Where in the world is infertility prevalence high
Sub Saharan Africa
Why is infertility prevalence high in sub Saharan Africa
Increasing STDs, post abortal, puerperal sepsis
What is infertility
Inability of couple to achieve pregnancy within period of unprotected intercourse over 1 year
What is primary infertility
Couple with no previous pregnancy
What is secondary infertility
At least one pregnancy irrespective of outcome
What is sterility
Either of couple has absolute defects preventing fertility
Main congenital causes of infertility
Chromosomal abnormalities
Genital tract malformation
Abnormal endocrine functin
Causes acquired infertility
STDs
Pelvic inflammatory disease
Post abortal sepsis
Puerperal sepsis
Is male factor the same percentage as woman factor in infertility
Yes - 30 to 40 %
Female factors in infertility
Disorder of ovulation Hirsute women Androgen excess (acne , oily skin ) Galactorrhea hyperprolactinemia Thyroid disorders Pelvic factors like occlusions, pelvic inflammatory diseases Endometriosis Cervix operation hx Cervical mucus alterations form drugs Dilatation and curettage Previous abortion Growths - polyps , myoma Diethylstilbestrol exposure Uterine pathologies Cervical incompetence Uterine fibroids Congenital abnormality of uterus Endometritis Adenomyosis Luteal phase defect
Male factor involved in infertility
Azoospermia Oligospermia Athenozoospermia Teratospermia Aspermia Gonorrhea hx STDs Mumps orchitis Undescended testis surgery Hydrocele hx
What is Azoospermia
No sperm cell
What’s oligospermia
Less than 20million per ml sperm concentration
What’s athenozoospermia
Less than 50% sperm motility
What’s Teratospermia
Less than 50% sperm with normal morphology
What is Aspermia
No ejaculate
Female history suggesting possible infertility
PID Puerperal , post abortal sepsis K tuberculosis Peritonitis Appendicitis Pelvic surgery ovarian cystectomy Delayed puberty
Investigation of infertility
History Menstrual history Pregnancies Abortions Contraception Exposure to environmental toxins Pregnancy with different partner Std
Physical examination of infertility
General appearance to rule out turners syndrome BMI Acne Hirsutisme Galactorrhea Clitoromegaly
Basic investigation of infertility
Seminal fluid analysis
Ovulation test
Tubal potency test
Postcoital test
Seminal fluid analysis procedure
No sex 3-5 days before
Semen sample by masturbation
Test of ovulation
Basal body temperature
Midluteal phase - serum progesterone endometrial biopsy day 21-28
Examination of vaginal cytology and cervical mucus
Serial ultrasound folliculography
Test of tubal patency
Hysterosalpingography
Laparoscopy
Ultrasound scan , hysterocontrats sonography
Post coital test goal assess cervical factors
