Infertility

Definition: infertility is defined as the failure to conceive within
one year of unprotected regular sexual intercourse. Infertility is
said to be primary if no previous conception occur while it is
called secondary if previous conception occur whatever its fate.
Infertility affects about 15 % of couples. The single most
important factor in determining fertility is the age of the female,
fertility rapidly reducing after the age of 35 years. Other factors
that reduce the chance of spontaneous conception include:
• Duration of infertility more than 3 years.
• Low coital frequency.
• No previous pregnancy.
• Smoking.
• Body mass index out side the range 20-30 kg/m2
(weight/height2) in women.
• Low number of motile healthy sperms.
Causes of infertility:
The main causes of infertility are anovulation, male factor, tubal
damage & unexplained. Other causes include endometriosis &
fibroids. Tubal factor is more common in patient with secondary
infertility.
Ovulatory disorders:
Ovulation problems can arise as a result of a defect in the
hypothalamus, pituitary or the ovary. Factors that affect the
pulsatile release of GnRH will lead to disordered ovulation.
These factors include stress, psychological disturbances, weight
change & systemic diseases as well as tumours & structural
lesions in the hypothalamus.
Hypothyroidism & hyperthyroidism may cause ovulatory
failure. Hyperprolactinaemia, renal failure, hepatic dysfunction
& phenothiazin drug reduce the pulsatile release of GnRH
leading to anovulation.
The commonest cause of anovulatory infertility is polycystic
ovary syndrome (PCOS). Women affected by this condition
have a range of symptoms that include: menstrual cycle