وصف
The diagnostic evaluation and management of female infertility encompass a comprehensive and systematic approach. Initial assessments involve a detailed medical history, including menstrual patterns, gynecological history, and potential risk factors. Diagnostic tests such as hormonal assays, imaging studies like hysterosalpingography and pelvic ultrasound, and evaluation of ovarian reserve contribute to identifying underlying causes. Management strategies vary based on the diagnosed factors and may include lifestyle modifications, ovulation induction with medications, surgical interventions, or assisted reproductive technologies like in vitro fertilization (IVF). Individualized care, multidisciplinary collaboration, and ongoing support are integral components, ensuring a thorough and patient-centric approach to address the complexities of female infertility.
ملخص
- Infertility is defined as the inability to conceive after one year of regular, unprotected intercourse, or after six months for women over 35. Incidence of infertility is rising due to increased awareness and treatment-seeking behavior driven by internet resources and peer networks. Various terminologies like sterility, subfertility, and impaired fecundity (difficulty conceiving and carrying a pregnancy to term) describe different aspects of infertility.
- Female factors contribute to 25-37% of infertility cases, male factors 8-22%, and both contribute 20-38%. Unknown factors account for 3-4%. Female age is a critical determinant of fertility, with rates declining after 25. Being overweight or obese, indicated by high BMI, negatively impacts fertility.
- Initial female infertility investigation involves history, physical examination, and evaluation for endocrine disorders. Gynecologists should adopt a balanced approach, avoiding overly aggressive investigations. Endocrine evaluation is key, assessing hormones related to menstruation and overall hormonal balance. Laparoscopic or diagnostic laparoscopy aids in identifying pelvic pathologies.
- Endocrinologists play a role in identifying hormonal imbalances such as progesterone deficiency or issues with LH, FSH, and prolactin. Diagnostic laparoscopy can detect conditions like endometriosis and polycystic ovaries. ART (assisted reproductive technology) experts handle IVF and ICSI. Postcoital tests can assess sperm-cervical mucus interaction.
- Endocrine profiles, including FSH, LH, TSH, and prolactin levels, are important for diagnosis. Ovulation can be assessed via basal body temperature, cervical mucus, and progesterone testing. Polycystic ovaries are a common cause of infertility, associated with elevated LH.
- Pelvic ultrasound, particularly transvaginal, helps visualize follicles, the uterus, and ovaries for abnormalities. Diagnostic laparoscopy is valuable for identifying and addressing endometriosis and tubal issues, though it's not a first-line investigation. HSG is useful, but laparoscopy gives a more accurate and reliable assessment of tubal patency. MRI and CT scans are used for pituitary or adrenal tumors when hormone levels are abnormal.
- The initial visit should involve evaluation of both partners. Females can be classified into those with oligomenorrhea or amenorrhea, those with pelvic pathology, and those with no apparent cause. Treatment varies depending on the cause, with options including ovulation induction, lifestyle changes, and surgical intervention.
- For oligomenorrhea or amenorrhea, PCOS and hyperprolactinemia are potential causes, treatable with medications. Ovarian abnormalities can be diagnosed via pelvic ultrasound and may indicate syndromes like Turner syndrome. When treating PCOS, consider clomiphene citrate, letrozole, metformin, or gonadotropins. The goal is to induce ovulation and achieve pregnancy.
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