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
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