Practical Investigation of Infertility: UNI-MED SCIENCE

1. Unfulfilled desire to have children 12 1.1. Epidemiology 12 1.2. Fertility and age 13 1.3. The most common causes of impaired fertility 14 1.3.1. Unfulfilled desire to have children - a problem of the couple 14 1.3.2. Common causes of female infertility 15 1.3.3. Fertility and lifestyle 16 1.3.4. Duration of unfulfilled desire to have children correlates with the severity of the fertility disorder 17 1.3.5. Fertility and the mind 18 1.4. References 19 2. Efficient diagnostic investigation of fertility 22 2.1. Initial discussion and history 22 2.2. Clinical findings and targeted systematic investigation 22 2.2.1. Chlamydia serology and tubal sterility 24 2.2.2. Endometriosis 25 2.3. References 30 3. Investigation of ovarian dysfunction 32 3.1. Ovarian function in the context of a regular menstrual cycle 32 3.1.1. Natural family planning 32 3.1.2. Clinical and endocrine investigation of cycle function 34 3.2. Ovarian dysfunction in oligo-/amenorrhoea 39 3.2.1. Primary (hypergonadotropic) ovarian insufficiency 39 3.2.2. Secondary (normo- or hypogonadotropic) ovarian insufficiency 41 3.2.3. Hyperprolactinaemia 42 3.2.4. Hyperandrogenaemia 45 3.2.5. Thyroid function disorders 52 3.3. Treatment of ovarian dysfunction in the case of an unfulfilled desire to have a child 54 3.3.1. Treatment in the case of primary ovarian insufficiency 54 3.3.2. Induction of ovulation in secondary (hypogonadotropic) ovarian insufficiency 55 3.3.3. Treatment of hyperprolactinaemic ovarian dysfunction 56 3.3.4. Treatment of hyperandrogenaemic ovarian dysfunction 56 3.4. References 58 4. Investigation of organic fertility disorders 62 4.1. Ultrasound 62 4.1.1. Identification of abnormal findings such as fibroids, cysts or uterine malformations 62 4.1.2. Fibroids 62 4.1.3. Endometriosis 63 4.1.4. Cysts 63 4.1.5. Sactosalpinx 64 4.1.6. Polycystic ovaries (PCO) 64 4.1.7. Uterine anomalies 65 4.1.8. Endometrial polyps 65 4.1.9. Iatrogenic change in the uterus 65 4.1.10. Recognising complications of infertility treatment 65 4.2. Investigation of the tubal factor 66 4.2.1. Methods for examination of the Fallopian tubes 66 4.2.1.1. Hysterosalpingography (HSG) 66 4.2.1.2. Hysterosalpingo contrast sonography (HCSG or HyCoSy) 66 4.2.1.3. Laparoscopy 68 4.3. When to investigate the Fallopian tubes 69 4.4. What needs to be done if the Fallopian tubes are blocked? 70 4.5. Hysteroscopy 70 4.5.1. Operative hysteroscopy 71 4.6. Endometriosis 71 4.7. References 73 5. Investigation of fertility disorders in the male 76 5.1. Causes of male infertility 76 5.2. History and physical examination 76 5.3. Imaging investigations 78 5.4. Semen analysis 79 5.5. Endocrine investigations 80 5.6. Assessment of the ability of a male to father a child 81 5.7. Andrology and assisted reproduction 81 5.7.1. Intrauterine insemination 81 5.7.2. Intracytoplasmatic sperm injection (ICSI) as a treatment option in severe male subfertility 81 5.7.3. Testicular sperm extraction (TESE) 82 5.7.4. Exclusion of genetic disorders in azoospermia and severe oligozoospermia 82 5.8. References 82 6. Recurrent miscarriage 86 6.1. Genetic disorders 86 6.2. Uterine anomalies 86 6.3. Endocrine factors 87 6.4. Thrombophilia 87 6.5. Hyperhomocysteinaemia 88 6.6. Infections 88 6.7. Immune causes 88 6.8. References 89 7. Glossary 92 Index 93