INFERTILITY
Fertility depends on a healthy sperm reaching a freshly laid egg and
impregnating it, and the fertilized egg digging into a healthy endometrium
and being maintained in a healthy state until term. By visualizing the path
the sperm must follow to reach the egg, one can identify many important
causes of infertility. Male fertility, however, depends on a healthy
pituitary gland and testicles, and female fertility depends on a healthy
ovary and pituitary.
Thus, in the man, hypopituitarism, testicular atrophy (as in mumps), vas
deferens obstruction (due to gonorrhea or tuberculosis), prostatitis and
other prostatic disease, hypospadias, and other abnormalities of the urethra
may cause infertility. Failure of copulation may cause infertility; the
causes of this disorder are discussed in the sections on frigidity and
impotence (see pages 188 and 267).
In the female genital tract, the sperm may encounter antibodies, vaginitis,
vaginal deformities, cervicitis, cervical carcinoma, endometritis, carcinoma
of the endometrium, a retroverted uterus and other deformities, and
obstruction of the tubes by a tubo-ovarian abscess or endometriosis. The
ovary may not be able to develop an egg because of hypopituitarism or
ovarian diseases, such as Stein–Leventhal polycystic ovaries, ovarian
cysts, and tumors (especially hormone-secreting tumors of the ovary that
prevent the variation in estrogen–progesterone concentration necessary
during the cycle that allows maturation of the egg). There may be no ovaries
present from birth (Turner syndrome), or there may be acquired ovarian
failure (surgical removal or early menopause). Thyroid disorders (hyper- and
hypothyroidism) are known to cause infertility. Adrenocortical tumors and
hyperplasia may also cause infertility.
Approach to the Diagnosis
The workup of infertility first involves doing a sperm count on the
man. If that is normal and the examination of the woman discloses no gross
abnormality, a temperature chart is kept by the patient or the Spinnbarkeit
test is used to determine if ovulation occurs. Thyroid function studies and
serum/prolactin, FSH, LH, estradiol, and progesterone levels may all be
measured if ovulation is proved not to take place. Other tests such as tubal
insufflation, hysterosalpingogram, and a trial of clomiphene will be useful
in selected cases. Establishing the time of ovulation and ensuring
copulation at that time often solve the problem. Cauterizing a chronic
cervicitis may lead to fertility. Counseling about emotional problems may be
necessary.
Other Useful Tests
-
Gynecology consult
-
Sonogram (tubo-ovarian abscess)
-
Endometrial biopsy (polyps, neoplasm)
-
Laparoscopy (pelvic tumor, abscess)
-
CT scan of the brain (pituitary tumor)
-
Chromosomal analysis (Turner syndrome, etc.)
Pictures
Book Source Details
- Book Title: Differential Diagnosis in Primary Care
- Author(s): R. Douglas Collins MD, FACP
- Year of Publication: 2007
- Copyright Details: Differential Diagnosis in Primary Care, Copyright © 2007 Lippincott Williams & Wilkins.
Other Book Chapters Related to Infertility
Read excerpts from these other book chapters related to Infertility:
Medical Books Excerpts
- AMENORRHEA
- "Algorithmic Diagnosis of Symptoms and Signs" (2003)
- [ read ]
- Amenorrhea
- "Handbook of Signs & Symptoms (Third Edition)" (2006)
- [ read ]
- Amenorrhea
- "A Pocket Manual of Differential Diagnosis" (1999)
- [ read ]
- Amenorrhea
- "Professional Guide to Diseases (Eighth Edition)" (2005)
- [ read ]
- Amenorrhea
- "Professional Guide to Signs & Symptoms (Fifth Edition)" (2006)
- [ read ]
- Amenorrhea
- "The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter" (2000)
- [ read ]
- Amenorrhea
- "Signs & Symptoms: A 2-in-1 Reference for Nurses" (2007)
- [ read ]
Copyright Details: Differential Diagnosis in Primary Care, Copyright © 2008 Williams & Wilkins.
More About Causes of Infertility
» Next page: Medications causing Infertility
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