-IBIS-1.5.0-
tx
reproductive system
infertility: female
diagnoses
definition and etiology
definition:
Absence of conception after 1 year of regular intercourse while not using any contraceptives. (sterility: the inability to ovulate).
etiology:
10-15% of couples experience the inability to conceive, and the percentage is growing. Men account for 40% of failures to conceive. Of the woman who are responsible, failure to ovulate accounts for 30% of infertility problems; pelvic factors (such as tubal disease and endometriosis) account for 50%; cervical pathology is responsible 10% of the time; and in 10-20% of the women no reason is found.
signs and symptoms
lab findings:
Tests used to discover if the woman is ovulating:
» Basal body temperature (increases with ovulation).
» Change in cervical mucous (clear, elastic).
» Plasma progesterone equal to or greater than 5 mg/ml and endometrial biopsy in the post-ovulatory phase.
Tests for tubal competence:
» Hysterosalpingography (x-rays).
» Laparoscopy.
» Culposcopy.
» Tubal insufflation with CO2.
» assay of estrogen, progesterone, LH, FSH
Tests for uterine abnormalities: the normal variants of uterine positioning in the woman is not considered a factor with infertility, but other problems may be present.
course and prognosis
In fertility based on anovulation, conventional physicians use drugs to induce ovulation. Surgery can be used to fix nonpatent or damaged fallopian tubes, remove adhesions, and correct congenital uterine abnormalities. In-vitro fertilization and embryo transfers are also alternatives, and in some reports yield successful pregnancies in 30% of the women.
differential diagnosis
Determine the cause:
Endometriosis.
Tubal obstructions.
Immunologic problem.
footnotes