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Female Factors

  • Ovarian: 30-40% - PCOD and endometriosis
  • Tubal: 30-40% - Infection
  • Unexplained: 10-15 %
  • Miscellaneous (uterine/ cervical): 10-15%
  1. Ovarian factors
    1. iAnovulation Hypothalamo-pituitary
       
      ovary axis
       
      Thyroid
       
      Pituitary Sheehan’s syndrome
       
      Tumour
       
      Adrenal dysfunction CAH
       
      PCOD / POF / Endometriosis
    2. Luteal phase defect Life span CL <10 days drugs induced ovulation hypothyroidism
    3. Luteiniesd unruptured follicular syndrome
  2. Tubal Factors
    1. Defective pick up
    2. Defective tubal motility
    3. Loss of cilia
    4. Obstruction
    5. Infection
  3. Peritoneal factors
    1. Infective adhesions
    2. Endometriosis
  4. Uterine factors
    1. Hypoplasia
    2. Fibroid Uterus
    3. Endometritis
    4. Synechiae
    5. Congenital malformation
  5. Cevical Factors
    1. Anatomical defect
    2. Cervicitis
    3. Immunological
  6. Vaginal Factors
    1. Atresia
    2. Septum
    3. Vaginitis

A detailed history including sexual performance should be taken. Then a thorough physical and systemic examination of both partners to exclude congenital / anatomical causes. Systemic diseases should also be excluded.
 

WHO Category for Anovulation

 

I: Hypothalamic pituitary failure

 

II: Hypothalamic pituitary disturbance/PCOS

 

III: Ovarian failure

 

IV: Hyperprolactinemia





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