Causes of Infertility in Women

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Causes Of INFERTILITY In Women
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Inability to conceive despite trying and having
regular intercourse for one year. The causes
could be due to female factors or male factors
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Causes In Women
Unexplained
Cervical
Endometriosis
Tubal
Age
Ovarian
Vaginal
Uterine
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Cervical CAUSES OF INFERTILITY

• Laser conization- low secretion of mucous
• Anti-Sperm Antibodies
• Closed Cervix

VIGANAL CAUSES OF INFERTILITY

• Blockage of the vagina
• Imperforate hymen
• Extremely narrow vagina
• Painful infections in the vagina

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Uterine Causes of Infertility in Women

• Congenital
• Asherman Syndrome
• Fibroids
• Fibrosis
• Endometrial Polyps
• Adenomyosis

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• Asherman Syndrome
• Intra uterine adhesion (srepeated curettage,
  severe endometritis, scars of uterine surgery).
• Decreased amount of blood loss during
  menstruation.
• Can be diagnosed easily using hysterosalpingogram.
  

Treatment Hysteroscopic resection of these
adhesions can be done but it may need multiple
sessions, in addition to giving steroids with
estrogen for three weeks after surgery to avoid
recurrence.
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Fibroids Benign uterine tumor . Adenomyosis
They usually do not cause infertility unless it
affects the intrauterine cavity in an obvious
way, but if no other reason for infertility can
be found, it is better to do myomectomy (excision
of the fibroid ) and restore the intrauterine
cavity. Myomectomy can be done either by
Hysteroscopic resection or by laparotomy
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Fibrosis may happen after Endometritis and can be
diagnosed using HSG, hysteroscopy can help in
treatment.
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Endometrial polyp Its presence mimics IUCD,
polyps can be diagnosed by HSG, ultrasound or
hysteroscopy then polypectomy (removing the
polyp) can be done easily.
Adenomyosis Symptoms include secondary
dysmenorrhea, some hormonal treatments could be
helpful e.g. GNRH analogues, or Danazol, the
decision for this treatment should be taken by
the treating physician.
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Chronic Pelvic Infections
Fimbral End Destruction
Short tubes
Adhesions
Tubal Tumors
Tubal Cause Of Infertility
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• Chronic Pelvic Infections
• Cause tubal congestion.
• Obstruction (gt3cm ) results in impeding of the
  oocyte transfer,
• May result in pelvic adhesions that will affect
  tubal movement.
• Slowing it so inappropriate time for oocyte
  transfer interferes with fertilization.
• Tubal occlusion or pelvic adhesions that cause
  inability for the fimbrial ends to catch the
  oocyte from the ovary or as mentioned before
  abnormal movement of the tubes and oocyte
  transfer.
• Causes for PID include infections with E.coli, or
  Gonococcus infection (STD) PID affects ovarian
  function and tubal movement

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• Destruction of the fimbrial ends Disabling its
  function in catching oocytes into the tubes, PID
  or endometriosis can cause this.
• Adhesions Caused by tubal surgery done for
  ectopic pregnancy, pelvic surgery done to the
  tubes or due to appendicitis.
• Tubal Tumors affecting it's function.
• Short tubes (less than 4cm).

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Polycystic Diseases
Functional Failure
Endocrinopathy
Pituitary Failure
Hypothalamic Failure
Ovarian Dysfunction
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Polycystic ovarian disease 20 of females have
what is called polycystic ovary which involves
having follicles consisting of more than the
normal condition. In this case the woman has
normal fertility but if it is associated with
some conditions, it is called polycystic ovarian
syndrome and it is pathological.
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I V F P C O D

• Women with e tubal occlusion
• Male abnormal semen analysis
• Women with PCOD will need IVF, should be
  individualized
• Treatment of hormonal imbalance is the best thing

• Recurrent abortions in PCO
• Increased LH level
• Control before starting induction of ovulation.
• Ovarian diathermy lowers LH
• lower recurrent miscarriages

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Ovarian Failure

• Congenital Genetic and chromosomal causes
• Ovarian agenesis.
• Hereditary causes for accelerated loss of ovarian
  reserve.
• Familial premature ovarian failure.
• Chromosomal abnormalities (47XXX).

• Extras
• Autoimmune causes Presence of ovarian
  antibodies.
• Lack of (or dysfunction) of LH, FSH ovarian
  receptors.
• Idiopathic causes.
• Surgical oopherectomy.

• Exposure to certain factors
• Large amount of radiation exposure.
• Chemotherapeutic agents as in cancer treatment.
• Viruses such as mumps.
• Heavy smoking.

• Congenital enzymatic dysfunction
• 17-a Hydroxylase Deficiency.
• Galactosemia.

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Pituitary Failure

• Secondary disorder of Gonadotrophin Regulation
• High prolactine level
• Pituitary adenoma
• Idiopathic hypothyroidism
• side effect to medication
• Suprapituitary Tumors
• Pituitary Tumors, trauma such as in RTA,
• Radiation exposure to the pituitary.
• Idiopathic causes.
• LH and FSH gonadotrophin Deficiency due to
• Pituitary tumors.
• Destructive pituitary lesion.
• Pituitary ablation.

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Hypothalamic Failure

• Causes
• Rapid and sudden increase or decrease in body
  weight.
• Severe psychological and neurological stress
  strenuous exercises.
• Radiation exposure.
• Medications that cause hypothalamic failure.
• Tumors.
• Unknown causes.

• Endocrinopathy
• Adrenal gland dysfunction
• Thyroid gland problems.
• Hypothyrodism
• Pancreatic problems

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Endometriosis
"Endometriosis Is Presence of Endometrial Tissues
Outside Endometrial Cavity"

• Affects pregnancy either by forming chocolate
  cyst (endometrioma) or by causing adhesions.
• Diagnos -Laparoscopy
• Treatment
• Laparoscopic adhesiolysis,
• Cauterization of endometriotic spots,
• Salpingostomy and reanastomosis of fallopian tube
  problems.

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Fatty acids in the sperm
Cervical leucocytosis
Stress
Unexplained Causes
Strenuous exercise
Psychological causes
Unstable changes in weather
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STRESSES INFERTILITY

• Hypotheses
• Stress and worries changes in internal hormones
  ,decreased cervical secretions or muscular spasm,
  including those lining fallopian tubes causing
  its obstruction, or muscles lining the vagina
  causing dyspareunia.
• Stress also has its effects on the hypothalamus
  and ovarian function.
• Couple seeking pregnancy to try, as much as
  possible, to alleviate stress and worries and
  have trust in god and trust their treating
  physician.

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Learn More To Get World Class Infertility IVF
Gynecology and Obstetrics Facilities
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Dr Najeeb LayyousAmman, Jordan