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Home Gynecology and Obstetrics

Female factor infertility

Dr.Galal Baligh by Dr.Galal Baligh
November 25, 2019
in Gynecology and Obstetrics
211 7
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Female factor infertility

Female factor infertility

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Contents hide
1 Peritoneal factor infertility:
2 Uterine factor infertility:
2.1 Causes:
2.2 Diagnosis:
2.3 Investigations:
2.4 Treatment:
3 Cervical factor infertility:
3.1 Causes :
3.2 A. Organic causes:
3.3 Diagnosis:
3.4 Sperm cytotoxic Ab: destruction of sperms.
4 Vaginal factor infertility:

Peritoneal factor infertility:

Causes: the most important are endometriosis & chronic salpingitis.
Mechanism: (both affect the mechanism of ovum pick up by the tube) via:

1) Mechanical interference: adhesions.

2) Chemical interference: e.g. interleukin 1 & 6, tumour necrosis factor alpha & PGs.

Investigations: laparoscopy is the best.

Uterine factor infertility:

Causes:

1) Congenital: aplasia or severe hypoplasia.

2) Traumatic: Asherman syndrome.

3) Inflammatory: TB endometritis.

4) Neoplastic: submucous fibroid & bilateral cornual fibroid.

Diagnosis:

A. Symptoms:

1) Primary amenorrhea: aplasia.

2) Hypomenorrhea or recurrent abortion: hypoplasia.

3) History of curettage followed by amenorrhea: Asherman syndrome.

4) Menorrhagia: submucous fibroid.

B. Signs:

1) Absent or small uterus: aplasia or hypoplasia.

2) Failure to pass sound: Asherman syndrome.

3) Symmetrical enlargement: submucous fibroid.

Investigations:

1. U/S: detects congenital & neoplastic causes.

2. HSG: detects intrauterine adhesions, and space occupying mass.

3. Hysteroscopy: detects SMF & Asherman syndrome.

4. Endometrial biopsy: detects TB especially in basal layer.

Treatment:

treatment of the cause e.g. myomectomy for fibroid

Cervical factor infertility:

Causes :

A. Organic causes:

1. Congenital: *stenosis i.e. pin point os. *Elongation.

2. Traumatic: *Stenosis: due to excessive cauterization.

*Cervical incompetence: due to conization.

3. Inflammatory: chronic cervicitis ( hostile cervical mucus).

4. Miscellaneous:

*RVF uterus: external os of cervix a way from seminal pole.

*Virginal prolapse.

5. Neoplastic: cervical fibroid & cervical polyp.

B. Functional causes:

1. Poor quality of cervical mucus, or may contain anti- sperm antibodies.

Diagnosis:

A. History:

1) History of cervical operation e.g. cauterization or conization.

2) Vaginal discharge, backache & congestive symptoms: cervicitis.

3) Dyspareunia & urinary manifestations: cervical polyp.

B. Examination: Detect organic causes e.g. cervicitis, cervical polyp & stenosis.

C. Investigations:

1) Investigations for organic causes: e.g. culture & sensitivity of discharge

2) Investigations for functional causes:

i. Quality of cervical mucous:

• Normally: at mid cycle, cervical mucous under estrogen effect (thin, clear, profuse, acellular, +ve fern test & +ve thread test).

• Abnormally: quality changes: thick mucopurulent & cellular.

ii. Postcoital test (Sims-Huhner test)(in vivo test):

• Precautions:

a) Before coitus:

*semen analysis should be normal.

*No intercourse & no v. douches for 2 days.

b) During the coitus:

*should be at the time of ovulation.

*No use of lubricant during intercourse.

c) After the coitus:

* Sample should be examined within 6 hours postcoital.

* 2 Samples from posterior fornix & cervical mucous then microscopically observe number of motile sperms •

Idea: study of viability of sperms in vaginal fluid & cervical mucus.

• Results:

• N.B. : the test is considered normal with presence of ≥ 5 progressively motile sperms /HPF.

Female factor infertility
Female factor infertility

iii. Sperm mucus penetration test:

• Synonyms: Miller-Kurzrok test, in vitro test.

• Idea: study of sperm penetration through cervical mucus in vitro.

• Timing: day of ovulation.

• Technique: a cervical mucus drop is put with a drop of seminal fluid on a slide observing interaction.

• Results:

Normally: sperms penetrate mucus in a spearhead manner.

Abnormally: Dead sperms at the contact of cervical mucus.

iv. Anti-sperm antibodies:

• Types: * Ig A is present in cervical mucus.

* Ig E is present in wife serum.

• Procedure: * The husband sperms mixed with wife cervical mucus.

* The sample is incubated & examined for:

Sperm agglutinating Ab: agglutination of sperms.

Sperm immobilizing Ab: immobilization of sperms.

Sperm cytotoxic Ab: destruction of sperms.

Treatment:

A. Treatment of organic causes: e.g. cautery & proper antibiotics for cervicitis.

B. Treatment of functional causes:

1. Treatment of poor quality of the cervical mucus: e.g. due to clomid:

small dose of estrogen is added from 10th day to 15th day of the cycle.

2. Treatment of anti-sperm antibodies:

• Males: use condom for 6months.

• Females: receive prednisolone 5 mg tds for one week/month.

C. Assisted reproductive techniques

• AIH & GIFT if failed IVF is done.

Vaginal factor infertility:

1. Congenital: e.g. aplasia or transverse vaginal septum interfere with coitus.

2. Traumatic: e.g. vaginal operations causing dyspareunia due to tender scar & narrowing of the vagina.

3. Inflammatory: vaginitis.

4. Neoplastic: tumours interfere with coitus.

5. Miscancelleous: a) Vaginismus. b) High vaginal acidity: treated by precoital alkaline vaginal douches (NaHCO3 1%).

Ovarian factor infertility

Tags: Infertility
Dr.Galal Baligh

Dr.Galal Baligh

OB-GYN Specialist

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