Female

Primary Amernnorrhoea

• Gonadal Agenesis
• Disorders of Hypothalamus and Piturary Axis
• Chromosome abnormalities
• Turners Syndrome – (45 x 0)
• TURER MOSAICISM (45/46/x0) (45/46/x0/xy)
• GYNAETRESIA (absence of uterus and vegina)
• Cryptomenorrhoes (absence of periods)

Secondary Amennorrhoea and Oligamenorrhoes

• Hypothalamus
  Obesity
  Anerexia Nervosa
  Oral Contraceptives
  Tranquilizers
  Psychological Disturbances
• Pituotary
  Pituotary Thmours – Hyper prolactenimia
  Seehan’s Syndrome
• Thyroid
  Myxoedema
  Thyrotoxicosis
• Adrenal
  Adrenal Hyperplasia
• Ovary
  Ovarian failure
  Polycystic Ovary

Uterus

• Endometrial atrophy
• Asherman’s Sydrome (Repeated D & C)
• Cercial Stenosis

Cervical Factors

• Infections

Tubal Factors

• Tuberculosis
• Gonorrhoea
• Post partum and Post abortal infections
• Intra uterine coutraceptive devices
• Pelvic and post operative infections
• T.Mycoplasma
• Chlamydial infections

Unexplained causes of intertility

• Retroversion of uterus
• Tortuosity of felloplain Tubes
• Premeture release of immature ova
• Leutinising Unruptured follicle
• Hyper Androgenism – HIRSUTISM
• Leuteal phase defects
• Endometriosis
• Veginismus
• Sperm antibodies
• Rigid Hymen
• Chronic Leucorrhoea
• Inflamation of Vulva
• High degree of Acidity in Vegina
• Morework and insufficient sleep

When both the tubes are closed – (Test tube Baby)

• IVF – Invitro fertilization
• GIFT-Gammet Intra Fellopian Transfer
• POST – Peritoneal Ovum and Sperm Transfer
• Micro Manipulation Technique
• Forcible infection of sperm over egg

General Survey in femal infertility

• Ovulatory factors – 27%
• Tubal factors – 19%
• Endometriosis – 18%
• Uterine factors – 6%
• Male factors – 30%

Insufficient Hormone Stimulus to cause ovulation – pituitary Tumour

• Clomiphen citrate
or
• FSH+LH (Pergonal)

Leutealphase Defects Corpus leutuin Insuffiency

• Progesterone tablets or

Ammenorrhoes and Galactorrhoea or Hyperprolactenimia

• Prolactin Hormone Level
• Tt – Tab Bromocryptin or Protinal therapy

Endometriosis
Painful periods
Painful Intercourse
Excessive Menses Bleeding

Tt:- Family planning tablets

• Tale. Oestrogen + Progesterone Conulernaten
• or Depo – Vera (plainprogestrone)
• or Tab Danazol or Danogen or Ladogal
• 1 Bd to 6 to 9 months

More Androgens in Female Body

• No periods or irregular periods
• Excessive Body and fascial hair
• Masculaniation
• Anovulation
• Serum Testosterone > 76

Tt CLOMIPHENE + Predinisolone

Cervical Factors

Tt:-

• Antibiotics
• Cauterisation
• Clomid
• Lasser rays therapy
• Diethyl Stillbosterol
• Estrol Therapy

Poly cytic ovarian Syndrome or Stein Levanthan Syndrome

• Irregular periods
• Iufertility
• An ovulation
• Hairiness – Obesity
• Multiple cyst over ovary

Serum LH
Serum FSH – Normal
Tt Clomiphen Tablets

Tubal factors

• Gonorrhoea
• P.I.D
• Strepto and staphyto infection

Tt: – Micro surgery
Antibiotics

Obstructions

• Veginismus
• Veginal muscle spasm
• Tt. Veginal Dialators

Unexplained Infertility

Tt – Timing of intercourse Antibody factor change in sexual posture

Congential Defects

• Absence of Uterus or Ovaries
• Under developed uterus and ovaries

Failure of Ovulation

• Hyperprolactenimea
• Malfunctions of Diabetes
• Thyroid Diseases
• Adrenal Diseases
• Alcohol
• Smoking
• Drugs
• Stress
• Exposure to excessive radiation and heat

Abnormalities of fellopian tubes

• Lining cell defect
• Tubal block due to Gonorrhea - appendici tis - Septic abortion

Abnormalities of Uterus

• Fibroid
• Endometritis

Endometriosis

Bleading excess
Painful Periods
Tt:- (Danazol)
Cap Danogen, Ladogal
400 ml - 1 Bd for 6 to 9 months

Systemic illness leading to infertility

• TB abdomen
• TB Uterus
• Cervical TB

Crash Diet - Anorexia Nervosa

Unexplained Infertility

20% of all cases comes under this group