Infertility is defined as the absence of any contraception for one year, normal sexual intercourse and no successful pregnancy. The main categories are primary infertility and secondary infertility. Primary infertility is defined as never having conceived; secondary infertility is defined as having been pregnant and then becoming infertile.
The causes of infertility are divided into male infertility and female infertility. The primary etiological diagnoses are, in order, ovulation disorders, semen abnormalities, tubal abnormalities, unexplained infertility, endometriosis and others such as immunological infertility. Additional factors are cervical factors. Female infertility is mainly due to ovulation disorders, tubal factors and endometrial tolerance abnormalities, while male infertility is mainly due to sperm production abnormalities and sperm discharge disorders.
I. Female infertility
1. tubal infertility Blocked or incompetent fallopian tubes are an important cause of female infertility.
2. infertility caused by ovulation disorders These patients are characterized by poor response to ovulation induction and diminished ovarian function.
3. immunological infertility.
4. unexplained infertility.
II. Male infertility
1. abnormalities of reproductive organs, etc.
2.Endocrine abnormalities.
3. sexual dysfunction including hypoactive sexual desire, erectile dysfunction, premature ejaculation, non-ejaculation and retrograde ejaculation, etc., with semen not being ejaculated into the vagina normally
4. immune factors.
5, infection factors.
6, physical and chemical factors and environmental pollution.
7, history of drug surgery.
8, unexplained infertility About 31.6% of patients with male infertility are still unable to find out the exact cause after the current common examination methods.
Examination of female infertility
1. Examination of tubal infertility.
(1) Tubal lavage is blind and it is difficult to make a more correct judgment on the morphology and function of the fallopian tubes. The examination should be scheduled 3 to 7 days after menstruation without gynecological inflammation and sexual intercourse.
(2) Tubal lavage (SSG) under ultrasound surveillance.
(3) Hysterosalpingography (HSG) also provides a more comprehensive understanding of the uterine cavity and can determine lesions up to 5mm in size in the uterine cavity and is easy to perform.
(4) hysteroscopic tubal cannulation and lavage, which is a reliable method for diagnosis and treatment of interstitial tubal obstruction
(5) laparoscopy The microscopic lavage test can dynamically observe the degree of tubal patency and at the same time play the role of unblocking the tubal lumen, which is one of the best means of female infertility examination.
2. Examination of ovulatory dysfunctional infertility.
To determine anovulation and its etiology. Basal body temperature (BBT), the second method to determine the presence or absence of ovulation is urinary LH measurement, which is tested during the 10th to 16th day of menstruation.
3. Tests for immunological infertility.
(1) Sperm immunoassay in three parts: AsAb assay, seminal plasma immunosuppressive substance assay and cellular immunoassay of sperm.
(2) Sperm cervical mucus test Post-coital test (PCT).
4.Check for unexplained infertility
Before diagnosing unexplained infertility, the basic infertility assessment should confirm the presence of ovulation, patent fallopian tubes, normal uterine cavity and normal semen analysis; infertility in the presence of all these normal conditions is classified as unexplained infertility.
Examination of male infertility
1. general examination of blood pressure, height, weight, nutritional status and secondary sexual characteristics, including body shape, bones, fat distribution, distribution of body hair, presence of gynecomastia (suggestive of Klinefelter syndrome), presence of abnormal smell (suggestive of Kallman syndrome), etc.
2, examination of reproductive organs.
3, laboratory examination.
4, endocrine examination including T, FSH, LH, PRL, etc., through the determination of the hypothalamus, pituitary gland, testicular function to make an assessment and provide a basis for analyzing the causes of testicular failure.
5, immunological examination when encountering unexplained cases of poor sperm vitality, spontaneous sperm agglutination phenomenon, chronic reproductive system infection, etc., the anti-sperm antibodies in the serum and semen and cervical mucus of both spouses can be detected.
6, genetic examination the following patients should be considered for genetic testing, routinely using chromosomal banding technique, FISH technique, Y chromosome microdeletion examination.
7, imaging tests: CT or MRI is feasible for suspected intracranial pituitary lesions. Doppler ultrasonography helps to confirm varicocele.
8.Traumatic examination