Infertility (Female factor)

  • Infertility is not being able to achieve a pregnancy after a year of unprotected sex.
  • Impaired fecundity: either the inability to conceive or to carry a pregnancy to term.
    • To achieve pregnancy:
      • Female: Ovulation: release at least one egg per menstrual cycle.
      • Male: Enough motile sperm per ejaculate.
      • Clear passage to the egg for fertilization.
      • Site of fertilization: fallopian tubes.
      • Fertilized ovum: travel to the uterus.
      • Implantation: fertilized egg implant in the uterine lining.
    • Female risk factors:
      • Ovulation problem: Irregular or sparse cycles are not likely to be ovulating.
      • Blockage of the Fallopian tubes: Risk factors
        • Pelvic inflammatory disease.
        • Ruptured appendicitis in the past
        • STD secondary to chlamydia or gonorrhea
        • Abdominal surgery
          • Diagnosis:
          • Uterine abnormalities:
            • congenital defect.
            • Uterine fibroids.
              • Diagnosis:
                • Transvaginal ultrasound.
              • Advanced age.
              • Miscellaneous:
                • Alcohol abuse.
                • Excessive weight loss or weight gain.
                • Excessive emotional or physical stress.
              • Management:
                • Medical:
                  • Clomiphene citrate (Clomid): Acts directly on the pituitary gland to cause ovulation. Used in PCOs or in oligo-ovulation.
                  • Human menopausal gonadotropin (Pergonal, Repronex): Enhances ovulation in females with pituitary gland problems).
                  • FSH or follicle stimulating hormone: Injected and acts much like human menopausal gonadotropin: replaces FSH of the pituitary gland.
                  • GnRH or gonadotropin-releasing hormone.
                  • Metformin (Glucophage): Enhance ovulation in women with polycystic ovarian syndrome. Used alone or in combination with FSH or clomiphene. Decreases the phenomenon of hyperandrogenism.
                  • Bromocriptine (Parlodel): used in cases of anovulation due to hyperprolactinemia.
                • Intrauterine Insemination (IUI): Artificial insemination: Sperm that has been collected and washed is inserted into the female uterus at the time of ovulation (normal or stimulated ovulation). Used in case of male-factor infertility.
                • Assisted Reproductive Technology (ART): Egg and sperm are fertilized outside of the body
                • Surgical:
                  • Release of pelvic adhesions: Laparoscopic
                  • Myomectomy: In case of uterine fibroids
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