| ID | 327 |
|---|---|
| Name | STERILITY OR INFERTILITY |
| Cause | Causes: Male causes: 1. Undescendent testes 2. Incomplete development of testes 3. Previous orchitis due to mumps 4. Damage to the testes 5. Diseases of the testes e.g. T.B, syphilis etc. 6. Congenital or developmental obstruction of vas 7. Congenital absence 8. Inflammatory disease e.g gonorrhoea 9. Impotence 10. Premature ejaculation 11. Abnormalities of penis e.g hypospadias, phimosis etc. Female causes: 1. Ovarian hypoplasia 2. Adrenal failure 3. Bilateral tubal obstruction by salphingitis 4. Uterine absence, atrophy or hypoplasia 5. Tubercular endometritis 6. Failure of the endometrium to a normal ovarian stimulus 7. An impervious cervical plug 8. Lowering of PH of cervix 9. Cervical polyp or tumour 10. Excessive acidity in the vagina 11. Vaginal septa or membrane 12. Pelvic tumour e.g Fibromyoma, Endometriosis 13. Apareunia and dyspareunia 14. Obesity 15. Previous use of oral contraceptives or I.U.C.D |
| Signs Symptoms | |
| Diagnosis | |
| Investigations | Investigations: A. History: Age, ocupation, past illness of operations; previous marriage or pregnancy (if any). H/O syphilis, gonorrhoea, T.B; menstrual history. B. General examination: Should cover all systems with particular attention to reproductive system. C. Local examination: Reproductive system. D. Special investigation in male: 1. Semen analysis- volume, count, motility, morphology etc. 2. Testicular biopsy in azospermia. 3. Other tests- - chromosomal study of buccal mocosa. - radiograph of sella tursica for pituitary hypertrophy. - sex hormone assay. E. Special investigation infemale- 1. Pelvic ultrasonogram 2. Tubal patency test: Hysterosalpingography/Diagnostic laparoscopy. 3. Endometrial biopsy in the luteal phase associated with simultaneous serum progesterone levels (will rule out luteal phase deficiency). 4. Post coital test: Cervical mucous study. 5. Hormone assay. |
| Management | |
| Introduction | Sterility or infertility is an absolute state of inability to conceive or to procreate. Sub-fertility is a relative state of lowered capacity to conceive or to procrate. |
| History | |
| Etiology | |
| Clinical Features | |
| Preventions | |
| Treatment | Treatment: Treatment varies according to cause. Male: 1. Reassurance. 2. Improvement of general health. 3. Surgical treatment for- varicocele, phimosis, hypospadias etc. 4. Correction of coital difficulty & premature ejaculation. 5. Treatment of hypothyroidism or hypopituitarism. 6. Stimulation of spermatogenesis by hormone therapy e.g Gonadotropins or L.H/F.S.H-R.H - when there is hypothalamic-pituitary failure . Female: 1. Reassurance. 2. Improvement of general health. 3. Hormone therapy- - Oestrogen for ovarian hypoplasia. - FSH for ovulation. - HCG for ovulation. - Clomiphene citrate 50- lOOmg/day for 7 days starting on the 5th day of the cycle. 4. Treatment of endometriosis. 5. Surgical treatment for- tubal obstruction, uterine retroversion, fibroid uterus, ovarian tumor or cyst. 6. Correction of obesity, apareunia & dyspareunia etc. 7. Treatment of adrenal failure. 8. Artificial insemination in azoospermia (when female function is normal). 9. IVF (In Vitro Fertilization)- ET. |
| Complications | |
| Prognosis | |
| Types | Types: 1. Primary- no conception or procreation at all. 2. Secondary- a state of inability to conceive or procreate after a period of fertility. |
| Classification | |
| Observation | |
| Pathology |
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