Ebook Infertility in practice (4/E): Part 2
➤ Gửi thông báo lỗi ⚠️ Báo cáo tài liệu vi phạmNội dung chi tiết: Ebook Infertility in practice (4/E): Part 2
Ebook Infertility in practice (4/E): Part 2
13________________________________Unexplained InfertilityIntroductionOne can consider two approaches to the diagnosis and management of unexplained in Ebook Infertility in practice (4/E): Part 2nfertility. The first approach is strictly scientific, with a quest for and exclusion of each known cause of infertility before the label unexplained infertility can be given. The second approach is a pragmatic approach based upon a management-oriented policy, whereby treatment is commenced after th Ebook Infertility in practice (4/E): Part 2e common obstacles to fertility have been excluded [I], The treatment of unexplained infertility essentially aims to boost fertility, usually by a comEbook Infertility in practice (4/E): Part 2
bination of superovulation and close apposition of sperm and egg(s). Sometimes, the use of assisted conception techniques provides clues to the underl13________________________________Unexplained InfertilityIntroductionOne can consider two approaches to the diagnosis and management of unexplained in Ebook Infertility in practice (4/E): Part 2the Cause of InfertilityMany centres have their own highly specialised areas of interest and research that they then promote as the missing cause of unexplained infertility (Box 13.1). Thus, it is possible to draw long lists of putative and subtle causes of infertility, many of which cannot be prove Ebook Infertility in practice (4/E): Part 2n with certainty and few of which are actually amenable to a corrective remedy that has been shown to enhance fertility. One also should remember thatEbook Infertility in practice (4/E): Part 2
couples with normal fertility can have abnormal test results. Once the well-known and obvious causes of infertility have been excluded (sec Chapter 513________________________________Unexplained InfertilityIntroductionOne can consider two approaches to the diagnosis and management of unexplained in Ebook Infertility in practice (4/E): Part 2progesterone), sperm function (basic semen analysis) and tubal patency (hystcrosalpingogram). Supplementary investigations, such as follicular scanning, endometrial biopsy, laparoscopy/hystcroscopy and complex sperm function tests, are useful in helping to predict the chance of conception. but they Ebook Infertility in practice (4/E): Part 2may not influence the outcome of treatment.Studies of populations of patients with infertility indicate that approximately 10%-25% have unexplained inEbook Infertility in practice (4/E): Part 2
fertility. 20%-30% ovulatory dysfunction, 20%-35% tubal damage. 10%-50% sperm dysfunction. 5%-10% endometriosis. 5% cervical mucus problems and 5% coi13________________________________Unexplained InfertilityIntroductionOne can consider two approaches to the diagnosis and management of unexplained in Ebook Infertility in practice (4/E): Part 2 than an absolute barrier to conception. It should be remembered that the greater316Infertility in PracticeBOX 13.1 POSSIBLE SUBTLE CAUSES PROPOSED FOR SUBFERTILITYSubtle causes of subferlilily that have been proposed as underlying unexplained infertility, many of which have been found in couples of Ebook Infertility in practice (4/E): Part 2 normal fertility (correction of the abnormality has not always been show n to improve fertility).Ovarian and endocrine factors•Abnormal follicle growEbook Infertility in practice (4/E): Part 2
th•Luteiniscd unruptured follicles and functional ovarian cysts•Hypersecretion of luteinising hormone (LH)•Hypersecretion of prolactin in the presence13________________________________Unexplained InfertilityIntroductionOne can consider two approaches to the diagnosis and management of unexplained in Ebook Infertility in practice (4/E): Part 2llucidaPeritoneal factors•Altered macrophage and immune activity•Mild endometriosis•Antichlamydial antibodiesTubal factors•Abnormal peristaltic or cilial activity•Altered macrophage and immune activityEndometrial factors•Abnormal secretion of endometrial proteins•Abnormal integrin/adhesion molecules Ebook Infertility in practice (4/E): Part 2•Abnormal T-cell and natural killer cell activity•Secretion of embryotoxic factors•Abnormalities in uterine perfusion and contractilityCervical factorEbook Infertility in practice (4/E): Part 2
s•Altered cervical mucus•Increased immunogenicityGeneral immune factors13________________________________Unexplained InfertilityIntroductionOne can consider two approaches to the diagnosis and management of unexplained in13________________________________Unexplained InfertilityIntroductionOne can consider two approaches to the diagnosis and management of unexplained inGọi ngay
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