Unexplained Infertility and Its Causes
Unexplained infertility, defined as the inability to conceive after a year of unprotected intercourse with no detectable issues, affects around 22% of couples. Various factors such as ovarian, endocrine, tubal, and male factors contribute to this condition. Diagnosis involves a comprehensive evaluation to rule out other causes of infertility.
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Presentation Transcript
Dr Kavitha Chalasani M.S., DNB(OBG) Fellowship in Gynec Endoscopy Gold medalist in M.S from Kasturba Medical College, Manipal. Fellowship in Endoscopy at Ramesh Hospital, Bangalore Trained in advanced Infertility & IVF at Germany Secretary FOGSI, VIJAYAWADA Chapter Chief Endoscopic Surgeon SRIRAM HOSPITALS Core Infertility Specialist MORPHEUS SRIRAM IVF Centre, VIJAYAWADA
UNEXPLAINED INFERTILITY Definition: Inability to conceive after one year of unprotected intercourse with routine (standard, basic) investigations of infertility showing no abnormality. Real but unobservable defect
UNEXPLAINED INFERTILITY Incidence: 22 % Causes: Subtle, undetected defects in the reproductive process Conception is delayed by chance alone, as the couples fecundity may be on the lower side of normal distribution
UNEXPLAINED INFERTILITY Ovarian & Endocrine factors Abnormal follicle growth Leutinized unruptured follicle Hypersecretion of LH Hypersecretion of Prolaction Cytological abnormalities of oocytes Genetic abnormalities of oocytes
UNEXPLAINED INFERTILITY Tubal Factors Abnormal peristalisis or ciliary activity Endometrial Factors Abnormal secretion of endometrial protiens Abnormal adhesion molecules Secretion of Embryotoxic factors Abnormalities in uterine perfusion
UNEXPLAINED INFERTILITY Male Factors Reduction in motility, acrosome reaction, oocyte binding and zona penetration Ultrastructural abnormalities of head Embryological Factors Poor embryo quality Reduced progression to blastocyst in vitro
UNEXPLAINED INFERTILITY DIAGNOSIS
DIAGNOSIS By exclusion Was the infertility evalutaion Complete Performed correctly Interpreted appropriately
DIAGNOSIS ESHRE 2019 Diagnosing the ovary Menstrual history Regular cycles - Midluteal s.progesterone Irregular cyles - Ovarian and pitutary hormones
DIAGNOSIS ESHRE 2019 Diagnosing the ovary Tests for ovarian reserve Women at increased risk of decreased ovarian reserve age >35 Family h/o premature menopause Single ovary previous surgery Unexplained infertility Previous poor response to gonadotropin treatment Prior to ART
DIAGNOSIS ESHRE 2019 Diagnosing the ovary Tests for ovarian reserve Just 1 of D3 FSH + E2 AMH Don t use Ovarian volume Ovarian blood flow Inhibin B
DIAGNOSIS ESHRE 2019 Tubal Testing HSG Place of laparoscopy for infertility may be - strong suspicion of endometriosis - tubal occlusive disease - pelvic pathology - > 3 years of infertility but no recognized abnormality
DIAGNOSIS Male factor Routine semen analysis
UNEXPLAINED INFERTILITY TREATMENT
TREATMENT Prognosis Good If the duration of infertility < 2 years Lower female age Worse If the duration of infertility > 3 years Age of the female partner > 35 yea
TREATMENT Lines of treatment Expectant management Ovulation inducing agents IUI ICSI
UNEXPLAINED INFERTILITY ESHRE 2019 observations Unexplained infertlity Low Ovarian Reserve Poor quality oocytes Lower implantation rates Higher aneuploidy rate Higher miscarriage rate
UNEXPLAINED INFERTILITY ESHRE 2019 observations FSH > 8 IU/ml poor oocyte yield
UNEXPLAINED INFERTILITY ESHRE 2019 observations Age related effects on oocyte / embryo quality make it the main causal factor in unexplained infertility No age related effect on endometrium / sperm quality
