Causes of inferlity 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

Cervical

Tubal

Uterine

Ovarian

Endometriosis

Unexplained

Age

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Laser conization- low secretion of mucous Anti-Sperm Antibodies

Closed Cervix

Blockage of the vaginaImperforate hymenExtremely narrow vaginaPainful infections in the vagina

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Uterine Causes of Infertility in Women

CongenitalAsherman SyndromeFibroids FibrosisEndometrial Polyps Adenomyosis

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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.

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.

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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

Adhesions

Short tubes

Tubal Tumors

Tubal Cause Of Infertility www.layyous.com

Chronic Pelvic Infections:

Cause tubal congestion. Obstruction (>3cm ) 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

Pituitary Failure

Endocrinopathy

Hypothalamic Failure

Ovarian Dysfunction www.layyous.com

Polycystic ovarian disease: 20% of femaleshave what is called polycystic ovary whichinvolves having follicles consisting of morethan the normal condition. In this case thewoman has normal fertility but if it isassociated with some conditions, it is calledpolycystic ovarian syndrome and it ispathological.

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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 www.layyous.com

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Congenital: Genetic and chromosomal causes Ovarian agenesis. Hereditary causes for accelerated loss of ovarian

reserve. Familial premature ovarian failure. Chromosomal abnormalities (47XXX).

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-α Hydroxylase Deficiency. Galactosemia.

Extras : Autoimmune causes: Presence of ovarian

antibodies. Lack of (or dysfunction) of LH, FSH

ovarian receptors. Idiopathic causes. Surgical oopherectomy.

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Secondary disorder of GonadotrophinRegulation:1. High prolactine level 2. Pituitary adenoma3. Idiopathic hypothyroidism 4. side effect to medication5. Suprapituitary Tumors6. Pituitary Tumors, trauma such as in RTA, 7. Radiation exposure to the pituitary.8. Idiopathic causes.

LH and FSH gonadotrophin Deficiency due to:1. Pituitary tumors.2. Destructive pituitary lesion.3. Pituitary ablation.

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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 www.layyous.com

"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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Hypotheses

Stress and worries changes in internal hormones ,decreased cervicalsecretions or muscular spasm, including those lining fallopian tubes causingits 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 ObstetricsFacilities

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Dr Najeeb LayyousAmman, Jordan

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