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Culture Documents
REFERENCES
INTRODUCTION
Percentage incidence of
causes of infertility
DEFINITION/OCCURENCE
INTERLOCKING PLAYERS
The following are important players:
Woman's
ovulatory cycle
Production
Hormones
(gonadotropins) = affect
the ovaries and the testes
HORMONE PRODUCTION
SITES
REPRODUCTION
GONADOTROPINS
human
human
Ovulatory
Luteal
hormone (LH)
Oestrogen
Progesterone
FEMALE INFERTILITY
The following factors contribute:
ovarian (hormonal)
tubal
cervical
uterine
psychosocial
immunologic
FACTORS
continued
Factors contribution:
Ovulatory - 30% of all cases of
infertility
pelvic - 50%
immunologic - 5%.
Others - 15%
ENDOMETRIOSIS (causes
mechanical obstruction)
OVULATORY DYSFUNCTION
Can
Complicated
by many metabolic
diseases that affect ovulatory function.
There
HYPOGONADISM
Hypogonadism
(decreased functional
activity of the gonads) - also cause
infertility in the female
Either Hypergonadotropic or
hypogonadotropic (increased or
reduced gonadotropins)
REFERENCE VALUES
hCG
Postmenopause
1.68-15 IU/L
21.9 56.6
0.61-16.3
14.2-52.3
Male
1.24-7.8
Ovulatory
peak
Luteal
Postmenopause
1.37-9.9 IU/L
6.17 17.2
1.09-9.2
19.3-100.6
Male
1.42-15.4
Ovulatory
peak
Luteal
pregnant - 0-23ng/mL
Pregnant
Men
34-386 ng/mL
0-20 ng/mL
Children
3.2-20 ng/mL
timester
Second
Third
0.1-0.3 ng/mL
0.1-0.7 ng/mL
2-25 ng/mL
10-44 ng/mL
19.5-82.5 ng/mL
65-290 ng/mL
Hypergonadotropic
hypogonadism
Causes of hypergonatropic hypogonadism:
menopause and
Hypogonatropic
hypogonadism
Causes of hypogonatropic
hypogonadism:
pituitary or hypothalamic
insufficiency
hyperprolactinaemia.
LABORATORY ASSESSMENT
OF FEMALE INFERTILITY
Initial history + physical examination,
menstrual history important
Ovulation:
Infertile
Even
Ovulation evaluation
Ovulation evaluation
continued
This
Ovulation evaluation
continued
Ovulation evaluation
continued
Evaluation of endocrine
parameter
Hypergonadotropic hypogonadism
Hyperprolactinaemia
Evaluation of endocrine
parameter continued
Hypogonadotropic hypogonadism
Estradiol
Decreased
Decreased
Hypothyroidism
MALE INFERTILITY
Hypogonadism
Infertility
LABORATORY ASSESSMENT
OF MALE INFERTILITY
Semen analysis
Endocrine parameters
Endocrine parameters
Serum
Endocrine parameters
continued
Hypergonadtropic hypogonadism
FSH
-Should be measured in males with sperm counts
less than 5 10 million/mL.
Endocrine parameters
continued
Endocrine parameters
continued
Interpretation of results:
Increase < 2times FSH levels from initial value and /or
maximum level does not exceed 3mIu/mL indicates relative
pituitary insuffiency.
Endocrine parameters
continued
Immunologic parameters
Antisperm antibodies detected in the
techniques (agglutination, ELISAs RIAs, and
immunoflourescent)
Antibodies
High
AMMENORHOEA
Absence of menstrual bleeding in a
normal ovulatory menstrual cycle
Normal bleeding every after 28days
Varies
between 25 30 days in
healthy females
AMMENORHOEA
Primary
ammenorrhoea - NO spontaneous
periodic menstruation by the age of 16 years
(with/out female secondary sexual xteristics)
Secondary ammenorrhoea refers to
absence of periodic menstruation for
at
AMMENORHOEA
continued
HIRSUTISM continued
VIRILISM
Virilism
clitoris,
Increased hair growth of male distribution
deepening of voice and breast atrophy
Main causes - ovarian tumors which secrete androgens
mainly testosterone and adrenocortical pathology
especially tumors e.g pituitary dependent cushings
syndrome (although rarely). There is a rise in DHEAS