Infertility

and Sterility
Positive reproductive health
is a state of complete physical, mental and social
well-being.
Infertility
is the inability of a couple to get pregnant.
Sterility
is an absolute inability to get pregnant.
Diagnostic and examination conditions
a couple fails to achieve pregnancy after 1 year of
‘unprotected’ and regular intercourse
Physiological Sterility
 before puberty
 after menopause
 during pregnancy
Female Infertility etiology

1. Dyspareunia and vaginal causes.

2. Congenital defects in the genital tract.
3. Infection in the lower genital tract.
4. Cervical factors.
5. Uterine causes.
6. Tubal factors.
7. Ovaries.
8. Peritoneal causes.
9. Chronic ill health.
10.Hormonal—pituitary gland dysfunction, hyperprolactinaemia and
hypothalamic disorders.
 Dyspareunia
Definition: difficult, painful coitus.

Reasons:
 Due to the Male Partner
 Due to the Female Partner
 Inflammatory diseases
 Obstructive vaginal conditions
 Extragenital lesions
 Investigations

Dyspareunia Treatment:
etiological, symptomatic
Dyspareunia clinical forms
Congenital defects in the genital tract
 Infection in the vagina and cervix.
Chlamydia and gonorrhea are
important preventable causes of
pelvic inflammatory disease
(PID) and infertility.
 Cervical factors
Presence of antisperm antibodies in
the patient's blood serum and cervical
mucus
The test is negative if no spermatozoa are
found in the mucus.

The presence of any spermatozoa with

progressive motility in endocervical mucus 9–
14 hours after intercourse argues against
significant cervical factors, and sperm
autoimmunity in the male or female, as possible
causes of infertility.

When spermatozoa exhibiting a shaking

phenomenon are seen, there may be sperm
antibodies either in the mucus or on the
spermatozoa.
Uterine causes
Tubal factors
Ovarian factors
Peritoneal factors
 Chronic ill health
 Hypothalamic and pituitary disease

 hypothyroidism

 adrenal cortical dysfunction

 Diabetes

 tuberculosis

 Smoking
 Investigations
 History.

 Examination.

 Special investigations
Investigations
 History
 age
 obstetric history
 Infection
 coital difficulty
 menstrual history
 Hormone-dependent diseases
 Tests for Tubal Patency
 Hysterosalpingography (HSG)
 Laparoscopic chromotubation
 Sonosalpingography (SSG)
 Falloposcopy
 Ampullary and fimbrial salpingoscopy4
 Fertiloscopy
Tests for Tubal Patency: Hysterosalpingography (HSG)

Purpose
Visualization of the
uterine cavity and the fallopian tubes
Instruments
X-ray room
Foley catheter
Rubin cannula or
Leech-Wilkinson cannula
Tests for Tubal Patency: Hysterosalpingography (HSG)
Tests for Tubal Patency: Hysterosalpingography (HSG)
Tests for Tubal Patency Laparoscopic chromotubation
 Sonosalpingography (SSG)

Technic:
ultrasound scanning with a slow injection of
about 200 ml of saline solution into the
uterine cavity ,
through a Foley catheter
 Falloposcopy
Definition:
inspection of the fallopian tubes through a micro- endoscope.
The procedure
 The patient in a lithotomy position
 Hysteroscope is introduced into the
uterus to identify the proximal tubal ostium.
 Falloposcope is inserted through the
operative channel of the hysteroscope
 With the LEC system the balloon catheter
is advanced into the Uterine horn,
 Under endoscopic vision the endoscope
is advanced into the tube as the balloon
catheter unfurls.
 Findings can be projected on a videosystem
 Ampullary and fimbrial salpingoscopy

Laparoscopy combined with

hysteroscopy as a comprehensive
infertility treatment that allows you
to identify the cause of infertility
and cure it at one time
 Fertiloscopy
Technique:
1. Lithotomy position.
2. Local/general anaesthesia.
3. Insertion of Veress needle and
creation of hydroperitoneum with
saline.
4. Insertion of two fertiloscopes.
5. Chromotubation.
6. Inspection of organs.
7. Therapeutic, if it is needed
 Management of Tubal Infertility
Tuboplasty
 Tubal reanastomosis : resection of occluded tubal tissue and joining the healthy segments.
 Fimbrioplasty : separating agglutinated fimbriae.
 Salpingostomy : creating a new distal opening for the tube.
 Salpingolysis : removing adhesions from around the tube.
 Cornual implantation : resecting of an occluded transmural segment of the tube and
connecting the distal patent segment of the tube to the uterus so that it links up with the
endometrial cavity.
 Balloon tuboplasty and cannulation are done with a hysteroscope through transcervical
route for medial end block.
 ovarian examination
 Basal Body Temperature
 Endometrial Biopsy
 Fern Test
 Ultrasound
 Hormonal Study
ovarian examination Basal Body Temperature
 ovarian examination Endometrial Biopsy
 1 or 2 days before the onset of
menstruation
 Immediate fixation in formalin
saline solution
 Secretory changes prove that
the cycle has been
ovulatory
ovarian examination Fern Test
 ovarian examination Ultrasound

From the 10th to 16th

day of the
menstrual cycle
 Management of Anovulation
Clomiphene citrate
Doses Mechanism of action Adverse Effects

When the follicle reaches 20 mm,

human chorionic gonadotropin(1000 UNITS)
is injected
Management of Anovulation
 Management of Anovulation
FSH,LH(humegon) and hCG therapy

Goal: The pituitary and hypothalamic stimulation

Methodology:
 Humegon from 3-5 days of cycle for 7-14 days
 With a follicle size of 18-20 m, hCG is injected (10000 units)
 then 1500-5000 units every day No. 3

Complication: Ovarian hyperstimulation syndrome

 Management of Anovulation
Combination of CC and hMG

The patient is advised CC 50–100 mg/day from day 2 to day 6

of the cycle for 5 days.

Injecting hMG 75 units intramuscularly is added on day 3, 5 and 7, and

more if so required.
 Management of Anovulation
GnRH
There are three main protocols for ovarian function stimulation:
 Long: administration of GnRH from the middle of the LF cycle preceding
the therapeutic cycle of ovarian stimulation, and continues against the
background of gonadotropic stimulation until the appointment of an
ovulation trigger — human chorionic gonadotropin (hCG).
 Short :administration of GnRH begins on the 1st or 2nd day of the
treatment cycle and continues against the background of gonadotropic
ovarian stimulation until the introduction of hCG
 Ultrashort: Ultrashort protocol: and GnRH is administered, starting from
the 2nd day of the cycle, for 3 days and is canceled with the onset of
gonadotropic stimulation
Management of Anovulation

Prednisolone.
In women with anovulation and increased
androstenedione, the administration of 5.0
mg
prednisolone at night 1 2.5 mg every morning
is advised until spontaneous ovulation sets in.
Female infertility: Causes, investigations and managemen
 Assisted Reproductive Technology
Indications
 Abnormal fallopian tubes: Blocked tubes or absent tubes

 Endometriosis adversely affecting tubo-ovarian pick-up function

 Idiopathic or unexplained infertility.

 Male subfertility.

 Immunologic infertility.

 Failure of ovulation—donor ovum

Complications
Short Term:
 Failure.
 Oocyte retrieval can cause bleeding trauma, infection,
 pain, pelvic abscess.
 Ectopic and heterotopic pregnancy 0.4%.
 Multiple pregnancies and its complications.
 Abortion, IUGR.
 Hyperstimulation syndrome.
 Cost.
Long-term :
 Premature ovarian failure.
 Ovarian cancer—due to hyperstimulation.
 Breast cancer.