  Cause tubal congestion.  Obstruction (>3cm ) results in impeding of the oocyte transfer,  May result in pelvic adhesions that will affect tubal movement.  Slowing it so inappropriate time for oocyte transfer interferes with fertilization.  Tubal occlusion or pelvic adhesions that cause inability for the fimbrial ends to catch the oocyte from the ovary or as mentioned before abnormal movement of the tubes and oocyte transfer.  Causes for PID include infections with E.coli, or Gonococcus infection (STD) PID affects ovarian function and tubal movement

 Destruction of the fimbrial ends : Disabling its function in catching oocytes into the tubes, PID or endometriosis can cause this.  Adhesions: Caused by tubal surgery done for ectopic pregnancy, pelvic surgery done to the tubes or due to appendicitis.  Tubal Tumors affecting it's function.  Short tubes (less than 4cm).

Polycystic Diseases Functional Failure Pituitary Failure Endocrinopathy Hypothalamic Failure Ovarian Dysfunction

Polycystic ovarian disease: 20% of females have what is called polycystic ovary which involves having follicles consisting of more than the normal condition. In this case the woman has normal fertility but if it is associated with some conditions, it is called polycystic ovarian syndrome and it is pathological.

Women with e tubal occlusion Male abnormal semen analysis Women with PCOD will need IVF, should be individualized Treatment of hormonal imbalance is the best thing Recurrent abortions in PCO:  Increased LH level  Control before starting induction of ovulation.  Ovarian diathermy lowers LH  lower recurrent miscarriages

Congenital: Genetic and chromosomal causes  Ovarian agenesis.  Hereditary causes for accelerated loss of ovarian reserve.  Familial premature ovarian failure.  Chromosomal abnormalities (47XXX). Exposure to certain factors:  Large amount of radiation exposure.  Chemotherapeutic agents as in cancer treatment.  Viruses such as mumps.  Heavy smoking. Congenital : enzymatic dysfunction  17-α Hydroxylase Deficiency.  Galactosemia. Extras :  Autoimmune causes: Presence of ovarian antibodies.  Lack of (or dysfunction) of LH, FSH ovarian receptors.  Idiopathic causes.  Surgical oopherectomy.

Secondary disorder of Gonadotrophin Regulation: 1.High prolactine level 2.Pituitary adenoma 3.Idiopathic hypothyroidism 4.side effect to medication 5.Suprapituitary Tumors 6.Pituitary Tumors, trauma such as in RTA, 7.Radiation exposure to the pituitary. 8.Idiopathic causes. LH and FSH gonadotrophin Deficiency due to: 1.Pituitary tumors. 2.Destructive pituitary lesion. 3.Pituitary ablation. Secondary disorder of Gonadotrophin Regulation: 1.High prolactine level 2.Pituitary adenoma 3.Idiopathic hypothyroidism 4.side effect to medication 5.Suprapituitary Tumors 6.Pituitary Tumors, trauma such as in RTA, 7.Radiation exposure to the pituitary. 8.Idiopathic causes. LH and FSH gonadotrophin Deficiency due to: 1.Pituitary tumors. 2.Destructive pituitary lesion. 3.Pituitary ablation.

Causes :  Rapid and sudden increase or decrease in body weight.  Severe psychological and neurological stress strenuous exercises.  Radiation exposure.  Medications that cause hypothalamic failure.  Tumors.  Unknown causes. Causes :  Rapid and sudden increase or decrease in body weight.  Severe psychological and neurological stress strenuous exercises.  Radiation exposure.  Medications that cause hypothalamic failure.  Tumors.  Unknown causes. Endocrinopathy  Adrenal gland dysfunction  Thyroid gland problems.  Hypothyrodism  Pancreatic problems Endocrinopathy  Adrenal gland dysfunction  Thyroid gland problems.  Hypothyrodism  Pancreatic problems

"Endometriosis Is Presence of Endometrial Tissues Outside Endometrial Cavity" Affects pregnancy either by forming chocolate cyst (endometrioma) or by causing adhesions. Diagnos -Laparoscopy Treatment:  Laparoscopic adhesiolysis,  Cauterization of endometriotic spots,  Salpingostomy and reanastomosis of fallopian tube problems. Affects pregnancy either by forming chocolate cyst (endometrioma) or by causing adhesions. Diagnos -Laparoscopy Treatment:  Laparoscopic adhesiolysis,  Cauterization of endometriotic spots,  Salpingostomy and reanastomosis of fallopian tube problems.

Hypotheses  Stress and worries changes in internal hormones,decreased cervical secretions or muscular spasm, including those lining fallopian tubes causing its obstruction, or muscles lining the vagina causing dyspareunia.  Stress also has its effects on the hypothalamus and ovarian function. Couple seeking pregnancy to try, as much as possible, to alleviate stress and worries and have trust in god and trust their treating physician.

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