Fertility
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Definition[edit | edit source]
The World Health Organization calculated that over 10% of women are affected by infertility and subfertility.[1]
Fertility: refers to the capacity to conceive and produce offspring
Infertility: is the inability to conceive despite frequent coitus. Infertility refers to a state in which the capacity for fertility is diminished, but not necessarily absent
Etiology[edit | edit source]
Pathology affecting fertility[2]
- Ovulatory dysfunction – 21 percent
- Tubal damage – 14 percent
- Endometriosis – 6 percent
- Coital problems – 6 percent
- Cervical factor – 3 percent
- Unexplained – 28 percent
- Male factor (hypogonadism, post-testicular defects, seminiferous tubule dysfunction) – 26 percent
| Issues | Information | ||
|---|---|---|---|
| Ovary |
|
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| Fallopian tube abnormalities / Pelvic adhesions | |||
| Uterus |
|
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| Endometerosis | |||
| Cervical factors | |||
| Inherited thrombophilia | |||
| Immune factors |
|
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| Genetic causes | |||
| Lifestyle factors |
|
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| Unexplained |
Modifiable lifestyle factors affecting fertility
| Factors affecting fertility | Information |
|---|---|
| Tobacco use | |
| Weight | |
| Exercise | |
| Alcohol intake | |
| Diet | |
| Caffiene | |
| Stress | |
| Environmental factors | |
| Recreational drug use | |
| Sexual behaviour |
Management[edit | edit source]
Physiotherapy
Medical Interventions
The following tests are useful in most couples with infertility:[3]
- Semen analysis to assess male factors.
- Menstrual history, assessment of luteinizing hormone surge in urine prior to ovulation, and/or luteal phase progesterone level to assess ovulatory function.
- Hysterosalpingogram or sonohysterogram with a test of tubal patency such as hysterosalpingo-contrast-sonography to assess tubal patency and the uterine cavity.
- Assessment of ovarian reserve with day 3 serum follicle-stimulating hormone and estradiol levels, anti-Müllerian hormone, and/or antral follicle count.
- Thyroid-stimulating hormone.
In select couples, the following additional tests may be warranted:
- Pelvic ultrasound to assess for uterine myomas and ovarian cysts
- Laparoscopy to identify endometriosis or other pelvic pathology
Resources[edit | edit source]
References[edit | edit source]
- ↑ World Health Organization. Sexual and reproductive health. Available from https://www.who.int/reproductivehealth/topics/infertility/perspective/en/
- ↑ Hull MG, Glazener CM, Kelly NJ, Conway DI, Foster PA, Hinton RA, Coulson C, Lambert PA, Watt EM, Desai KM. Population study of causes, treatment, and outcome of infertility. Br Med J (Clin Res Ed). 1985 Dec 14;291(6510):1693-7.
- ↑ Practice Committee of the American Society for Reproductive Medicine. Diagnostic evaluation of the infertile female: a committee opinion. Fertility and sterility. 2012 Aug 1;98(2):302-7.
