INFERTILITY

1. In female
   1. TOF
   2. Disorder of ovulation
      1. Hypothalamic causes
      2. Pituitary disorder
      3. ovariancauses
      4. LUF
      5. thyroid and adrenal system

         Nota:

         • 0-hypo- / hyper-thyroidism . 1-cushing syndrome 
      6. chromosomal abnormalities

         Nota:

         • 0-turn syndrome 1-
   3. tubal dysfunction
   4. disorder of implantation

      Nota:

      • 0-leuteal insufficiency with impaired progesterone secretion. 1-submucous fibroid. 2-deficiency of Growth factor.
      1. endometriosis
2. in male
   1. disorder of sperm
   2. defect of sperm transport
   3. ejaculatory dysfunction
   4. anti sperm Ab

Nota:

• 0-types of infertility are primary ,secondary & un-explain . 1-

1. Gynecology Hx
2. Medical Hx
3. surgery Hx
4. medications
5. Social Hx
6. ethnicity
7. examination of male

   Nota:

   • 0-semen analysis. 1-prostocoital test. 2-
8. investigations Ix

   Nota:

   • 0-FSH +AMH test. 1-prolactin  level. /androgen level test. 2-thyroid functional test TFT. 3-Mid luteal progesterone level. 4-U/S (serial) between 10-12 day assay.( follicular & endometrial maturation / Dx POCs , uterine abnormality.) 5-assessment of tubal patency -HSG -laproscopy -HyCoSy

Nota:

• 0-based on Hx ,Ex, Ix:- 1- conservative trt /ovulation induction with or without intrauterine insemination . 2-ART (assisted reproductive  technique). 3-trt female as above. 4-trt male infertility 

1. conservative trt
2. ovulation induction

   Nota:

   • #1- Clomiphene Citrate CC 1-Tamoxifen 2-Aromatase inhibitor e.g. letrozole 2.5 mg. 3-Gonadotropin therapy (need it U/S,expensive , no com. with OHSS. #2-COMPLICATION (OHSS),MULTIPLE GESTATION        
3. Assisted reproductive technique