1. INFERTILITY
د.الق سعيد العارضي

2. INFERTILITY
Infertility is the inability to conceive a child. A couple may be considered infertile if, after two years of regular sexual intercourse, without contraception, the woman has not become pregnant (and there is no other reason, such as breastfeeding or postpartum amenorrhoea). Primary infertility is infertility in a couple who have never had a child. Secondary infertility is failure to conceive following a previous pregnancy.

3. PREVALANCE
15% of married couples complaining of inability to conceive .
By simple advise within 6 month , 60% will conceive , within 1 year .

4. PATHOPHISIOLOGY

5. INFERTILITY The fertility depends on several factors :
Mother age > 35 year , sever decline in the ability to conceive .
FSH level in male and female .
If there is no previous pregnancy is worser .
BMI .
Smoking .
Drugs .
Male factors .

6. PATHOPHISIOLOGY

7. PATHOPHISIOLOGY General factors affecting both sex :
Diabetes mellitus, thyroid disorders, adrenal disease.
Hypothalamic-pituitary factors
Hyperprolactinemia
Hypopituitarism
The presence of anti-thyroid antibodies is associated with an increased risk of unexplained subfertility.
Environmental factors Toxins such as glues, volatile organic solvents or silicones, physical agents, chemical dusts, and pesticides, Tobacco smokers are 60% more likely to be infertile than non-smokers.

8. PATHOPHISIOLOGY FEMALE FACTORS : Ovarian factors
Polycystic ovary syndrome.
Anovulation : Female infertility caused by anovulation is called "anovulatory infertility", as opposed to "ovulatory infertility" in which ovulation is present.
Diminished ovarian reserve.
Premature menopause
Menopause
Luteal dysfunction
Gonadal dysgenesis (Turner syndrome)
Ovarian cancer

9. PATHOPHISIOLOGY

10. PATHOPHISIOLOGY FEMALE FACTORS : Tubal (ectopic)/peritoneal factors
Endometriosis can lead to anatomical distortions and adhesions( has been suggested that endometriotic lesions release factors which are detrimental to gametes or embryos, or, alternatively, endometriosis may more likely develop in women who fail to conceive for other reasons and thus be a secondary phenomenon).
Pelvic adhesions
Pelvic inflammatory disease
(PID, usually due to chlamydia)
Tubal occlusion
Tubal dysfunction

11. PATHOPHISIOLOGY
FEMALE FACTORS : Uterine factors 1.Uterine malformations 2.Uterine fibroids (leiomyoma) 3.Asherman's Syndrome] Cervical factors 1.Cervical stenosis 2.Antisperm antibodies 3.Non-receptive cervical mucus Vaginal factors 1.Vaginismus 2.Vaginal obstruction

12. PATHOPHISIOLOGY Male factors : Disorder of spermatogenesis
impaired sperm transport
Ejaculatory dysfunction
Immune factors
infections

13. PATHOPHISIOLOGY

14. MANAGEMENT
Diagnosis of infertility begins with a medical history and physical exam :
History about :
Duration of infertility
Age of female
Life style
Regularity of sexual intercourse
Any medical illness
Hx of pelvic surgery
Drug history of both male and female
Nutritional history
Menstrual history

15. MANAGEMENT Examination : Examination of female : Examination of male :
Secondary sexual charecterstics
Abnormal fusion of labia majora and minora
Hypertrophy of clitoris
Examination of male :
Hypogonadism
Abscent testis , undescended testis
Abnormality of shape of external genitalia
Abscense of pubic hair , axillary hair or gynaecomastia

16. MANAGEMENT INVESTIGATION : Lab tests
hormone testing, to measure levels of female hormones at certain times during a menstrual cycle
day 2 or 3 measure of FSH and estrogen, to assess ovarian reserve
measurements of thyroid function (a thyroid stimulating hormone (TSH) level of between 1 and 2 is considered optimal for conception)
measurement of progesterone in the second half of the cycle to help confirm ovulation

17. MANAGEMENT Examination and imaging :
an endometrial biopsy, to verify ovulation and inspect the lining of the uterus
laparoscopy, which allows the provider to inspect the pelvic organs
fertiloscopy, a relatively new surgical technique used for early diagnosis (and immediate treatment)
Pap smear, to check for signs of infection
pelvic exam, to look for abnormalities or infection
a postcoital test, which is done soon after
intercourse to check for problems with sperm
surviving in cervical mucous
(not commonly used now because of test
unreliability)
special X-ray tests

18. MANAGEMENT Investigations for male : Seminal fluid analysis
Hormonal analysis ( FSH , LH , prolactine and testesterone )
Check for liver function
Check for renal function
Bloob sugar in case of DM

19. MANAGEMENT TREATMENT : Medical treatments
Medical treatment of infertility generally involves the use of fertility medication, medical device, surgery, or a combination of the following.
If the sperm are of good quality and the mechanics of the woman's reproductive structures
are good (patent fallopian tubes,
no adhesions or scarring),
physicians may start by
prescribing a course of ovarian
stimulating medication.

20. MANAGEMENT
The physician may also suggest using a conception cap cervical cap, which the patient uses at home by placing the sperm inside the cap and putting the conception device on the cervix, or intrauterine insemination (IUI), in which the doctor introduces sperm into the uterus during ovulation, via a catheter. In these methods, fertilization occurs inside the body.
If conservative medical treatments fail to achieve a full term pregnancy, the physician may suggest the patient undergo in vitro fertilization (IVF). IVF and related technique (ICSI) are called assisted reproductive technology (ART) techniques.

21. MANAGEMENT
ART techniques generally start with stimulating the ovaries to increase egg production. After stimulation, the physician surgically extracts one or more eggs from the ovary, and unites them with sperm in a laboratory setting, with the intent of producing one or more embryos. Fertilization takes place outside the body, and the fertilized egg is reinserted into the woman's reproductive tract, in a procedure called embryo transfer.
Other medical techniques are e.g. tuboplasty, assisted hatching, and Preimplantation genetic diagnosis.