IVF Centre Dehradun, Uttarakhand, INDIA

Infertility

Causes of Female Infertility



HYPOTHALMUS
o Weight
o Exercise
o Systemic Disease
o Liver
o Kidney
o Kallamann's Syndrome

PITUTARY GLAND
o Hyperprolactinemia
o Hypothyroidism
o Sheehan's Syndrome

• OVARY
o Premature Ovarian Failure (POF)
o Luteinized Unruptured Follicle (LUF)
o Polycystic Ovarian Disease (PCOD)
o Luteal Phase Defect (LPD)

• CERVIX
o Stenosis
o Poor Cervical Mucus

• FALLOPIAN TUBE
o Infection
o Obstruction

• UTERUS
o Asherman's syndrome
o Fibroids/Polyps
o Mullerian Anomalies
o Endometrial receptivity
o Endometriosis

• OTHERS
o Douching
o Smoking

• UNEXPLAINED

• Loss of ovarian reserve – AGE!!

• Anovulation or Amenorrhea (absence of menstruation)
• High gonadotrophin secretion – ovarian failure, premature menopause
• Low gonadotrophin secretion - hypothalamic or pituitary failure
• Gonadotrophin insensitivity – oestrogen levels fail to rise
• Follicular cysts
• Polycystic Ovarian Syndrome (PCOS) – high T, high BMI, hirsutism
• Short luteal phase

Etiologic Causes OF Infertility



o Male factor(40%)
o Female factor (40%)
o Ovulatory(20% - 40%)
o Tubal(20% - 40%)
o Endometritis (10%)
o Advanced age(18% - 50%)
o Luteal phase defect (< 10%)
o Uterine Factors (10%)
o Fibroids (2% - 3%)
o Unexplained (10% - 15%

Causes of Male Infertility



o Genetic Factors
o Psychological Dysfunctions
o Anatomic Factors
o VARICOCOELE
o CRYPTORCHIDISM
o CONGENITAL ANOMOLIES
o Hypospadias
o Epispadias

• Endocrine Factors
o CUSHING'S SYNDROME
o ACROMEGALY
o PITUTARY TUMOUR

• Infection
o GONORRHEAL/CHLAMYDIA
o PROSTATITIS
o EPIDIDYMITIS

• Idiopathic Factors

• Immunologic Factors
o SPERM ANTIBODIES
o Prescribed Medications
o Toxins and Environmental Substances
o Mechanical Damage
1. TRAUMA/TORSION OF TESTES
o Ejaculatory Dysfunction
1. RETROGRADE EJACULATION
2. EJACULATORY FAILURE
3. NEUROLOGIC IMPAIRMENT

• Hypogonadotrophic hypogonadism- impaired secretions of gonadotropins

• High FSH

• Maldescent of testis – cryptochidism

• Testis subjected to infection, trauma, or chemical agents
o mumps virus
o X-irradiation
o Antimitotic agents/chemotherapy
o Insecticides
o heavy metals (Cd, Hg, Pb)
o excess alcohol.

• Varicocele - inadequate venous drainage and dilatation of spermatic vein.

• Obstruction of epididymis or no vas deferens
o can be congenital
o associated with cystic fibrosis

• Lifestyle factors
o BMI, smoking, drug usage