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- Infertility (difficulty or inability
to produce a pregnancy) is usually diagnosed if pregnancy does
not occur within one year of normal sexual activity. A
combination of factors can be the cause, with the male
partner contributing to 40% of the cases. The average
female menstrual cycle is 28 days (though this varies
slightly from woman to woman). Ovulation (release of
the egg) usually takes place around day 14, though this can
vary and may occur earlier or later in many women. The
egg, once released, is viable for 12 to 24 hours, so it
needs to be fertilized during this window of opportunity in
order for impregnation to take place. Since sperm
live for 3 to 5 days, sexual relations should take place
about 24-48 hours before
ovulation.
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- Contraceptives
- Decreased libido/sexual activity
- Sexual technique problems
- Sex not timed with ovulation
- History of Miscarriages
- Mother's use of DES
- Excess cigarettes
- Excess alcohol
- Recreational drugs
- Prescription drugs (that decrease male potency)
- History of pelvic inflammatory disease
- Underactive or
overactive thyroid
- Excessive
exercise
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- Timing -- Basal temperature testing or ovulation predictor kit can be used to predict when the best time is, to have sexual relations is. The best time is usually about 24 to 48 hours before ovulation.
- Cervicitis --
treat with antibiotics
- Thyroid problems -- treat appropriately
- Excess exercise -- decrease exercise
- Surgical treatment of ovarian tumors, tubal obstruction, tubal adhesions, or endometriosis
- Low Progesterone level
--Progesterone given at end of cycle or clomiphene also works
- Low quality cervical mucus --
estrogen given on days 5 to 15
- Clomiphene citrate is used to induce ovulation (5% of pregnancies will result in twins, and rarely multiple births)
- Bromocriptine
- Human menopausal gonadotropins
- In Vitro Fertilization -- The egg
and sperm are brought together in the laboratory, then
implanted in the uterus. It is more expensive than
medications such as clomiphene, but does not result in
multiple births.
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What is
Basal Temperature Monitoring?
- This is a technique to determine when
ovulation is occurring. Every morning as soon as she
awakens, before she gets
out of bed, a
woman needs to take her temperature and
record it to the decimal. This information is then charted on a
graph with the x-axis representing the days of the
cycle and the y-axis representing temperatures starting from 96 degrees,
and going up to 100 in increments of 0.1
degrees (most books on fertility will have
these graphs already made out for you). What will be seen is
a sharp rise in temperature on the day that
the woman ovulates. This does not help you this month, but
helps to predict future months what day in your cycle you
ovulate, and therefore you know to have sexual relations 24- 48
hours before this time. It also can tell you, after the
fact, if your timing of sexual relations was correct.
A special ovulation thermometer is helpful, because the lines on this special
thermometer are easy-to-read.
- General physical exam for both partners
- Both partners are checked for sexually transmitted
diseases such as Chlamydia and Syphilis
- Basal body temperature monitoring for women -- see
below
- Post-sexual intercourse testing on day 12 or 13 of
the cycle
- Cervical mucous should be abundant, clear, and
elastic
- An examination of mucous under the microscope
- Serum Progesterone blood level on day 21 of
the cycle
- Thyroid function testing
- Hystero-salpingography -- oil-based dyes are put
into the uterus, allowing the uterus and its tubes to be
evaluated with X-Rays
- LH and FSH levels -- if elevated, there is probably
ovarian failure
- Prolactin level
-- if elevated it
indicates a pituitary tumor
- Endometrial biopsy to rule out later in the
menstrual cycle
- Laparoscopy -- scope passed through the navel
to evaluate for Endometriosis or tubal
adhesions
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