Tubal/peritoneal factors
- Endometriosis
- Pelvic adhesions
- Pelvic inflammatory disease (PID, usually due to chlamydia)
- Tubal occlusion

The fallopian tube is responsible for efficient transfer of gametes and for fostering their approximation.

Functions of the fallopian tube are twofold.

Mechanical functions act to:
Convey recently ovulated ova into fallopian tube
Permit spermatozoa to enter to oviduct
Effect transfer of the blastocyst into the uterine cavity

b. Environmental functions provide for:
Fertilization of the ovum
Capacitation of spermatozoa
Place for early development and segmentation of the fertilized ovum

The reason of 30% of female infertility is tubal/peritoneal factor.

The main – is impassability of tube for gametes and blastocyst because of abdomenal adhesions

Hysterosalpingography
Hysterosalpingography is radiological visualisation of the genital tract by the injection of radio-opaque contrast medium through the cervix. It shows if the tubes are open and shows the shape of the uterus. It has largely been replaced by laparoscopic hydrotubation, but may be useful in women wishing to avoid a general anaesthetic. Hysterosalpingography may be a useful supplementary test in women who have tubal blockage demonstrated at laparoscopy. Hysterosalpingography allows the site of tubal blockage to be demonstrated, which is helpful if surgery is contemplated.

Laparoscopic hydrotubation
Tubal patency can be assessed at laparoscopy. The cervix is instrumented with a cannula, and 5-20 ml of methylene blue dye is injected into the cavity of the uterus. If the fallopian tubes are patent, dye can be seen spilling out of the end of each tube. Laparoscopic hydrotubation has the advantage that the pelvic organs can be inspected during the procedure. Conditions such as pelvic adhesions and endometriosis, both of which may reduce fertility, can be noted and repaired. The major disadvantage of laparoscopy is that it is an operative procedure and that a general anaesthetic is required.

Tubal surgery
When tubal disease has been confirmed, tubal patency may be improved by surgery. The best results are obtained when surgery is performed by an operator trained in these techniques, using an operating microscope.
Surgery may be performed laparoscopically, or at an open procedure. The aim of surgery is to restore tubal patency and mobility. However, restoration of tubal patency does not guarantee pregnancy, since tubal function may have been permanently destroyed or impaired.

Popularity: 16% [?]

Uterine factors
- Uterine malformations
- Uterine fibroids (leiomyoma)
- Asherman’s Syndrome (intrauterine synechiae)

Uterine factor. The uterus supports the journey of spermatozoa from the cervix to fallopian tube and performs many important roles in reproduction.

The roles of the uterus in reproduction include:
a. Retention of the zygote after arrival from the fallopian tube for several days before implantation
b. Provision of a good environment for implantation
c. Protection of embryo/fetus from the external environment

Evaluation of the uterine factor is done by the following methods:

Endometrial sampling by biopsy to determine:
The occurrence of ovulation when evidence of progesterone secretion (i.e. secretory endometrium) is found on biopsy
The duration of hormonal influence and defects incorpus luteum secretion of progesterone.
The presence of infection

b. Endometrial culture to identify bacterial organisms in the presence of endometritis

c. Ultrasound examination - to detect anomalous uterine development, uterine diseases and conditions of endometrium.

d. Hysteroroscopy – visual examination of uterine cavity for detecting of anomalous development, polyps, tumors an synechiae.

e. Laparoscopy to detect and delineate anomalous uterine development or myomata. (Laparoscopy permits visualization of the abdominal and pelvic cavities. The endometrial cavity cannot be visualized with a laparoscope, only the outside of the uterus.) This procedure requires anesthesia and can be done at the time of hysteroscopy.

Popularity: 16% [?]

Female infertility
Cervical factors
- Cervical stenosis
- Antisperm antibodies
- Insufficient cervical mucus (for the travel and survival of sperm)

The cervix is the first major barrier encountered by sperm after arrival in the female reproductive tract. Spermatozoa migrate rapidly through the endocervical canal and have been demonstrated in the fallopian tube as early as 5 minutes after deposition at the cervix.

Abnormalities in the cervix or the cervical mucus that interfere with sperm migration

a. Abnormal position of the cervix (prolapse or uterine retrovision)
b. Chronic infections which may produce ah unfavorable mucus for sperm (e.g., Streptococcus, Staphylococcus, Gardnerella)
c. Colonization with organisms that are cytotoxic to sperm (e.g., Ureaplasma)
d. Previous electrocautery
e. The presence of sperm antibodies in cervical mucus.

Cervical factors can be assessed by physical, biochemical, and physiologic parameters including:
1. Colposcopy
2. pH of mucus
3. Bacteriologic culture for microorganisms
4. Crystallization (ferning) of midcycle mucus
5. Serologic tests for antibodies
6. Tests of sperm behavior in mucus
7. In vitro microscopic study of penetration of sperm through cervical mucus

Popularity: 15% [?]

Female causes

1. General factors
Diabetes mellitus, thyroid disorders, adrenal disease
Significant liver, kidney disease
Psychological factors

2.Hypothalamic-pituitary factors:
Kallmann syndrome
Hypothalamic dysfunction
Hyperprolactinemia
Hypopituitarism

3.Ovarian factors
Polycystic ovary syndrome
Anovulation
Diminished ovarian reserve
Luteal dysfunction
Premature menopause
Gonadal dysgenesis (Turner syndrome)
Ovarian neoplasm

4.Tubal/peritoneal factors
Endometriosis
Pelvic adhesions
Pelvic inflammatory disease (PID, usually due to chlamydia)
Tubal occlusion

5.Uterine factors
Uterine malformations
Uterine fibroids (leiomyoma)
Asherman’s Syndrome

6.Cervical factors
Cervical stenosis
Antisperm antibodies
Insufficient cervical mucus (for the travel and survival of sperm)

7.Vaginal factors
Vaginismus
Vaginal obstruction

8.Genetic factors
Various intersexed conditions, such as androgen insensitivity syndrome

Popularity: 18% [?]

Speaking about Infertility, it had been one of the major concern today. Lots of studies and researches had been started to overcome this obstacles.

Previously, women are blamed most often if the married partner don’t have any children or pregnancies. But the world todays had changed! Both women and men are carry the equal responsibility on this problem.

What is infertility? It is not being able to get pregnant after at least one year of trying.

It divided into Primary and Secondary. Primary infertility is the inability to conceive in a couple who have had no previous pregnancies. While Secondary infertility is difficulty conceiving after already having conceived and carried pregnancy.

In world population today, there are 10%-20% of the reproductive age couples are INFERTILE! Which means 2 out of 10 couples are INFERTILE! This number is BIG!

Let’s see the divisions of problems. 50% is caused by women, 40% is caused by men and 10% is caused by unknown reasons.

In this post, I will share about the causes from the men. and in next post causes from women.

It is divided into
Pretesticular causes, Testicular causes and Post Testicular causes.

Pretesticular causes include:
Endocrine problems, i.e. diabetes mellitus, thyroid disorders
Hypothalamic disorders, i.e. Kallmann syndrome
Hyperprolactinemia
Hypopituitarism
Hypogonadism due to various causes
Psychological factors
Drugs, alcohol

Testicular factors include:
Genetic defects on the Y chromosome
Abnormal set of chromosomes
Klinefelter syndrome
Neoplasm, e.g. seminoma
Idiopathic failure
Cryptorchidism
Varicocele
Trauma
Hydrocele
Mumps
Testicular dysgenesis syndrome

Posttesticular causes include
Vas deferens obstruction
Infection, e.g. prostatitis
Retrograde ejaculation
Hypospadias
Impotence

Those are the important causes of men infertility! Of course, the detailed reasons will be a lot!

Popularity: 29% [?]

Newer Posts »