4. الدكتورة زينب عبد الكاظم فتنان شهاده الدبلوم العالي في الامراض النسائية والتوليد والعقم شهادة البورد ( الدكتوراة ) في النسائية والتوليد والعقم بكلوريوس طب وجراحة عامة كليه الطب جامعة الكوفة

5. بسم الله الرحمن الرحيم " لله ملك السموات والارض يخلق مايشاء يهب لمن يشاء اناثا ويهب لمن يشاء الذكوراو يزوجهم ذكرانا واناثا ويجعل من يشاء عقيما انه عليم قدير " صدق الله العلي العظيم الايه (49-50) سورة الشورى

7. Definition: Subfertility is the inability of a couple to conceive following 12– 24 months of exposure to pregnancy or regular unprotected intercourse.

8. T HE NATURAL CONCEPTION RATE OVER A THREE - YEAR PERIOD.

9. Types of sub fertility: primary: in couples who have never conceived. Secondary: in couples who have previously conceived.

10. AgeSmokingAlcohol Body weight Drugs : Occupatio nal hazards Infection Factors that adversely affect fertility :

11. CAUSES OF SUB FERTILITY

12. Causes of female subfertil ity: Ovulatory causes Tubal causes Endomet rial causes

16. Causes of male subfertility: Approximately one in 20 men is sub fertile, about 85 per cent have suboptimal semen quality, while azoospermia, coital dysfunction and immune factors contribute to the rest.

17. Volume >2 mL. PH >7.2. Sperm concentration >20 million per mL. Total sperm number >40 million per ejaculate.

18. How to approach to a couple with subfertilit y: HistoryExaminationInvestigation

19. Ovulation induction (OI). Intrauterine insemination (IUI). Donor insemination (DI). In vitro fertilization (IVF). Donor egg with IVF. Medical treatment criteria:

20. Operative laparoscopy Myomectomy Tubal surgery Laparoscopic ovarian Assisted reproduction. Surgical

21. Q UESTIONS :