infertility-1 - Infertility: the role of the family doctor...

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Infertility: the role of the family doctor Carroll Haymon, M.D. January 7, 2002
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Definitions Infertility = Inability of a couple practicing frequent intercourse and not using contraception to fail to conceive a child within one year. Infertility affects 15-20% of couples, or 11 million reproductive age people in the U.S.
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Causes of infertility Tubal pathology 35% Male factor 35% Ovulatory dysfunction 15% Unexplained 10% Cervical/other 5%
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Counsel patience! In normal young couples: 25% conceive after one month 70% conceive after six months 90% conceive by one year Only an additional 5% will conceive in an additional 6-12 months
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Fecundity and Age In a federal survey: Impaired fertility in women < 25y is 11.7% Impaired fertility in women > 35y is 42.1% In another study: 74% of women < 31y conceived in one year. 54% of women >35y conceived in one year. Our challenge: presenting data in a supportive, non-judgmental manner
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Tubal/ Pelvic pathology Congenital anomalies Tubal occlusion Evaluated by: hysterosalpingogram laparoscopy hysteroscopy May occur as sequelae of PID endometriosis abdominal/pelvic surgery peritonitis
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Male factor Male partner should be evaluated simultaneously with female Causes of male infertility: reversible conditions (varicocele, obstructive azoospermia) not reversible, but viable sperm available (ejaculatorydysfunction, inoperative obstructive azoospermia) not reversible, no viable sperm (hypogonadism) genetic abnormalities testicular or pituitary cancer
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Ovulatory dysfunction Causes 15% of infertility Diagnosed by menstrual irregularities, basal body temperature charting, ovulation prediction kits, serum progesterone levels.
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Ovulatory Dysfunction - 2 Causes of ovulatory dysfunction: polycystic ovary syndrome hypothalamic anovulation hyperprolactinemia premature and age-related ovarian failure luteal phase defect (theoretical)
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This note was uploaded on 12/24/2011 for the course STEP 1 taught by Professor Dr.aslam during the Fall '11 term at Montgomery College.

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infertility-1 - Infertility: the role of the family doctor...

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