Female subfertility causes

 

What are the usual causes of female subfertility? However, in order of prevalence the following are the common causes of female subfertility: - Anovulation (PCOS), Early endometriosis, Unexplained infertility.  Ovarian insufficiency and Immunological infertility is an uncommon cause.

 

How to elicit personal history and corroborating pelvic   findings  with personal history and family history and conjugal life history. This will curtail list of investigations keeping her dignity or personal respect??

The usual causes of female subfertility are 1) Anovulation (mostly PCOS & high BMI > 30 )-  but history of regular cycles almost always exclude the possibility of anovulatory subfertility ; 2)  Minimal endometriosis –it is difficult to think about this common diseases  unless a diag laparoscopy is contemplated. The problem is in fair number of caes  minimal endometriosis have no dysmenorrhoea or menorrhagia or palpatory findings 3) Tubal block-this may be clinically suspected by tender palpable adnexal masses but such is not always felt. 4) Pelvic adhesive disease – fixity of pelvic organs may be present but laparoscopy will confirm the diagnois àAdhesiolysis  6) Myomasà Any myoma > 4 cm should be removed if it is intestinal in nature as this makes endometrial contractions more frequent. Similar even a sell submucous myoma can be responsible for subfertility by inducing same chemical changes in the site of submucous myoma. Saline infusion sonography can pick up small submucous myoma thereby avoiding anesthesia of hysteroscopy.. 7) Delayed marriage—low AMH and associated medical disorders backed up by poor seminal parameters within advancing age of spouse . 8) Delayed child bearing -àDelayed pregancy -à deferring the pregnancy-many husband / wife seek job security, own flat even after marriage  9) Couples stays  employed in separate places and meet occasionally, 10) Infrequent coitus, excess stress and anxiety. Poor knowledge on fertile period à improper timing of coitus is an important factor in rural areas where husband is employed far outside his village, . Multiple times sex is needed to achieve pregnancy around the time of  ovulation. (Conception window-fertile window is often not known to many couple 11) Promiscuity and more polygamy and rising prevalence of STI is another cause of concern. 12) Smoking, environmental pollution, addictions, 13) Night shift duty of any one / day shift of another ,Life style changes are important modifiable factors which lead to subfertility. 14)  due to delayed child bearing there is   rising prevalence of metabolic diseases, particularly PCOS and allied anovulatory disease, Endometriosis, Pelvic adhesive diseases, environmental pollutants causing damage to oocytes and presence of endocrine disruptors causing defective cell signaling and Diminished Ovarian reserve and unfortunately  POF by early 4^th decade of life.

 

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