FEMALE SUBFERTILITY

Question 1

What the CAUSES of the female subfertility ?

Answer 1

✚ Anovulation or oligo-ovulation :

  ✦ Hyperprolactinemia 
  ✦ Polycyctic ovary syndrome
  ✦ Early menopause 
  ✦ Hypothyroidism 
  ✦ Pituitary or hypothalamic dysfunction 

✚ Anatomical & tubo-peritoneal dysfunction

  ✦ Fallopian tube damage or blockage.
  ✦ Endometriosis 
  ✦ Uterine fibrosis
  ✦ Pelvic Adhesions 
  ✦ presence of antibodies against sperm in the cervical mucus.
  ✦ Cervical stenosis 
  ✦ Lower genitalia problems 

✚ General causes

✦ Medical disease - TB , DM , MUMPS
✦ Excessive smoking and alcohol

Question 2

What are the History that we can get from female subfertility ?

Answer 2

✚ Age >35

✚ Length of infertility

✚ Menstruation History - Interval , Amount , Duration

✚ Reproductive history - abortion , ectopic pregnancy

✚ Contraception- IUCD , combine oral contraception use

✚ Drugs - NSAIDs

✚ Sexual History

✚ Family History - twinning , hereditary disease

✚ Social History - Occupation , tobacco , alcohol , drugs

Question 3

What are the PHYSICAL EXAMINATION that can be performed in female subfertility ?

Answer 3

✤ Bi-manual and rectrovaginal examination
✤ Secondary sexual character - absent
✤ Internal and external genitalia developmental condition
✤ Abnormalities
✤ Pelvic inflammatory disease
✤ Myoma or endometriosis

Question 4

What are the INVESTIGATIONS that can be performed in female subfertility patient ?

Answer 4

▶ Hormone testing
★ Hypothalamic - pituitary failure
★ level of FSH , LH and estradiol
★ Test for ovulation = progesterone day 21
★ Thyroid function test
▶ basal body temperature (BBT) chart.
❇oral temperature taken every morning on getting
up , and before taking any fluids or food.

❇ Ovulatory chart is biphasic - ↑in temperature at
luteal phase & ↓ in temperature around ovulation.

❇ Remains monophaisc in cases of anovulation.

▶ Urinary LH testing
▶ Cervical mucus
▶ Transvaginal ultrasound
▶ Tubal patency test