MALE CAUSES OF INFERTILITY:
🔸dueProblems with the delivery of sperm:
to sexual problems, such as premature ejaculation or
impotence; certain genetic diseases, such as cystic fibrosis;
structural problems, such as a blockage in the testicle; or damage
🔸
or injury to the reproductive organs.
Overexposure to certain environmental factors:
such as pesticides and other chemicals,and radiation. Cigarette
smoking, alcohol, marijuana, anabolic steroids or sex steroid-
Testosterone-, and taking medications to treat bacterial infections,
🔸
high blood pressure and depression also can affect.
Frequent exposure to heat:
such as in saunas or hot tubs, can raise body temperature and may
affect sperm production.
FEMALE CAUSES OF INFRTTILITY:
🔸 1- Ovarian factor (30-40%):
Anovulation Oligo-ovulation and luteal phase defect Poor For pregnancy to occur there must be fertile sperm and
secretory changes in endomtrium and prevent implantation of egg a means of bringing them together and receptive
fertilized ovum. Congenital absence (agenesis or dysgenesis) of
🔸
endometrium to allow the resulting embryo to implant.
A defect at any of these stages can lead to subfertility.
🔸
ovary.
2-Pelvic Adhesions:
Lead to prevent the passage of ovum. Occurs with pelvic
-It has been estimated that in 35 percent of cases a male
factor is the reason for infertility, in the remaining 65 per
cent of cases female factor is identified in 50 percent of
peritonitis or pelvic endometriosis .
•Tubal and peritoneal abnormalities: 🔸
couples and no cause will be identified in the remainder
Abnormal sperm production or function due to
undescended testicles, genetic defects, health problems
Causes of Infertility
-Salpingitis.
such as diabetes, or infections such as chlamydia,
⬛
- Pelvic inflammatory disease
gonorrhea or HIV, inflammation of testis(Orchitis,
-Adhesion due to peritonitis
-Appendicitis
Epidimytis, Ductus Deference, TB,Mumps, Syphilis), Infertility
inflammation of Vesicles and prostate .
-Post-abortal infection Enlarged veins in the testes (varicocele) also can affect
-is defined by the failure of the couple of reproductive age to conceive after 12
-Endometriosis
-Ovarian periovarian tumour
the quality of sperm.
📍
months of regular coitus without contraception.
Primary infertility:
🔸
-Congenital malformation
3-Vaginal causes.
-Rigid or small hymen.
📍
-exists when a woman has never been pregnant.
Secondary infertility:
-Partial or complete vaginal atresia( aplasia and hypoplasia) -occurs when a women has a history of one or more previous pregnancies.
-Psychogenic vaginismus.
-Vaginitis.
-Vaginal septum.
🔹 Fecundability is the probability of achieving pregnancy with one menstrual
cycle, for the normal couple this is approximately 25%.
🔸
Causes in female
4-Cervical abnormalities:
-Cong. atresia or elongation
▪️ INCIDENCE:
-Chronic infection. -It has been estimated that infertility affects 9 per cent of couples, of whom 70
-Obstruction with surgical injuries like conization and per cent suffer from primary infertility, and 30 per cent secondary infertility.
cauterization - Worldwide more than 70 million couples suffer from infertility the majority being
-Malposition residents of developing countries .
- cervical fibroid -The recent advances in infertility treatment and the access of patients to such
-cervical antisperm
information have led to early presentation of these patient and their request for
Hostile cervix: when the cervical mucus become scanty and
thick preventing ascent of spermatozoa. treatment.
Causes: ch. cervicitis, -This may give a false impression of an increasing infertility problem.
cautrization,co -nization,
excessive amputation, clo
🔸
miphenen therapy, antisperm Ab,oestrrogen deficiency
5-Uterine Factors(5-10%):
🔶
-Uterine hypoplasia or absence {Testicular feminization
(absence of uterus)- 46XY} 🔸 Vaginal (smear)cytology:
Preovulatory:
-Pycknotic cells.
-Congenital malformation(bicornuate or septate)
-Small nucleus.
-Inadequate progestational stimulation or absence of its
-Stained red pink with
receptors.
-Endometritis e.g TB. 🔸
-Heosin stain.
Post ovulatory:
🔸
-Asherman's syndrome
6-Endocrine causes
-Squamous cells.
-Rolled edge.
- Hyperprolactinemia with adenoma.
-Hyperprolactinemia without adenoma. INFERTILITY -Stained blue with Hematoxylin Eosin stain.
-Shower of leukocytes.
-Hypothalmus-Hypophyseal defect.
-Adrenal defect. 🔶Evaluation of the cervical mucus :
A- Assesment of quantative and qualitive of the cervical mucus.
-Thyroid defect.
🔸 Pre-ovulatory showed :
-Ferning test: “estrogenic effect"
one drop of the cervical mucus dried on microscopic slide, the mucus displays a ferning
pattern.
**First visit: -Spinnbarkiet test: “estrogenic effect"
🔶
1-History of the couple a drop of mucus placed between 2 points stretched and form threads up to 15 cm.
-Proper complete history. (The mucus becomes more abundant, clear, slippery, and smooth; it can be stretched Evaluation of the uterus:
between two fingers without breaking. Under the influence of estrogen, this mucus looks
by fatema okoff -Firstly everyone should be interrogated independently
like egg whites. It is called spinnbarkeit mucus. After ovulation, the cervical mucus becomes
1-hystrosalpingography
2-Physical examination. 2-Endometrial biopsy
thick and dry under the influence of progesterone. Near ovulation, the cervix feels soft and
🔸
-General examination. 3-Hystroscopy
-Genital examination: is high/deep in the vagina, the os is slightly open)
1 Hystrosalpingography
-Speculum examination Pre-ovulatory mucus is:
-hysterosalpingogram or HSG is an x-ray procedure used to see
-Vaginal examination. -Clear- a cellular
whether the fallopian tubes are patent (open) and if the inside of the
-Bimanual examination. -Watery -copious
uterus (uterine cavity) is normal.
-Rectal examination. -PH >8 -cervical os is gaping
-HSG is an outpatient procedure that usually takes less than 5
3-Routine para clinical examination: **Note; after ovulation the progestrone effect dominates the cervical os closed and the
🔸
minutes to perform.
-CBC- Blood sugar and urea.- Urinalysis - Vaginal swab. mucus become scanty, viscous and impenetrable to sperm.
2 Hysteroscopy
4-Semen analysis. -Hysteroscopy is a procedure that allows your doctor to look inside
5-Ferning test -Spinnbarkiet test B-Post-coital test: "Sim's Huhner's test“: your uterus in order to diagnose and treat causes of abnormal
6-Ultrasonography. bleeding.
7-Functional vaginal cytology. PROCEDURES FOR 2-6 hours after coitus- a sample of cervical mucus obtained and examine
microscopically. Normal at least 10 active sperm should be present in high -Hysteroscopy is done using a hysteroscope, a thin, lighted tube that
8-Basal body temperature.
Watch BBT for 3 months EVALUATION OF power field.
is inserted into the vagina to examine the cervix and inside of the
uterus.
-The same time and site. -Any effect of general health FEMALE INFERTILITY: Hydrotubation:
-Write the day of sexual intercourse
C-In vitro test of cervical mucus. -Inject indigo carmine solution through uterine cannula under direct
vision of laparoscopy, you will see the dye spills from a tube if it is
Second visit:
Evaluate the previous step in the first step.
🔸
-Sperm penetration tests in vitro
Kremar libag test: Put a sperm in a capillary test tube, then the a sample of
cervical mucus. Put the tube at 30 degree, Normally sperm go up through a
patent
•Assessment of tubal patency:
1- Tubal patency - Rubin test - H.S.G. Rubin's test: Insufflation of tubes by air or carbon dioxide through the
2-Laparoscopy
3-Semen analysis - Sperm penetration test
4-Serum prolactin - FSH-LH -Estrogen
🔸
cervical mucus.
Miller Kurzrok test:
-One drop of cervical mucus near to one drop of the sperm on the slide. Failure
cervical canal.
-Signs of patent tube:
1-Auscultation of the gas through the abdomen
2-Referred phrenic shoulder pain.
🔶
Progestrone - androgen - DHEA - of penetration suggests unfavorable test.
🔸
DHEAS TSH -T3 -T4 -Adrenal function test 3- by kymography trace.
Evaluation of the uterus:
3 Endometrial biopsy
1-hystrosalpingography
* Endometrial biopsy should be taken at 21st Of the cycle.
2-Endometrial biopsy
To show a secretary changes of endometrium
MANAGEMENT 🔶
3-Hystroscopy
Evaluation of the peritoneum By laparoscopy:
-Indication of laparoscopy:
-Serum progestrone. > 10 nmol/ml at time of ovulation at
19 day of cycle > 24nmol/ml
-urinary pregnandiol
1-If HSG showed tubal peritoneal abnormalities
2-Suspected endometriosis.
Treatment of infertility 3-Suspected ovarian disease.
1-Cervical problem:
-Antibiotics -Repair cervical defect
4-if all survey of infertility shows no abnormalities
-Estrogen -if low Spinnbarkiet test
2-Uterine causes 🔶Evaluation of immunologic 🔶 Detect of ovulation:
1-Basal body temperature
🔸Kibrick’s test:
-Surgical: for myoma or congenital anomalies. compatabil -Normal BBT chart.
-Antibiotics
-There is a slight fall in temperature (thermal nadir), just about the
-Progestrone.
*Mix 1 ml of fresh sperm+ 10% gelatin equal volume + equal volume of female timeof LH surge . Ovulation occures about 24 hours later.
-Asherman's syndrome: Surgical debridmen better by hystroscopy
serum. -Biphasic pattern 0.5 -1 degree elevation
-IUCD inserted with estrogen therapy
2.Urinary Luteinizing hormone Kits:
3-Tubal causes _If there is clumping of sperm positive.
It assumed that ovulation will occur within the following 12 to 24
-Hydrotubation for fimbrial stenosis **Other test: hours.
-Salpingolysis -Mix the cervical mucus with sperm, then under microscopic examination, if 3. Serum progesterone level.
-Salpingostomy
there is clumping of sperm means > positive Greater than 4ng/ml suggest ovulation, and 10ng/ml inmidluteal
-Tuboplasty
**Detection of sperm antibodies in the female serum. phase represent an adequate level of progesterone
-IVF (In vitro fertilization):
-Last resort if fallopian tube have destroyed
-Harvesting ova at time of ovulation
🔸 Laparoscopy
Allow direct visualization of the ovary and is most reliable method of
-Culture in special media.
demonstrating a pre-ovulatory follicle
-Extracorporeal fertilization.
-Culture fertilized ova until reaches Blastule 8-16 CELLS
-Trans cervical implantation into the uterine cavity.
-ICSI (intra cyto plasmic sperm injection)
Treatment of immunological infertility:
-Condom for 6-12 months.
-Prednisolone 5mg. X tds x 2 weeks
-Trial AIH (Artificial insemination of the husband).
4- Ovarian causes :
- Un ovulatory cycles:
1- Hyper prolactinemia
-Skull X-ray CT scan
-Dopergin tablets
2- Hypothyroidism : correct thyroid function
3-Ovarian dysfunction
FOUR categories:
1-Un ovulation with high estrogen
Clomid + pregnyl or HMG + PREGNYL
2-Hypogonadotropin hypogonadal patient treated by HMG + HGC
个
3-Ovarian failure: 个
FSH - LH treated by egg donor
4-Polcystic ovaries : hypoglycemic agents
-laparoscopic cyst drillings
🔸dueProblems with the delivery of sperm:
to sexual problems, such as premature ejaculation or
impotence; certain genetic diseases, such as cystic fibrosis;
structural problems, such as a blockage in the testicle; or damage
🔸
or injury to the reproductive organs.
Overexposure to certain environmental factors:
such as pesticides and other chemicals,and radiation. Cigarette
smoking, alcohol, marijuana, anabolic steroids or sex steroid-
Testosterone-, and taking medications to treat bacterial infections,
🔸
high blood pressure and depression also can affect.
Frequent exposure to heat:
such as in saunas or hot tubs, can raise body temperature and may
affect sperm production.
FEMALE CAUSES OF INFRTTILITY:
🔸 1- Ovarian factor (30-40%):
Anovulation Oligo-ovulation and luteal phase defect Poor For pregnancy to occur there must be fertile sperm and
secretory changes in endomtrium and prevent implantation of egg a means of bringing them together and receptive
fertilized ovum. Congenital absence (agenesis or dysgenesis) of
🔸
endometrium to allow the resulting embryo to implant.
A defect at any of these stages can lead to subfertility.
🔸
ovary.
2-Pelvic Adhesions:
Lead to prevent the passage of ovum. Occurs with pelvic
-It has been estimated that in 35 percent of cases a male
factor is the reason for infertility, in the remaining 65 per
cent of cases female factor is identified in 50 percent of
peritonitis or pelvic endometriosis .
•Tubal and peritoneal abnormalities: 🔸
couples and no cause will be identified in the remainder
Abnormal sperm production or function due to
undescended testicles, genetic defects, health problems
Causes of Infertility
-Salpingitis.
such as diabetes, or infections such as chlamydia,
⬛
- Pelvic inflammatory disease
gonorrhea or HIV, inflammation of testis(Orchitis,
-Adhesion due to peritonitis
-Appendicitis
Epidimytis, Ductus Deference, TB,Mumps, Syphilis), Infertility
inflammation of Vesicles and prostate .
-Post-abortal infection Enlarged veins in the testes (varicocele) also can affect
-is defined by the failure of the couple of reproductive age to conceive after 12
-Endometriosis
-Ovarian periovarian tumour
the quality of sperm.
📍
months of regular coitus without contraception.
Primary infertility:
🔸
-Congenital malformation
3-Vaginal causes.
-Rigid or small hymen.
📍
-exists when a woman has never been pregnant.
Secondary infertility:
-Partial or complete vaginal atresia( aplasia and hypoplasia) -occurs when a women has a history of one or more previous pregnancies.
-Psychogenic vaginismus.
-Vaginitis.
-Vaginal septum.
🔹 Fecundability is the probability of achieving pregnancy with one menstrual
cycle, for the normal couple this is approximately 25%.
🔸
Causes in female
4-Cervical abnormalities:
-Cong. atresia or elongation
▪️ INCIDENCE:
-Chronic infection. -It has been estimated that infertility affects 9 per cent of couples, of whom 70
-Obstruction with surgical injuries like conization and per cent suffer from primary infertility, and 30 per cent secondary infertility.
cauterization - Worldwide more than 70 million couples suffer from infertility the majority being
-Malposition residents of developing countries .
- cervical fibroid -The recent advances in infertility treatment and the access of patients to such
-cervical antisperm
information have led to early presentation of these patient and their request for
Hostile cervix: when the cervical mucus become scanty and
thick preventing ascent of spermatozoa. treatment.
Causes: ch. cervicitis, -This may give a false impression of an increasing infertility problem.
cautrization,co -nization,
excessive amputation, clo
🔸
miphenen therapy, antisperm Ab,oestrrogen deficiency
5-Uterine Factors(5-10%):
🔶
-Uterine hypoplasia or absence {Testicular feminization
(absence of uterus)- 46XY} 🔸 Vaginal (smear)cytology:
Preovulatory:
-Pycknotic cells.
-Congenital malformation(bicornuate or septate)
-Small nucleus.
-Inadequate progestational stimulation or absence of its
-Stained red pink with
receptors.
-Endometritis e.g TB. 🔸
-Heosin stain.
Post ovulatory:
🔸
-Asherman's syndrome
6-Endocrine causes
-Squamous cells.
-Rolled edge.
- Hyperprolactinemia with adenoma.
-Hyperprolactinemia without adenoma. INFERTILITY -Stained blue with Hematoxylin Eosin stain.
-Shower of leukocytes.
-Hypothalmus-Hypophyseal defect.
-Adrenal defect. 🔶Evaluation of the cervical mucus :
A- Assesment of quantative and qualitive of the cervical mucus.
-Thyroid defect.
🔸 Pre-ovulatory showed :
-Ferning test: “estrogenic effect"
one drop of the cervical mucus dried on microscopic slide, the mucus displays a ferning
pattern.
**First visit: -Spinnbarkiet test: “estrogenic effect"
🔶
1-History of the couple a drop of mucus placed between 2 points stretched and form threads up to 15 cm.
-Proper complete history. (The mucus becomes more abundant, clear, slippery, and smooth; it can be stretched Evaluation of the uterus:
between two fingers without breaking. Under the influence of estrogen, this mucus looks
by fatema okoff -Firstly everyone should be interrogated independently
like egg whites. It is called spinnbarkeit mucus. After ovulation, the cervical mucus becomes
1-hystrosalpingography
2-Physical examination. 2-Endometrial biopsy
thick and dry under the influence of progesterone. Near ovulation, the cervix feels soft and
🔸
-General examination. 3-Hystroscopy
-Genital examination: is high/deep in the vagina, the os is slightly open)
1 Hystrosalpingography
-Speculum examination Pre-ovulatory mucus is:
-hysterosalpingogram or HSG is an x-ray procedure used to see
-Vaginal examination. -Clear- a cellular
whether the fallopian tubes are patent (open) and if the inside of the
-Bimanual examination. -Watery -copious
uterus (uterine cavity) is normal.
-Rectal examination. -PH >8 -cervical os is gaping
-HSG is an outpatient procedure that usually takes less than 5
3-Routine para clinical examination: **Note; after ovulation the progestrone effect dominates the cervical os closed and the
🔸
minutes to perform.
-CBC- Blood sugar and urea.- Urinalysis - Vaginal swab. mucus become scanty, viscous and impenetrable to sperm.
2 Hysteroscopy
4-Semen analysis. -Hysteroscopy is a procedure that allows your doctor to look inside
5-Ferning test -Spinnbarkiet test B-Post-coital test: "Sim's Huhner's test“: your uterus in order to diagnose and treat causes of abnormal
6-Ultrasonography. bleeding.
7-Functional vaginal cytology. PROCEDURES FOR 2-6 hours after coitus- a sample of cervical mucus obtained and examine
microscopically. Normal at least 10 active sperm should be present in high -Hysteroscopy is done using a hysteroscope, a thin, lighted tube that
8-Basal body temperature.
Watch BBT for 3 months EVALUATION OF power field.
is inserted into the vagina to examine the cervix and inside of the
uterus.
-The same time and site. -Any effect of general health FEMALE INFERTILITY: Hydrotubation:
-Write the day of sexual intercourse
C-In vitro test of cervical mucus. -Inject indigo carmine solution through uterine cannula under direct
vision of laparoscopy, you will see the dye spills from a tube if it is
Second visit:
Evaluate the previous step in the first step.
🔸
-Sperm penetration tests in vitro
Kremar libag test: Put a sperm in a capillary test tube, then the a sample of
cervical mucus. Put the tube at 30 degree, Normally sperm go up through a
patent
•Assessment of tubal patency:
1- Tubal patency - Rubin test - H.S.G. Rubin's test: Insufflation of tubes by air or carbon dioxide through the
2-Laparoscopy
3-Semen analysis - Sperm penetration test
4-Serum prolactin - FSH-LH -Estrogen
🔸
cervical mucus.
Miller Kurzrok test:
-One drop of cervical mucus near to one drop of the sperm on the slide. Failure
cervical canal.
-Signs of patent tube:
1-Auscultation of the gas through the abdomen
2-Referred phrenic shoulder pain.
🔶
Progestrone - androgen - DHEA - of penetration suggests unfavorable test.
🔸
DHEAS TSH -T3 -T4 -Adrenal function test 3- by kymography trace.
Evaluation of the uterus:
3 Endometrial biopsy
1-hystrosalpingography
* Endometrial biopsy should be taken at 21st Of the cycle.
2-Endometrial biopsy
To show a secretary changes of endometrium
MANAGEMENT 🔶
3-Hystroscopy
Evaluation of the peritoneum By laparoscopy:
-Indication of laparoscopy:
-Serum progestrone. > 10 nmol/ml at time of ovulation at
19 day of cycle > 24nmol/ml
-urinary pregnandiol
1-If HSG showed tubal peritoneal abnormalities
2-Suspected endometriosis.
Treatment of infertility 3-Suspected ovarian disease.
1-Cervical problem:
-Antibiotics -Repair cervical defect
4-if all survey of infertility shows no abnormalities
-Estrogen -if low Spinnbarkiet test
2-Uterine causes 🔶Evaluation of immunologic 🔶 Detect of ovulation:
1-Basal body temperature
🔸Kibrick’s test:
-Surgical: for myoma or congenital anomalies. compatabil -Normal BBT chart.
-Antibiotics
-There is a slight fall in temperature (thermal nadir), just about the
-Progestrone.
*Mix 1 ml of fresh sperm+ 10% gelatin equal volume + equal volume of female timeof LH surge . Ovulation occures about 24 hours later.
-Asherman's syndrome: Surgical debridmen better by hystroscopy
serum. -Biphasic pattern 0.5 -1 degree elevation
-IUCD inserted with estrogen therapy
2.Urinary Luteinizing hormone Kits:
3-Tubal causes _If there is clumping of sperm positive.
It assumed that ovulation will occur within the following 12 to 24
-Hydrotubation for fimbrial stenosis **Other test: hours.
-Salpingolysis -Mix the cervical mucus with sperm, then under microscopic examination, if 3. Serum progesterone level.
-Salpingostomy
there is clumping of sperm means > positive Greater than 4ng/ml suggest ovulation, and 10ng/ml inmidluteal
-Tuboplasty
**Detection of sperm antibodies in the female serum. phase represent an adequate level of progesterone
-IVF (In vitro fertilization):
-Last resort if fallopian tube have destroyed
-Harvesting ova at time of ovulation
🔸 Laparoscopy
Allow direct visualization of the ovary and is most reliable method of
-Culture in special media.
demonstrating a pre-ovulatory follicle
-Extracorporeal fertilization.
-Culture fertilized ova until reaches Blastule 8-16 CELLS
-Trans cervical implantation into the uterine cavity.
-ICSI (intra cyto plasmic sperm injection)
Treatment of immunological infertility:
-Condom for 6-12 months.
-Prednisolone 5mg. X tds x 2 weeks
-Trial AIH (Artificial insemination of the husband).
4- Ovarian causes :
- Un ovulatory cycles:
1- Hyper prolactinemia
-Skull X-ray CT scan
-Dopergin tablets
2- Hypothyroidism : correct thyroid function
3-Ovarian dysfunction
FOUR categories:
1-Un ovulation with high estrogen
Clomid + pregnyl or HMG + PREGNYL
2-Hypogonadotropin hypogonadal patient treated by HMG + HGC
个
3-Ovarian failure: 个
FSH - LH treated by egg donor
4-Polcystic ovaries : hypoglycemic agents
-laparoscopic cyst drillings
