A couple is said to be infertile if they doesn't concieve after regular unprotected intercourse for 1 year at least .
Incidence is increasing around 30-40%
Female factor 40%
Male factor 40%
Both partners 20%
AGE AND FERTILITY
Female age is very important factor fertility. When menstruation starts around age of 12 , ovaries start functioning with intermittent ovulation. Age 20 to 30 is the most fertile period for females . After 30 fertility goes down by 20% and after 35 till 40 it comes down to 50%. As age advances the quantity of eggs and quality (chromosomal pattern and cytoplasmic changes) goes down.
AMH(anti mullerian harmones) and AFC (antral follicle count) are the predictors of ovarian reserve.
Low AMH doesn't means no chance at all , still we can get eggs .
Normal size uterus (6.5×4.5×4cm) is good for conception .
Bicornuate uterus needs correction .
Fibroid which are disturbing anatomy and compressing cavity and endometrium needs myomectomy.
Adenomyosis cannot be corrected.
For smaller uterus , trials can be given to reshape it for fertility issue.
It is internal lining of uterus which start growing after 5th day of period and comes to peak level ie around 9 to12 mm with 3 line pattern on usg with good blood flow on colour Doppler (between 13th to 16th day of period) is best for Embryo implantation.
Thin endometrium must be corrected.
Endometrial polyp has to be removed.
Normal functioning and patent fallopian tubes are required for natural conception.
Patency of tubes can be checked by HSG and Chromopertubation methylene blue test in Laproscopy.
Functioning of tubes can be challenged by doing IUI for fertility treatment if tubes are patent. If with 3 to 4 IUI, (No positive result) tubes are not functioning then we must go for IVF/ICSI.
Poly Cystic Ovarian Desease is very common disorder nowadays in around 40% of fertile age group females.
Its a anovulation disorder mostly seen in overweight females who doesn't ovulate and have long menstrual cycles . Treatment is wt reduction , regular physical exercise , ovulation induction by Inj FSH/HMG , Laproscopic ovarian drilling and aggressive fertility treatment .
Polycystic ovaries looks bulky large round balls like instead Normal ovulating ovary shows ovulation scars and looks like compressed ball.
It's a condition (seen in 10-20% females) where there are endometrial implants present outside uterus ie may be in ovaries , pouch of douglas, colons which bleeds when pt gets menses usually very very painful and leads to severe adhesions, inflammation involving fallopian tubes and chocolate ovarian cysts ie endometriomas.
Best option is to laproscopically correct adhesion , remove endometriomas and get pregnant earliest possible by IVF before it worsens.
Semen analysis is important examination to check male factor to be done after 3-5 days of abstinence.
Things to see in analysis are
Volume- more than 1.5ml
Count- more than 20 million/ml
Motility- 40% or more Actively Motile
Viable - should be more than 50%
Liquefaction time should be 30-45 min
Morphology normal should be more than 5%
Antisperm Antibodies must not present
Abnomalitìes are = .Azoospermia(No sperm in semen) If testis is normal then sperms may present in testis , can be available for ICSI by TESA.
.Oligospermia(count less than 20mln/ml) Treatment to be taken for 3 months. .Teratospermia(abnormal morphology) Normal sperm can be selected by IMSI Factors Affecting Sperms= .Hot condition like Cook, Boiler workers .Excessive smoking, alcohol .Tight undergarments .Prolonged standing leads to varicocele .Drug addiction .Childhood infections orchitis , mumps .Undescended testis .Hernia surgeries ICSI is the technique where we require just 1 healthy sperm per egg to get healthy embryos and healthy baby