Infertility

Aetiology:
1) Ovarian factor -
@ Corpus luteal phase defect
 - due 2 progesterone def.     Or short duration of luteal    phase
- seen in : in vitro fertilization,  hyperprolactinemia, excess    luteolysis, hypothyridism,      clomiphene therapy.
@ PCOD
@ Periovarian adhesion due    2 pelvic inf.
@ Luteinised unruptured        follicular syndrome

2) Tubal
@ salpingitis
- adhesion around abdominal   osteum
- tubal blockage due 2          adherent plicae
- causes- gonorrhea             chlamydia, n following          septic abortion n puerperal   sepsis. Genital TB

3) Uterine
- Asherman syndrome:
  due to endometrial TB,        currettage, puerperal          infection, packing of cavity    2 control PPH
- Fibroid
  cornual fibroid blocking F     tube opening, submucous n   cervical fibroid.
- Malformations

4) Cervical
- congenital elongation, 2nd     deg uterine prolapse, acute   retroverted uterus

5) Pelvic
- endometriosis
- adhesions
6) Vaginal
- atresia, trans. vaginal          septum, septate vagina,       vaginitis.
7) Dyspareunia
8) Hypothalamic n pituitary dis.
   Hypothyroidism, adrenal       dysfunction Causes           anovultn.
9) smoking, DM, TB

Investigations

1) History : regarding above causes
2) examination :
general examination. n abdominal exam. 4 fibroid
3)special investigation-
 tests 4 tubal patency

a) Hysterosalpingography

- visualisation of uterine cavity n tubes
- done betn end of menstr. Period n ovulation.
- under aseptic precautns 15 ml of radiopaque dye( 50% iodine with 6% polyvinyl alcohol) injected thro cannula in uter. cavity under direct vision wth fluoroscopic screen.

b) Laparoscopic chromotubation
- apart 4m tubal visualisation peritubal adhesion n endometriosis can b diagnosd
- Adv : if adhesions n fimbrial block diagn. therapeutic intervention can b done.

c) Sonosalpingography.
d) Falloscopy n hysteroscopy
e) Ampullary n fimbrial salpingoscopy

Rx
1) Tubal microsurgery :
  indicated in tubal blockage

2) laparoscopic tubal adhesiolysis, fimbrioplasty, n tubal surgery

3) In vitro fertilization
- in whom tuboplasty failed n women wth extensive tubal damage

4) Balloon tuboplasty n cannulation wth hysteroscope transcervically 4 medial end block.

5) Tubal cannulation

6) Gamete intrafallopian transfer (GIFT)
- useful in c/o immunological infertility wth tubes patent.