The couple's infertility

definition

L`infertilité is defined by l`absence pregnancy after 12 months of regular sexual intercourse without contraception.

Fertility declines with the age of the woman, it is maximum al`age 25 years.



diagnosis



-The Temperature curve

-The Postcoital test

-The spermogram

-L`hystérosalpingographie

-The Hormone assays

-The Endometrial biopsy

Monitoring -L`échographie

-The laparoscopy



Etiologies and treatment



I- female infertility

Vulvovaginal ►Stérilité:

etiologies
-Malformations:

Imperforate l`hymen.

Vagina atresia.

-Fonctionnelle:

Vaginismus the impossibility of penetration.

treatment

-Chirurgical: Incision, neo-vagina ...

-Psychothérapie.

cervical ►Stérilité

etiologies

-Traumatiques And iatrogenic: electrocautery, cone biopsy, removal of the cervix ...

-Hormonale: Quality of mucus.

-Immunologiques: Anti-sperm antibodies diagnosed by post coital test crosses.

-Anomalie The receptivity of cervical glands to estrogen.

treatment

Oetrogénothérapie, antibiotics, steroids, artificial insemination.

►Stérilité uterine

etiologies

-Fibromes Uterine.

Uterine -Synéchies.

Uterine -Malformations.

-Anomalies Endometrial (polyp, hyperplasia, endometritis).

treatment

Myomectomy, hysteroscopic release of adhesions, uterine plasty, treatment l`endométrite ...

►Stérilité tubal

It`s the most common cause of infertility in Morocco.

etiologies

-Salpingites.

-Tuberculose Urogenital.

-Endométriose.

-Causes Iatrogenic: Postoperative adhérations.

-Malformatives: Agenesis.

treatment

Recanalization surgery, in vitro fertilization.

endocrine ►Stérilité

etiologies

-Dysgénésies Ovary.

-Ménopause Early.

Ovarian -Dystrophie.

Tumors of the pituitary.

-Causes Hypothalamic.

-Causes Diencephalic.

-Aménorrhée Psychogenic.

-Hypothyroïdie.

-Syndrome Cushing.

-insufficient Kidney.

-Hyperprolactinémie.

treatment

Inductors d`ovulation a share: hypothalamic, pituitary, ovarian, hyperprolactinemia.

II- Male infertility

etiologies

►Azoospermie: absence of sperm in the semen analysis

-Origine Excretory:

Infectious ▪Causes: MST.

Surgical ▪Causes: vasectomy.

Congenital ▪Causes: agenesis of the vas.

Secretory -Origine:

High hypothalamic-pituitary ▪Origine

Congenital causes Morsier Kallman syndrome.

Acquired causes hypothalamic and pituitary tumors.

Testicular low ▪Origine

Congenital causes Klinefelter syndrome.

Acquired causes chemo and radio therapy.

►OligoAsthénoTératospermie: OAT

-Varicocèle.

Genital -Infection.

-Immunisation: Ac anti sperm.

-Métabolique: Diabetes.

-Hormonale: Hypothyroidism.

-Toxic: Alcohol and tobacco.

Unexplained -Origine: stress.

treatment

▪Azoospermie excretory:

Micro surgery if failure assisted reproduction.

▪Azoospermie high secretory:

Gonadotropins (FSH, LH).

▪Azoospermie low secretory:

No treatment: adoption or sperm Don.

▪OAT:

Treatment according l`étiologie.