INFERTILITY 03:25 Unknown 0 <script async src="//pagead2.googlesyndication.com/pagead/js/adsbygoogle.js"></script> <!-- peace --> <ins class="adsbygoogle" style="display:block" data-ad-client="ca-pub-1597694717782005" data-ad-slot="3836701773" data-ad-format="auto"></ins> <script> (adsbygoogle = window.adsbygoogle || []).push({}); </script> <div class="MsoNormal"> <b><span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;"> </span></b><br /> <div class="separator" style="clear: both; text-align: center;"> <b><span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhDdNRz-jTWECpJBCDNZ9s1Vg3NE72iAxhmREyE53eC28esaqxsBWbf2fumP5t0ekBO-Rtfxohq9uGTFPYKAiadPP_PdtrfEb1EKD_7A3uR5jQfeUg6WvqJoYEa0f1H9iobBOXvQt_1LCY/s1600/fertility+2.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhDdNRz-jTWECpJBCDNZ9s1Vg3NE72iAxhmREyE53eC28esaqxsBWbf2fumP5t0ekBO-Rtfxohq9uGTFPYKAiadPP_PdtrfEb1EKD_7A3uR5jQfeUg6WvqJoYEa0f1H9iobBOXvQt_1LCY/s1600/fertility+2.jpg" /></a></span></b></div> <b><span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;"> <o:p></o:p></span></b></div> <div class="MsoNormal"> <b><span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;"> </span></b><br /> <b><span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;"> </span></b><span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;">This is defined as a couple’s inability to achieve pregnancy after 1 year of unprotected intercourse. Primary infertility refers to a couple who has never had a child. Secondary infertility means that at least one conception has occuerred, but currently the couple cannot achieve a pregnancy. In the United States, infertility affects 6 million couples. It is often a complex physical problem, and its causes are usually related to azoospermia, anovulation, or tubal obstruction.<o:p></o:p></span></div> <div class="MsoNormal"> <span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;"> Most infertility is really some degree of subfertility and 1 in 7 couples who have conceived before. The WHO (1992) defines subfertility as ‘the inability of a couple to achieve conception or to bring a pregnancy to term after a year or more of regular, unprotected intercourse’. <o:p></o:p></span></div> <div class="MsoNormal"> <span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;"> Infertility is categorized as primary if there has been no prior conception and secondary if there has been a previous pregnancy irrespective of the outcome. Couples now have fewer than two children on average in most European countries and they tend to postpone reduction in fertility. Under normal circumstances the chance of a couple conceiving within one menstrual cycle is 20-25% given that unprotected intercourse occurs at the optimum time, the female partner is ovulating regularly and the male partner is producing sperm of sufficient quality. Approximately one-third of cases of infertility involve problems with both partners in one-third of couples the causes of infertility remain unexplained. The most common causes are ovulation failure and sperm disorders.<o:p></o:p></span></div> <div class="MsoNormal"> <b><span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;">INITIAL MANAGEMENT OF THE INFERTILE COUPLE<o:p></o:p></span></b></div> <div class="MsoNormal"> <b><span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;"> </span></b><span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;">Much of the initial management is via primary care, therefore the preliminary investigation of both partners and subsequent referral to specialist care will be through the general practitioner. Each referral should be instigated for couples where the female partner is over 35 years and where there is amenorrhoea or significant pelvic infection.<o:p></o:p></span></div> <div class="MsoNormal"> <span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;"> <b>CAUSES OF INFERTILITY<o:p></o:p></b></span></div> <div class="MsoNormal"> <b><span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;">MALE INFERTILITY<o:p></o:p></span></b></div> <div class="MsoNormal"> <span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;">ENDOCRINE DISORDERS<o:p></o:p></span></div> <div class="MsoNormal"> <span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;">Dysfunction of<o:p></o:p></span></div> <div class="MsoListParagraphCxSpFirst" style="mso-list: l4 level1 lfo1; text-indent: -.25in;"> <!--[if !supportLists]--><span style="font-family: "symbol"; font-size: 14.0pt; line-height: 115%;">·<span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;">Hypothalamus<o:p></o:p></span></div> <div class="MsoListParagraphCxSpMiddle" style="mso-list: l4 level1 lfo1; text-indent: -.25in;"> <!--[if !supportLists]--><span style="font-family: "symbol"; font-size: 14.0pt; line-height: 115%;">·<span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;">Pituitary<o:p></o:p></span></div> <div class="MsoListParagraphCxSpMiddle" style="mso-list: l4 level1 lfo1; text-indent: -.25in;"> <!--[if !supportLists]--><span style="font-family: "symbol"; font-size: 14.0pt; line-height: 115%;">·<span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;">Adrenals<o:p></o:p></span></div> <script async src="//pagead2.googlesyndication.com/pagead/js/adsbygoogle.js"></script> <!-- peace --> <ins class="adsbygoogle" style="display:block" data-ad-client="ca-pub-1597694717782005" data-ad-slot="3836701773" data-ad-format="auto"></ins> <script> (adsbygoogle = window.adsbygoogle || []).push({}); </script> <div class="MsoListParagraphCxSpLast" style="mso-list: l4 level1 lfo1; text-indent: -.25in;"> <!--[if !supportLists]--><span style="font-family: "symbol"; font-size: 14.0pt; line-height: 115%;">·<span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;">Thyroid<o:p></o:p></span></div> <div class="MsoNormal"> <span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;">Systemic disease<o:p></o:p></span></div> <div class="MsoListParagraphCxSpFirst" style="mso-list: l13 level1 lfo2; text-indent: -.25in;"> <!--[if !supportLists]--><span style="font-family: "symbol"; font-size: 14.0pt; line-height: 115%;">·<span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;">Diabetes mellitus<o:p></o:p></span></div> <div class="MsoListParagraphCxSpMiddle" style="mso-list: l13 level1 lfo2; text-indent: -.25in;"> <!--[if !supportLists]--><span style="font-family: "symbol"; font-size: 14.0pt; line-height: 115%;">·<span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;">Coelic disease<o:p></o:p></span></div> <div class="MsoListParagraphCxSpLast" style="mso-list: l13 level1 lfo2; text-indent: -.25in;"> <!--[if !supportLists]--><span style="font-family: "symbol"; font-size: 14.0pt; line-height: 115%;">·<span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;">Renal failure<o:p></o:p></span></div> <div class="MsoNormal"> <span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;">Testicular disorders<o:p></o:p></span></div> <div class="MsoListParagraphCxSpFirst" style="mso-list: l6 level1 lfo3; text-indent: -.25in;"> <!--[if !supportLists]--><span style="font-family: "symbol"; font-size: 14.0pt; line-height: 115%;">·<span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;">Trauma<o:p></o:p></span></div> <div class="MsoListParagraphCxSpLast" style="mso-list: l6 level1 lfo3; text-indent: -.25in;"> <!--[if !supportLists]--><span style="font-family: "symbol"; font-size: 14.0pt; line-height: 115%;">·<span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;">Environmental (high temperature)<o:p></o:p></span></div> <div class="MsoNormal"> <span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;">Congenital ( hydrocele, undescended testes)<o:p></o:p></span></div> <div class="MsoNormal"> <span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;">Occupational (furnaceman, long distance lorry driver)<o:p></o:p></span></div> <div class="MsoNormal"> <span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;">Acquired ( Varicocele, tight clothing)<o:p></o:p></span></div> <div class="MsoListParagraph" style="mso-list: l12 level1 lfo4; text-indent: -.25in;"> <!--[if !supportLists]--><span style="font-family: "symbol"; font-size: 14.0pt; line-height: 115%;">·<span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;">Cancer treatment<o:p></o:p></span></div> <div class="MsoNormal"> <span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;">Defective transport<o:p></o:p></span></div> <div class="MsoListParagraphCxSpFirst" style="mso-list: l12 level1 lfo4; text-indent: -.25in;"> <!--[if !supportLists]--><span style="font-family: "symbol"; font-size: 14.0pt; line-height: 115%;">·<span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;">Obstruction or absence of seminal ducts:<o:p></o:p></span></div> <div class="MsoListParagraphCxSpMiddle" style="mso-list: l12 level1 lfo4; text-indent: -.25in;"> <!--[if !supportLists]--><span style="font-family: "symbol"; font-size: 14.0pt; line-height: 115%;">·<span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;">Infection<o:p></o:p></span></div> <div class="MsoListParagraphCxSpMiddle" style="mso-list: l12 level1 lfo4; text-indent: -.25in;"> <!--[if !supportLists]--><span style="font-family: "symbol"; font-size: 14.0pt; line-height: 115%;">·<span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;">Congenital anomalies<o:p></o:p></span></div> <div class="MsoListParagraphCxSpLast" style="mso-list: l12 level1 lfo4; text-indent: -.25in;"> <!--[if !supportLists]--><span style="font-family: "symbol"; font-size: 14.0pt; line-height: 115%;">·<span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;">Trauma<o:p></o:p></span></div> <div class="MsoNormal"> <span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;">Impaired secretions from prostate or seminal vesicles:<o:p></o:p></span></div> <div class="MsoListParagraphCxSpFirst" style="mso-list: l14 level1 lfo5; text-indent: -.25in;"> <!--[if !supportLists]--><span style="font-family: "symbol"; font-size: 14.0pt; line-height: 115%;">·<span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;">Infection<o:p></o:p></span></div> <div class="MsoListParagraphCxSpLast" style="mso-list: l14 level1 lfo5; text-indent: -.25in;"> <!--[if !supportLists]--><span style="font-family: "symbol"; font-size: 14.0pt; line-height: 115%;">·<span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;">Metabolic disorders<o:p></o:p></span></div> <div class="MsoNormal"> <span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;">Ineffective delivery<o:p></o:p></span></div> <div class="MsoListParagraphCxSpFirst" style="mso-list: l11 level1 lfo6; text-indent: -.25in;"> <!--[if !supportLists]--><span style="font-family: "symbol"; font-size: 14.0pt; line-height: 115%;">·<span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;">Psychosexual problems (impotence)<o:p></o:p></span></div> <div class="MsoListParagraphCxSpMiddle" style="mso-list: l11 level1 lfo6; text-indent: -.25in;"> <!--[if !supportLists]--><span style="font-family: "symbol"; font-size: 14.0pt; line-height: 115%;">·<span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;">Drug-induced (ejaculatory dysfunction)<o:p></o:p></span></div> <div class="MsoListParagraphCxSpMiddle" style="mso-list: l11 level1 lfo6; text-indent: -.25in;"> <!--[if !supportLists]--><span style="font-family: "symbol"; font-size: 14.0pt; line-height: 115%;">·<span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;">Physical disability<o:p></o:p></span></div> <div class="MsoListParagraphCxSpLast" style="mso-list: l11 level1 lfo6; text-indent: -.25in;"> <!--[if !supportLists]--><span style="font-family: "symbol"; font-size: 14.0pt; line-height: 115%;">·<span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;">Physical anomalies<o:p></o:p></span></div> <div class="MsoNormal"> <span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;">Hypospadias<o:p></o:p></span></div> <div class="MsoNormal"> <span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;">Epispadias<o:p></o:p></span></div> <div class="MsoNormal"> <span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;">Retrograde ejaculation (into bladder)<o:p></o:p></span></div> <div class="MsoNormal"> <b><span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;">FEMALE INFERTILITY<o:p></o:p></span></b></div> <div class="MsoNormal"> <span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;">Defective ovulation<o:p></o:p></span></div> <div class="MsoNormal"> <span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;">Endocrine disorders<o:p></o:p></span></div> <div class="MsoListParagraphCxSpFirst"> <span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;">Dysfunction of<o:p></o:p></span></div> <div class="MsoListParagraphCxSpMiddle" style="margin-left: 1.0in; mso-add-space: auto; mso-list: l2 level1 lfo7; text-indent: -.25in;"> <!--[if !supportLists]--><span style="font-family: "symbol"; font-size: 14.0pt; line-height: 115%;">·<span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;">Hypothalamus<o:p></o:p></span></div> <div class="MsoListParagraphCxSpMiddle" style="margin-left: 1.0in; mso-add-space: auto; mso-list: l2 level1 lfo7; text-indent: -.25in;"> <!--[if !supportLists]--><span style="font-family: "symbol"; font-size: 14.0pt; line-height: 115%;">·<span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;">Pituitary<o:p></o:p></span></div> <div class="MsoListParagraphCxSpMiddle" style="margin-left: 1.0in; mso-add-space: auto; mso-list: l2 level1 lfo7; text-indent: -.25in;"> <!--[if !supportLists]--><span style="font-family: "symbol"; font-size: 14.0pt; line-height: 115%;">·<span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;">Adrenals<o:p></o:p></span></div> <div class="MsoListParagraphCxSpLast" style="margin-left: 1.0in; mso-add-space: auto; mso-list: l2 level1 lfo7; text-indent: -.25in;"> <!--[if !supportLists]--><span style="font-family: "symbol"; font-size: 14.0pt; line-height: 115%;">·<span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;">Thyroid<o:p></o:p></span></div> <div class="MsoNormal"> <span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;">Systemic disease<o:p></o:p></span></div> <div class="MsoListParagraphCxSpFirst" style="mso-list: l1 level1 lfo8; text-indent: -.25in;"> <!--[if !supportLists]--><span style="font-family: "symbol"; font-size: 14.0pt; line-height: 115%;">·<span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;">Diabetes mellitus<o:p></o:p></span></div> <div class="MsoListParagraphCxSpMiddle" style="mso-list: l1 level1 lfo8; text-indent: -.25in;"> <!--[if !supportLists]--><span style="font-family: "symbol"; font-size: 14.0pt; line-height: 115%;">·<span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;">Coelic disease<o:p></o:p></span></div> <div class="MsoListParagraphCxSpLast" style="mso-list: l1 level1 lfo8; text-indent: -.25in;"> <!--[if !supportLists]--><span style="font-family: "symbol"; font-size: 14.0pt; line-height: 115%;">·<span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;">Renal failure<o:p></o:p></span></div> <div class="MsoNormal"> <span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;">Physical disorders<o:p></o:p></span></div> <div class="MsoListParagraphCxSpFirst" style="mso-list: l7 level1 lfo9; text-indent: -.25in;"> <!--[if !supportLists]--><span style="font-family: "symbol"; font-size: 14.0pt; line-height: 115%;">·<span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;">Obesity<o:p></o:p></span></div> <div class="MsoListParagraphCxSpMiddle" style="mso-list: l7 level1 lfo9; text-indent: -.25in;"> <!--[if !supportLists]--><span style="font-family: "symbol"; font-size: 14.0pt; line-height: 115%;">·<span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;">Anorexia nervous or strict dieting<o:p></o:p></span></div> <div class="MsoListParagraphCxSpLast" style="mso-list: l7 level1 lfo9; text-indent: -.25in;"> <!--[if !supportLists]--><span style="font-family: "symbol"; font-size: 14.0pt; line-height: 115%;">·<span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;">Excessive exercise<o:p></o:p></span></div> <div class="MsoNormal"> <span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;">Ovarian disorders<o:p></o:p></span></div> <div class="MsoListParagraphCxSpFirst" style="mso-list: l9 level1 lfo10; text-indent: -.25in;"> <!--[if !supportLists]--><span style="font-family: "symbol"; font-size: 14.0pt; line-height: 115%;">·<span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;">Hormonal<o:p></o:p></span></div> <div class="MsoListParagraphCxSpMiddle" style="mso-list: l9 level1 lfo10; text-indent: -.25in;"> <!--[if !supportLists]--><span style="font-family: "symbol"; font-size: 14.0pt; line-height: 115%;">·<span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;">Ovarian cysts or tumours<o:p></o:p></span></div> <div class="MsoListParagraphCxSpMiddle" style="mso-list: l9 level1 lfo10; text-indent: -.25in;"> <!--[if !supportLists]--><span style="font-family: "symbol"; font-size: 14.0pt; line-height: 115%;">·<span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;">Polycystics ovary disease<o:p></o:p></span></div> <div class="MsoListParagraphCxSpLast" style="mso-list: l9 level1 lfo10; text-indent: -.25in;"> <!--[if !supportLists]--><span style="font-family: "symbol"; font-size: 14.0pt; line-height: 115%;">·<span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;">Ovarian endometiosis<o:p></o:p></span></div> <div class="MsoNormal"> <span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;">Defective transport<o:p></o:p></span></div> <div class="MsoListParagraphCxSpFirst" style="mso-list: l3 level1 lfo11; text-indent: -.25in;"> <!--[if !supportLists]--><span style="font-family: "symbol"; font-size: 14.0pt; line-height: 115%;">·<span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;">Ovum<o:p></o:p></span></div> <div class="MsoListParagraphCxSpLast" style="mso-list: l3 level1 lfo11; text-indent: -.25in;"> <!--[if !supportLists]--><span style="font-family: "symbol"; font-size: 14.0pt; line-height: 115%;">·<span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;">Tubal obstruction<o:p></o:p></span></div> <div class="MsoNormal"> <span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;">Infection (gonorrhea, peritonitis, pelvic inflammatory disease)<o:p></o:p></span></div> <div class="MsoNormal"> <span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;">Previous tubal surgery<o:p></o:p></span></div> <div class="MsoListParagraphCxSpFirst" style="mso-list: l8 level1 lfo12; text-indent: -.25in;"> <!--[if !supportLists]--><span style="font-family: "symbol"; font-size: 14.0pt; line-height: 115%;">·<span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;">Fimbrial adhesians<o:p></o:p></span></div> <div class="MsoListParagraphCxSpMiddle" style="mso-list: l8 level1 lfo12; text-indent: -.25in;"> <!--[if !supportLists]--><span style="font-family: "symbol"; font-size: 14.0pt; line-height: 115%;">·<span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;">Previous surgery<o:p></o:p></span></div> <div class="MsoListParagraphCxSpLast" style="mso-list: l8 level1 lfo12; text-indent: -.25in;"> <!--[if !supportLists]--><span style="font-family: "symbol"; font-size: 14.0pt; line-height: 115%;">·<span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;">Endometriosis<o:p></o:p></span></div> <div class="MsoNormal"> <span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;">Sperm<o:p></o:p></span></div> <div class="MsoNormal"> <span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;">Vaginal<o:p></o:p></span></div> <div class="MsoListParagraphCxSpFirst" style="mso-list: l10 level1 lfo13; text-indent: -.25in;"> <!--[if !supportLists]--><span style="font-family: "symbol"; font-size: 14.0pt; line-height: 115%;">·<span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;">Psychosexual problems (Vaginismus)<o:p></o:p></span></div> <div class="MsoListParagraphCxSpMiddle" style="mso-list: l10 level1 lfo13; text-indent: -.25in;"> <!--[if !supportLists]--><span style="font-family: "symbol"; font-size: 14.0pt; line-height: 115%;">·<span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;">Infection (causing dyspareunia)<o:p></o:p></span></div> <div class="MsoListParagraphCxSpLast" style="mso-list: l10 level1 lfo13; text-indent: -.25in;"> <!--[if !supportLists]--><span style="font-family: "symbol"; font-size: 14.0pt; line-height: 115%;">·<span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;">Congenital anomaly<o:p></o:p></span></div> <div class="MsoNormal"> <span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;">Cervix<o:p></o:p></span></div> <div class="MsoListParagraphCxSpFirst" style="mso-list: l5 level1 lfo14; text-indent: -.25in;"> <!--[if !supportLists]--><span style="font-family: "symbol"; font-size: 14.0pt; line-height: 115%;">·<span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;">Cervical trauma or surgery (cone biopsy)<o:p></o:p></span></div> <div class="MsoListParagraphCxSpMiddle" style="mso-list: l5 level1 lfo14; text-indent: -.25in;"> <!--[if !supportLists]--><span style="font-family: "symbol"; font-size: 14.0pt; line-height: 115%;">·<span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;">Infection<o:p></o:p></span></div> <div class="MsoListParagraphCxSpMiddle" style="mso-list: l5 level1 lfo14; text-indent: -.25in;"> <!--[if !supportLists]--><span style="font-family: "symbol"; font-size: 14.0pt; line-height: 115%;">·<span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;">Hormonal (hostile mucus)<o:p></o:p></span></div> <div class="MsoListParagraphCxSpLast" style="mso-list: l5 level1 lfo14; text-indent: -.25in;"> <!--[if !supportLists]--><span style="font-family: "symbol"; font-size: 14.0pt; line-height: 115%;">·<span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;">Antisperm antibodies in mucus<o:p></o:p></span></div> <div class="MsoNormal"> <span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;">Defective implantation<o:p></o:p></span></div> <div class="MsoListParagraphCxSpFirst" style="mso-list: l0 level1 lfo15; text-indent: -.25in;"> <!--[if !supportLists]--><span style="font-family: "symbol"; font-size: 14.0pt; line-height: 115%;">·<span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;">Hormonal imbalance<o:p></o:p></span></div> <div class="MsoListParagraphCxSpMiddle" style="mso-list: l0 level1 lfo15; text-indent: -.25in;"> <!--[if !supportLists]--><span style="font-family: "symbol"; font-size: 14.0pt; line-height: 115%;">·<span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;">Congenital anomalies<o:p></o:p></span></div> <div class="MsoListParagraphCxSpMiddle" style="mso-list: l0 level1 lfo15; text-indent: -.25in;"> <!--[if !supportLists]--><span style="font-family: "symbol"; font-size: 14.0pt; line-height: 115%;">·<span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;">Fibroids<o:p></o:p></span></div> <div class="MsoListParagraphCxSpMiddle" style="mso-list: l0 level1 lfo15; text-indent: -.25in;"> <!--[if !supportLists]--><span style="font-family: "symbol"; font-size: 14.0pt; line-height: 115%;">·<span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;">Infection<o:p></o:p></span></div> <div class="MsoListParagraphCxSpMiddle"> <b><span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;">ASSISTED REPRODUCTIVE TECHNIQUES<o:p></o:p></span></b></div> <div class="MsoListParagraphCxSpMiddle"> <b><span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;"> </span></b><span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;">A range of assisted reproductive techniques is available to treat the infertile couple and it is important that the appropriate treatment option is offered. Those techniques include the followings:<o:p></o:p></span></div> <div class="MsoListParagraphCxSpMiddle" style="mso-list: l0 level1 lfo15; text-indent: -.25in;"> <!--[if !supportLists]--><span style="font-family: "symbol"; font-size: 14.0pt; line-height: 115%;">·<span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;">In vitro fertilization (IVF) treatment<o:p></o:p></span></div> <div class="MsoListParagraphCxSpMiddle" style="mso-list: l0 level1 lfo15; text-indent: -.25in;"> <!--[if !supportLists]--><span style="font-family: "symbol"; font-size: 14.0pt; line-height: 115%;">·<span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;">Donor insemination (DI) treatment<o:p></o:p></span></div> <div class="MsoListParagraphCxSpMiddle" style="mso-list: l0 level1 lfo15; text-indent: -.25in;"> <!--[if !supportLists]--><span style="font-family: "symbol"; font-size: 14.0pt; line-height: 115%;">·<span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;">Gamete intrafallopian transfer (GIFT) where donated sperm or eggs are used in treatment.<o:p></o:p></span></div> <div class="MsoListParagraphCxSpLast" style="mso-list: l0 level1 lfo15; text-indent: -.25in;"> <!--[if !supportLists]--><span style="font-family: "symbol"; font-size: 14.0pt; line-height: 115%;">·<span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;">Storage of gametes or embryos<o:p></o:p></span></div> <div class="MsoNormal" style="margin-left: .5in;"> <span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;">Each of the techniques highlighted above will be discussed in details in the next article.<o:p></o:p></span></div> <div class="MsoNormal" style="margin-left: .5in;"> <b><span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;">OVULATION INDUCTION<o:p></o:p></span></b></div> <div class="MsoNormal" style="margin-left: .5in;"> <b><span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;"> </span></b><span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;">There are many reasons for ovulatory failure and although menstruation is strongly suggestive of ovulation it is not conclusive. Women with amenorrhoea or oliogomenorrhoea can be treated with ovulation inducing agents provided that the male partner has an adequate sperm count.<o:p></o:p></span></div> <div class="MsoNormal" style="margin-left: .5in;"> <span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;">Clomifene is the most commonly prescribed drug but should be prescribed only when there are no other factors contributing to infertility and there is access to ovarian ultrasound feedback that stimulates the release of GnRH; which in turn leads to an increase in FSH and ovarian follicular growth and can be effective in up to 80% of appropriately selected women.<o:p></o:p></span></div> <div class="MsoNormal" style="margin-left: .5in;"> <span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;"> Treatment should be limited to six cycles with the lowest effective dose. The side effect of clomifene include multiple pregnancy and ovarian hyperstimulation and minority of women may experience symptoms such as hot flashes, abdominal distention, nausea, vomiting, breast tenderness, headaches, hair loss and blurred vision.<o:p></o:p></span></div> <div class="MsoNormal" style="margin-left: .5in;"> <span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;"> Women with clomifene resistant polycystic ovarian syndrome (PCOS) can be treated with human menopausal gonadotrophin (HMG) and FSH injections. Cabergoline as opposed to bromocriptine, is rapidly becoming the treatment of choice for women suffering from anovulatory hyperprolactinaemia. This is because latter is associated with the unpleasant side effects of nausea, headaches, vertigo and drowsiness whereas the former has significantly fewer side effects.<o:p></o:p></span></div> <div class="MsoNormal" style="margin-left: .5in;"> <b><span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;">INTRAUTERINE INSEMINATION (IUI)<o:p></o:p></span></b></div> <div class="MsoNormal" style="margin-left: .5in;"> <span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;">IUI is indicated where there are problems such as hostile cervical mucus, antisperm antibodies or male fertility problems such as low sperm count, premature ejaculation, retrograde ejaculation, anatomical problems or impotence. It is also useful for cases of unexplained infertility. The tubal patency of the female partner must be assured. In order to increase the chances of success, ovulation is induced and the sperm prepared to maximize its fertilizing ability before being inserted high into the uterus.<o:p></o:p></span></div> <div class="MsoListParagraphCxSpFirst"> <b><span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;"> <o:p></o:p></span></b></div> <br /> <div class="MsoListParagraphCxSpLast"> <br /></div> <script async src="//pagead2.googlesyndication.com/pagead/js/adsbygoogle.js"></script> <!-- peace --> <ins class="adsbygoogle" style="display:block" data-ad-client="ca-pub-1597694717782005" data-ad-slot="3836701773" data-ad-format="auto"></ins> <script> (adsbygoogle = window.adsbygoogle || []).push({}); </script> assisted reproductive techniques infertilty ovulation INFERTILITY This is defin... Read more »
