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| Infertility is defined as the inability of a couple to conceive with regular intercourse without use of contraception after 12 months in women less then 35 years of age, and after 6 months in women 35 years and older. | | {{#lst:Infertility (female)|infertility}} |
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| We can distinguish primary and secondary infertility. In primary, the woman has never achieved pregnancy, while in secondary, there’s been at least one previous pregnancy.
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| Fecundability is also relevant. It’s the probability of achieving a pregnancy in one menstrual cycle. This number is maximally around 25%, but it decreases with the age of the woman. In a 40 year old woman, the number is only a few percent.
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| In Hungarian literature, the terms infertility and sterility are usually distinguished. Sterility is defined as how infertility is defined above, but infertility is defined as the inability to carry out a pregnancy.
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| Infertility is relatively prevalent. In women 15 – 34 years old, it affects 7 – 9%. In women from 35 – 45, the number is 25 – 30%.
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| == Etiology ==
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| The cause of infertility according to gender is distributed like this:
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| * 40% of cases are due to male infertility
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| * 45% of cases are due to female infertility
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| * 10% of cases are due to both
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| * 5% of cases are unknown
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| The causes of female infertility are as follows:
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| * Functional infertility
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| ** Disorders of the hypothalamic-pituitary-ovarian axis causing anovulation
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| *** Same disorders as of amenorrhoea
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| ** Disorders of the adrenal gland
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| ** Disorders of the thyroid gland
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| ** Anorexia
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| ** Obesity
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| ** Stress
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| * Organic infertility
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| ** Endometriosis (adhesions, abnormal „interleukine millieau”)
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| ** Fallopian tube disorders (occlusion, infection, ciliary motility problems)
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| ** Uterine abnormalities (Mullerian disorders, Asherman syndrome, fibroids)
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| ** Cervical abnormalities (conglutination, mucous and immunological problems)
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| ** Vaginal abnormalities (septum)
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| However, the most common causes are increased age, hypothyroidism, endometriosis, PCOS, etc.
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| The causes of male infertility are as follows:
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| * Endocrine disorders
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| ** Hypothalamic dysfunction (Kallman syndrome)
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| ** Pituitary dysfunction (hyperprolactinaemia)
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| ** Thyroid disease
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| ** Steroid use
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| * Spermatogenesis abnormalities
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| ** Mumps
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| ** Varicocoele
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| ** Heat, radio, chemo
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| ** Orchitis
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| * Sperm motility abnormalities
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| ** Posttesticular obstruction
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| ** Epididymitis
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| * Sexual dysfunction
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| ** Retrograde ejaculation
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| ** Impotence
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| Kallmann syndrome is characterised by the absence of GnRH-producing cells in the hypothalamus as well as anosmia.
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| == Diagnosis and evaluation ==
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| Thorough history is important. It’s important to evaluate:
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| * Duration of infertility
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| * Menstrual history
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| * Diseases which can cause infertility
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| * Previous surgeries, especially gynaecological
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| * Sexual history
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| * Family history
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| * Stress, smoking
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| Physical examination may reveal features of the underlying cause, such as:
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| * BMI, abdominal obesity
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| * Incomplete secondary sexual characteristics
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| ** (hypogonadotropic hypogonadism, Turner syndrome)
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| * Galactorrhoea, hirsutism, acne, male pattern baldness
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| ** (hyper- or hypothyroidism, hyperprolactinemia, polycystic ovary syndrome, adrenal disorder)
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| * Tenderness or masses in the adnexae
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| ** (chronic pelvic inflammatory disease)
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| * Palpable tender nodules
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| ** (endometriosis)
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| * Vaginal/cervical structural abnormalities, discharge
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| ** (müllerian anomaly, infection)
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| * Uterine enlargement, irregularity, or lack of mobility
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| ** (leiomyoma, endometriosis, adhesions)
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| Semen analysis is important, to look for oligoszoospermia, asthenozoospermia, teratozoospermia, etc. Semen should be collected after 3 – 5 days of ejaculatory abstinence, and collected in special rooms in the clinic or at home but examined within one hour.
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| The following as well:
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| * Evaluation of the ovulatory function is also important and is covered in topic B4.
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| * Laboratory evaluation of thyroid disorders, prolactin disorders, PCOS, etc.
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| * Assessment of uterine cavity and fallopian tube patency
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| ** By hysterosalpingography or hysterosalpingo-contrast-sonography
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| ** Only for uterine cavity: hysteroscopy, saline hysterosonography
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| | See also topic B4. |
| [[Category:Obstetrics and gynaecology 2]] | | [[Category:Obstetrics and gynaecology 2]] |