Infertility

Published on 09/03/2015 by admin

Filed under Obstetrics & Gynecology

Last modified 22/04/2025

Print this page

rate 1 star rate 2 star rate 3 star rate 4 star rate 5 star
Your rating: none, Average: 0 (0 votes)

This article have been viewed 991 times

Chapter 10 Infertility

Definitions. Infertility is the failure to achieve a successful pregnancy after 12 months or more of regular unprotected intercourse. Primary infertility is no previous pregnancy, regardless of the outcome. Secondary infertility is previous pregnancy, regardless of the outcome. Fecundability is the probability of achieving a pregnancy per menstrual cycle. Fecundity is the probability of achieving a live birth per menstrual cycle.

Incidence. The overall incidence of primary infertility is 10%–15% of couples. Female fertility declines with age and the incidence of infertility increases: 5% under the age of 25; 10% under the age of 30; 15% under the age of 35; 30% under the age of 40; and 60% over the age of 40.

Investigations

Extended investigations

Extended investigations are performed when the initial investigations have not identified a cause or when further elucidation is required.

Management

Management of infertility is directed by the assessment of the three main factors (ovulatory, pelvic and male) as above.

Ovulatory factor infertility

Management options include:

Assisted reproduction

Definitions. IVF: in-vitro fertilisation; ICSI: intracytoplasmic sperm injection.

Success rates. IVF—fresh embryo transfer: 35–40%; frozen embryo transfer: 25–30%.

Steps in assisted reproduction

The aim of assisted reproduction is to induce the development of multiple mature ovarian follicles. There are five steps.

Ovarian hyperstimulation syndrome

Ovarian hyperstimulation syndrome (OHSS) is an exaggerated response to ovulation/ovulation triggers characterised by increased vascular permeability, intravascular depletion and third space fluid sequestration. It is usually an iatrogenic, self-limiting disorder associated with ovulation induction/ovarian stimulation. It may be:

Incidence. Severe OHSS occurs in 0.5% episodes of assisted reproduction.

Pathophysiology. OHSS occurs in response to endogenous or exogenous LH or hCG, resulting in increased vascular permeability, arterial dilation, fluid shift from vascular to third space, intravascular depletion and circulatory dysfunction.

Management