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Sub-fertility Causes Management

Definitions:. Sub fertility- Involuntary failure to conceive within 12 months of commencing unprotected sexual intercourse. Primary infertility - No previous pregnancy.Secondary infertility- previous pregnancy.

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Sub-fertility Causes Management

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    1. Sub-fertility Causes &Management Dr. Yousef Gadmour Professor, Al-fateh university Senior consultant, Al-Jalla Hospital Tripoli , Libya

    2. Definitions: Sub fertility- Involuntary failure to conceive within 12 months of commencing unprotected sexual intercourse. Primary infertility - No previous pregnancy. Secondary infertility- previous pregnancy. (whatever the outcome)

    3. Causes (and approximate incidence) 1. Idiopathic - 25 per cent 2. Sperm defects or functional disorder - 25 per cent 3. Ovulation failure - 20 per cent 4. Tubal damage - 15 per cent 5. Endometriosis - 5 per cent 6. Coital failure - 5 per cent 7. Cervical mucus defect - 3 per cent 8. Obstruction of sperm ducts - 2 per cent

    4. Principles of management: Deal with the sub fertile couple together. No one is at fault or to blame. Give good explanations of causes , prognosis and outline of treatment of sub fertility. Carry out investigations and treatments consistency in proper sequence.

    5. History - General Both couples should be present. Age. Previous pregnancies by each partner. Length of time without pregnancy. Sexual history : Frequency and timing of intercourse Use of lubricants Impotence, anorgasmia, dysparunia Contraceptive history

    6. History - Male Infections; gonorrhea , tuberculosis. Radiation, toxic exposures ,drugs. Mumps orchitis. Testicular injury/surgery. occupation (Excessive heat exposure). Smoking. Diabetes mellitus.

    7. History - Female Detailed menstrual history ; Irregular menses, amenorrhea. Hirsutism. Galactorrhoea. Previous pregnancies and mode of deliveries. Ectopic pregnancy history. PID.

    8. History - Female Appendicitis. IUCD use. Endometriosis. Stress. Weight changes. Excessive exercise. Cervical and uterine surgery.

    9. Physical Examination - Male Weight & Height (BMI). Size of testicles (orchidometry). Testicular descent. Varicocele. Outflow abnormalities (hypospadias, etc). General look- Klinefelter syndrome (47XXY).

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