1. Infertility

2. Fertility Sub fertility Sterility Infertility:Diminished capacity to conceive and bear a child Sterility:Absolute and irreversible inability to conceive Clinically:Involuntary failure to conceive after 12 months of unprotected frequent intercourse. Primary: No previous pregnancy Secondary:Previous pregnancies what ever the outcome. Prevalence:10-15% 1/3 In the Female 1/3 in the male 1/3 in the couple combined

3. FACTORS AFFECTING FERTILITY: Age Psychological Health General Health

4. DISORDERS: 1. Involving each of the major physical events that are necessary to produce a pregnancy. 2. Production of a healthy eggs. 3. Production of a healthy sperm. 4. Transportation of the sperm to the site of fertilization. 5. Transportation of the egg and zygote to the uterus for implantation. 6. Successful implantation in a receptive endometrium 7. Presence of other factors.

5. No OOCYTES production and OOCYTES abnormalities: Failure to ovulate The disorders are grouped into three general categories:  Hypothalamus]  Pituitary ]  Ovarian ] Dysfunction

6. HYPOTHALAMUS = Abnormalities of weight, body composition. Strenuous Ex. Stress, travel PITUITARY:  Hyperprolactinaemia  Hypothyroidism OVARIAN:  PCOS  Premature ovarian failure

7. ANATOMIC ABNORMALITIES: TUBAL FACTOR:20%  Pelvic Infection  adhesion  Rupture appendicitis  Septic abortion  Previous surgery  IUCD  Ectopic Pregnancy

8. UTERINE FIBROID: ENDOMETRIOSIS :  Ectopic Endometrium Presence of tissue that resembles endometrium outside its normal positon. Glands and stroma = responsive to gonadal hormone. Increase in prostaglandin  inflammatory response fibrosis and scarring.

9. MALE INFERTILITY TESTES:Under GnRH 1 -Steroidogenesis Leydig cells between seminiferous tubule  Testesterone – (LH) 2 – Spermatogenesis Sertoli cells (inhibin) – (FSH) Both lead to production of healthy spermatozoa. Cryptoorchidism: Infection – orchitis – mumps Occupation – excess heat, radiation, toxic

10. Lifestyle – smoking, alcohol Drugs-salfasalyasin Ejaculation – disorders – Retrograde Premature Ejeculation - Impotence  Congenital abnormalities  Chromosomal anomalies  Traumatic causes  Coital Abnormalities  Vascular  Hormonal  Inflammatory  Immunological  Environmental

11. EXAMINATION:  General Health  Presence of 2 0 sexual characteristics  Genital Examination  Epididymis  Testes

12. INVESTIGATION: Hormonal  Testesterone  FSH ChromosomeKaryotype Semen Analysis Volume-2 – 6ml Liquefa-within 30 min. Density-20-250 million/ml Motility-> 50% progressive movement

13. AZOOSPERMIA  Obstructive Non obstructive PRINCIPLE OF MANAGEMENT Deal with the couple together AIM OF INVESTIGATION:  To give an explanation of the cause  To form basis for treatment.  Prognosis

14. IN THE FEMALE:  Rubella status  Check for ovulation ●Basal body temperature chart ●Serum progesterone D21-22 (28 day cycle) ●LH Surge ●Ultrasound (TVU)  S. Prolactin  LH / FSH ratio  Thyroid function test  Endometrial biopsy

15. EVALUATION OF FALLOPIAN TUBE  Chlamydia titre  Laparoscopy  Hysteroscopy  Hysterosalpigography (HSG)  Tubal insufflation – CO2 POST COITAL TEST Once evaluation is complete, treatment of infertile couple is directed by the findings.

16. WOMEN = Anovulatory cycles Correct underlying cause/ Weight Hyperprolactinaemia Hypothyroidism Ovulation Induction Clomaphine citrate……Multiple ? Gonadotrophine, injection…OHSS ? Surgery:  Tubal  Endometriosis

17. Assisted ConceptionA.R.T  AIH - IUI  ZIFT  GIFT  IVF  ICSI