The Epidemiology of Infertility

The Epidemiology of Infertility
The Epidemiology of Infertility

1) Greater interest in advanced education and career among women.

2) Later marriage and more frequent divorce.

3) Improvements in contraception and access to family    planning services.

4) Delayed childbearing.

5) Decreased family size.

Aging and Female Fertility

Physiology of Reproductive Aging

Oocyte and aging folicles

Ovarian Reserve Tests

1)FSH LEVEL:

2)clomiphene citrate challenge test:

The clomiphene citrate challenge test is a provocative and even more sensitive test of ovarian reserve that probes the endocrine dynamics of the cycle under both basal and stimulated conditions before (cycle day 3 FSH and estradiol) and after (cycle day 10 FSH) treatment with clomiphene citrate (100 mg/day, cycle days.

3)Inhibin-B

4)antimiillerian hormone (AMH) levels

5)The number of small antral follicles

observed by transvaginal ultrasound examination at the outset of the menstrual cycle reflects the size of the resting follicular pool and correlates with age and response to gonadotropin stimulation

6)Ovarian volume

Guiding Principles in the Evaluation of Infertility

Guiding Principles in the Evaluation of Infertility
Guiding Principles in the Evaluation of Infertility

1)Overweight

2)Substance abuse :smoking

3)caffeine Intake

4)potentially harmful occupational and environmental exposures

Normal Reproductive Efficiency

Indications for Evaluation

The Female Infertility Evaluation

Physical Examination

Screening Tests

Screening Tests
Screening Tests

1) Male Factor: Abnormalities of Semen Quality

2) Ovarian Factor

Menstrual History

 Basal Body Temperature (BBT)

 during the follicular phase of the cycle, then is modestly higher (0.4°-0.8° over the average preovulatory temperature during   the luteal phase

3) Cervical Factor: Abnormalities of Sperm-Mucus Interaction

4)Uterine Factor: Anatomic and Functional Abnormalities

5) Tubal Factor: Tubal Occlusion and Adnexal Adhesions

6) Unexplained Infertility

 

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