INFERTILITTY SALWA NEYAZI CONSULTANT OBSTETRICIAN GYNECOLOGIST PEDIATRIC & ADOLESCENT GYNECOLOGIST
INFERTILITY Failure to conceive after one year of unprotected intercourse Incidence 15% of couples 1ry /2ry infertility The normal fecundability rate 20% What are the causes of infertiliy? Anovulation 10-25% Tubal blockage & endometriosis 30-50% Male factor 30-40% Cervical factor 5-10% Unexplained 5%
EVALUATING INFERTILE COUPLES History Age of both husband & wife Length of time conception has been attempted Previous pregnancies Frequency of intercourse/ dysparunea Menstrual history/ dysmenorrhea Headache visual changes & galactorrhea Excessive stress or exercise Symptoms of thyroid disease Pelvic surgery / appendicitis PID/ septic aborrtion/ ectopic pregnancy/IUCD Cervical conization or cryocautery / trauma D&C
HISTORY Husband Does he have children from another wife Testicular injury or surgery Mumps Medical diseases DM, renal disease, chemotherapy Exposure to heat, drugs,alcohol, smoking
PHYSICAL EXAMINATION Signs of androgen excess Signs of thyroid dysfunction Obesity Emaciation / anorexia nervosa Galactorrhea Pelvic examination Signs of pelvic infection -Uterosacral ligament nodularity -Immobility of the uterus -Irregular shape of the uterus -Pelvic mass
INVESTIGATIONS Semen analysis To test for ovulation -BBT -Endometrial biopsy -Serum progestrone FSH, LH, prolactin, TFT HSG Laparoscopy Post coital test
TREATMENT Depends on the cause 1-Anovulation PCO -Clomiphene citrate Ovulation 70% Pregnancy 40% Twins 5-10% -HMG / pure FSH -Glucophage -Ovarian drilling -IVF
TREATMENT OF ANOVULATION Hypothalamic – pituitary failure “ Hypogonadotropic hypogonadism ” Kalman ’ s syndrome / Anorexia nervosa / Stress -HMG pergonal -Synthetic pure FSH puregon / gonal F -Pregnyl (HCG) act like LH The risk of gonadotropin therapy Hyperstimulation syndrome Multiple pregnancy 10-15%
TREATMENT OF ANOVULATION Hyperprolactinemia Bromocriptin 2.5 mg bd Surgical excision Hypothyroidism / hyperthyroidism anovulation due to altered estrogen metabolism Anovulation due to ovarian failure Premature menopause
TREATMENT OF PERITONEAL FACTORS Tubal blockage -Laparoscopic salpingostomy for distal obstruction -Hystroscopic tubal canulation for proximal obstructuion -Microsurgery -IVF Endometriosis 10-25% -Surgical treatment Laparoscopic cauterization of endometriotic spots or laser ablation preg rate mild/mod dis 60% severe dis 35%
TREATMENT OF PERITONEAL FACTORS Medical treatment of endometriosis OCP continuously 6M preg rate 40-50% Danazole GnRH analogues
TREATMENT OF CERVICAL FACTORS / MALE FACTOR / UNEXPLAINED INFERTILITTY Superovulation + IUI Assissted reproductive techniques TREATMENT OF UTERINE FACTOR Asherman syndrome Hystroscopic lysis of adhesions followed by estrogen therapy Pregnancy rate 70%
ASSISSTED REPRODUCTIVE TECHNIQUES IVF GIFT ZIFT ICSE