Female reproductive system & male and female infertility
1. PHYSIOLOGICAL ANATOMY.
2. THE MONTHLY OVARIAN CYCLE
3. HORMONES INFLUENCING THE
FEMALE REPRODUCTIVE SYSTEM
FEMALE REPRODUCTIVE SYSTEM
• Female’s role in reproduction is more
complicated than the male’s. The essential
Production of ova, reception of sperm and their
transport to a common site for union
Maintenance of the developing fetus (gestation
Formation of placenta that serves as the organ of
exchange between mother and fetus.
Parturition (delivering the baby)
Nourishing the infant after birthDr. Misbah-ul-Qamar
PHYSIOLOGICAL ANATOMY OF FEMALE
• Female Reproductive Organs Include the
Ovaries and Accessory Sex Organs.
Function of Female Reproductive
• Produce sex hormones
• Produce functioning gametes [ova]
• Support & protect developing embryo.
General Physical Changes
• Axillary & pubic hair growth
• Changes in body conformation [widening
of hips, development of breasts]
• Onset of first menstrual period [menarche]
• Mental changes
• Each ovary is about the size and shape of an
• In young women the ovaries are about 1½ - 2
inches long, 1 inch wide & 1/3 inch thick.
After menopause they tend to shrink.
• They produce eggs (also called ova) - every
female is born with a lifetime supply of eggs.
• They also produce hormones:
Estrogen & Progesterone
Male Homolog = testesDr. Misbah-ul-Qamar
• Stretch from the uterus to the ovaries and measure
about 8 to 13 cm in length.
• Range in width from about one inch at the end next to
the ovary, to the diameter of a strand of thin spaghetti.
• The ends of the fallopian tubes lying next to the ovaries
feather into ends called fimbria.
• Millions of tiny hair-like cilia line the fimbria
and interior of the fallopian tubes.
• The cilia beat in waves hundreds of times
a second catching the egg at ovulation
and moving it through the tube to the
• Fertilization typically occurs in the fallopian
• Pear-shaped muscular organ in the upper
female reproductive tract.
• The fundus is the upper portion of the uterus
where pregnancy occurs.
• The cervix is the lower portion of the uterus that
connects with the vagina and serves as a
sphincter to keep the uterus closed during
pregnancy until it is time to deliver a baby.
• The uterus expands considerably during the
reproductive process. the organ grows to from
10 to 20 times its normal size during pregnancy.
• The main body consists of a firm outer coat of
muscle (myometrium) and an inner lining of
vascular, glandular material (endometrium).
• The endometrium thickens during the
menstrual cycle to allow implantation of a
• Pregnancy occurs when the fertilized egg
implants successfully into the endometrial
lining. If fertilization does not occur, the
endometrium sloughs off and is expelled as
• Functional zone – layer closest to the
cavity – contains majority of glands.
Thicker portion – undergoes changes with
• Basal zone – layer just under myometrium,
attaches functional layer to myometrial
tissue, has terminal ends of glands.
• Arcuate arteries - encircle endometrium
• Radial arteries – connect arcuate to
• Straight arteries – deliver blood to basilar
• Spiral arteries – deliver blood to functional
• The lower portion or neck of the uterus.
• The cervix is lined with mucus, the quality and quantity of
which is governed by monthly fluctuations in the levels of
the estrogen and progesterone.
• When estrogen levels are low, the mucus tends to be
thick and sparse, hindering sperm from reaching the
fallopian tubes. But when an egg is ready for fertilization,
estrogen levels are high, the mucus then becomes thin
and slippery, offering a “friendly environment” to sperm
• At the end of pregnancy, the cervix acts as the passage
through which the baby exits the uterus into the vagina.
The cervical canal expands to roughly 50 times its
normal width in order to accommodate the passage of
the baby during birth
• vagin = sheath
• a muscular, ridged sheath connecting the
external genitals to the uterus.
• Functions as a passageway for sperms
and serves as the birth canal.
• Present in both sexes - normally only functional in
• Developmentally they are derived from sweat glands.
• Contained within a rounded skin-covered breast anterior
to the pectoral muscles of the thorax.
• Slightly below center of each breast is a ring of
pigmented skin, the areola - this surrounds a central
• Internally - they consist of 15 to 25 lobes that radiate
around and open at the nipple.
• Each lobe is composed of smaller lobules- these contain
alveoli that produce milk when a women is lactating.
• Non-pregnant women - glandular structure is
undeveloped - hence breast size is largely due to the
amount of fat deposits.
• Lesser Vestibular (Paraurethral, Skene's)
( Male Homolog = prostate) located on the upper
wall of the vagina, around the lower end of
the urethra. They drain into the urethra
and near the urethral opening
• Function - mucus production to aid
lubrication during intercourse
• Greater Vestibular (Bartholin's) (Male
Homolog = bulbourethral glands) located slightly
below and to the left and right of the
opening of the vagina. They secrete
mucus to provide lubrication.
PHYSIOLOGIC Anatomy OF FEMALE
• The principle organs include:-
OVARIES:- lie within the pelvic cavity.
OVIDUCTS:- 2 oviduct (uterine or fallopian tubes)
lie in close association with the ovaries. It is the
site for fertilization.
UTERUS:- Thick walled hollow organ. Responsible
for maintaining the fetus during development
and expelling it out at the end of pregnancy.
VAGINA:- A muscular expandable tube that
connects uterus to external environment. .
• It is a series of steps through which a
developing egg differentiates into a mature
• The process completes itself in 2 phases:
– Phase I
– Phase II
• Phase I: Starts during early embryonic
development of female fetus & ends by the 5th
month of fetal development.
• What is achieved in phase I? formation of
primary oocyte & only 1st stage of meiosis!
• At birth: ovary contains about 1-2 million
• Development of egg to maturity after puberty
• comprises of 2 divisions of meiosis.
• The phase starts with 1st meiotic division of
oocyte which occurs after puberty.
• In this division: each oocyte divides into 2 cells:
– A large ovum
– A small 1st polar body
• 2nd division: as a result of this division, sister
chromatids separate from each other in the same
Relation of oogenesis with ovulation
• Ovulation is the release of ovum from the ovary
• Before ovulation, the ovum is in an arrested state
of pause in meiosis
• After ovulation, If the ovum is fertilized, the final
step in meiosis occurs
• This final step dispatches the sister chromatids of
ovum to separate cells
– Half remain in fertilized ovum
– Other half are released in a 2nd polar body which then
Outcome of Oogenesis
• At puberty, only about 300,000 oocytes
remain in the ovaries.
• Only a small percentage of these oocytes
• Many thousands of oocytes that do not
Female reproductive years
• Between about 13 and 46 years of age.
• During these years of adult life, 400-500 of
primordial follicles develop enough to expel
• Only one ovum is expelled each month
• Remainder of developing follicles become
acretic by degeneration
• It is the end of female reproductive capability.
• What happens at follicular level?
• Only a few primordial follicles remain in the
ovaries, and even these follicles degenerate
FEMALE HORMONAL SYSTEM
• Normal reproduction in females is achieved through
monthly rhythmical changes in rates of secretion of
female hormones & corresponding physical changes in
ovaries & other sexual organs.
• Hormonal system consists of 3 hierarchies of
1. GnRh (Gonadotropin-releasing hormone)
2. Anterior pituitary sex hormones (Gonadotropins)
3. Ovarian hormones
These various hormones are secreted at drastically
differing rates during different parts of monthly sexual
• It is a releasing hormone from hypothalamus
• FSH & LH are secreted in response to its
• It is formed in the hypothalamus & then
transported to anterior pituitary gland by way
of hypothalamic-hypophysial portal system.
• Secreted in short(5-25 minutes) pulses
averaging once every 90 minutes(1-2hours)
stimulate pulsatile release of LH
• The pulsatile nature of GnRH release is
essential to its functions
• If it is infused continuously, its ability to cause
the release of LH & FSH is lost
Hypothalamic centers for GnRH
• Neuronal activity that causes its release occurs
primarily inarcuate nuclei of medio-basal
• Additionally neurons in preoptic area of
anterior hypothalamus also secrete GnRH in
Psychic control of GnRH
• Multiple neuronal centers in higher brain’s
limbic system transmit signals into arcuate
nuclei modify both the intensity of GnRH
release & the frequency of pulses
• That’s how the psychic factors often modify
female sexual function.
(female sex hormones)
• Ovarian changes during sexual cycle depend
completely on gonadotropins(FSH &LH)
• During childhood, almost no pituitary
gonadotropins are secreted ovaries remain
• At age 9-12, pituitary begins to secrete
progressively more FSH & LH onset of normal
monthly sexual cycle (menarche) beginning b/w
ages 11 & 15(puberty).
• During each cycle, there is a cyclical increase &
decrease of FSH & LH cyclical ovarian changes.
Functions of gonadotropins
• Both FSH & LH have stimulatory effects on
target ovarian cells:
• Increase in cells’s rate of secretion
• Growth & proliferation of target cells
ovaries begin to grow
Ovarian sex hormones
• CHEMISTRY: STEROID HORMONES.
, ESTRIOL, ESTRONE.
PROGESTERONE, 17 OH
– mainly Cholesterole (derived from blood)
– Acetyl coenzyme A (to a slight extent)
• PROGESTERONE AND androgens
FORMED BY THE OVARIES
CONVERTED TO ESTROGEN BY THE
GRANULOSA CELLS (not theca cells) IN
THE FOLLICULAR PHASE (by action of
Transport of estrogens & progesterone
• Transported in blood bound with:
– Mainly albumin
– Specific estrogen & progesterone binding
• This binding is loose enough to release the
hormones to tissues over a period of 30
minutes or so.
Fate of ovarian sex hormones
ESTROGEN & PROGESTERONE
ELIMINATED BY THE LIVER.
Role of liver in ovarian hormone
• It conjugates the estrogens
– 1/5 of conjugated estrogen is excreted in bile,
remainder in urine
• Coverts potent estrogens (estradiol & estrone)
into almost totally impotent estrogen (estriol)
– Diminished liver function increased activity of
estrogens in body hyperestrinism
• It degrades progesterone to other steroids
with no progestational effect.
• FUNCTIONS OF THE ESTROGEN:
ON UTERUS AND EXTERNAL FEMALE
ON THE FALLOPIAN TUBULES.
ON THE BREASTS.
ON THE SKELETON.
ON PROTEIN DEPOSITION.
• ON BODY METABOLISM AND FAT
• ON HAIR DISTRIBUTION.
• ON SKIN.
• ON ELECTROLYTE BALANCE.
• FUNCTIONS OF PROGESTERONE:
ON FALLOPIAN TUBULES.
ON THE BREASTS.
Monthly ovarian cycle
(less accurately called menstrual
Function of the gonadotropic
Introduction to Ovarian cycle
• This cycle corresponds to physical changes in
ovaries & other sexual organs
• Duration: 28 days (average)
• Abnormal cycle length is frequently associated
with decreased fertility
• Gonadotropic hormones cause 8-12 follicles to
begin to grow in ovaries…….
Effect of gonadotropins on ovaries
Follicular development in the ovaries
• Reproduction begins with formation of ova in
• Every month a single ovum is expelled from
ovarian follicle, which passes through the
fallopian tubes into the uterus, if fertilization
occurs, it is implanted in the uterus, where it
develops into fetus, otherwise it undergoes
Introduction to ovarian cycle
• About every 28 days, gonadotropic hormones cause 8-
12 new follicles to begin to grow in ovaries.
• During the growth,estrogen is secreted.
• One of follicles become mature & ovulates.
• After ovulation, corpus luteum is formed by secretory
cells of ovulating follicle
• CL secretes progesterone & estrogen for 2 weeks &
• Menstruation begins upon this degeneration & a new
• The normal cycle that includes development
of an ovarian follicle, rupture of the follicle,
release of the ovum, and formation and
regression of a corpus luteum
• PHASES OF OVARIAN CYCLE
“The phase of ovarian cycle dominated by the
presence of maturing follicles”
It shows the progressive stages of follicular
growth in ovaries.
A cohort of follicles begin to develop.
The others, lacking hormonal support
During this phase the primary oocyte is
synthesizing and storing material for future
When a female child is born
Each ovum is surrounded by a thin layer of cells
the granulosa cells
The ovum with this granulosa cell layer is known as
At puberty pulsatile release of GnRH causes the
release of FSH & LH, under the effect of which
some ovarian follicles to grow.
Ovum increases twofold to threefold in diameter,
followed by additional layer of granulosa cells.
called as PRIMARY FOLLICLE
pulsatile release of GnRH causes the
release of FSH & LH, under the effect of
which some ovarian follicles to grow.
Ovum increases twofold to threefold in
diameter, followed by additional layer of
granulosa cells. called as PRIMARY FOLLICLE
The follicular phase includes:-
1.Proliferation of granulosa cells and formation
of zona pellucida
2.Proliferation of thecal cells and estrogen
3.Formation of antrum
4.Formation of a mature follicle
1.PROLIFERATION OF GRANULOSA LAYER AND
FORMATION OF ZONA PELLUCIDA
• Single layer of granulosa cells proliferate to form
several layers that surround the oocyte and
separate it from the surrounding cells.
• This innervating membrane is known as ZONA
PROLIFERATION OF THECAL CELLS AND
• As oocyte enlarges and granulosa cells
proliferate, the ovarian connective tissue cells
in contact with granulosa cells proliferate and
differentiate to form an outer layer of thecal
• FOLLICULAR CELLS
• The thecal cells and granulosa cells are
collectively called follicular cells.
• They function as a unit to secrete estrogen.
FORMATION OF ANTRUM
• The fluid filled cavity that forms in a developing
• This stage is characterized by formation of a fluid
filled cavity in the middle of granulosa cells.
• The follicular fluid originates from two sources:-
1.Transudation of plasma (through capillary pores)
2.Partially from follicular cells secretion
• At the time of antrum formation the oocyte has
reached its maximum size and this is the period
of rapid follicular growth.Dr. Misbah-ul-Qamar
FORMATION OF MATURE FOLLICLE
• One of the follicle grows rapidly than the
others, developing into mature ( preovulatory,
tertiary, or Graffian) follicle within 14 days
after the onset of follicular development.
• The antrum occupies most of the space in
• The oocyte surrounded by zona pellucida and
a single layer of granulosa cells, is displaced
asymmetrically at one side of growing follicle
It is the release of a mature ovum form a mature
• Rupture of follicular cells to release ovum is
facilitated by the enzymes released from
follicular cells that digest the connective tissue
in the wall.
• The ovum is swept out of the follicular cells by
the antral fluid into the abdominal cavity.
• The released ovum is quickly withdrawn into
the oviduct where fertilization may or may not
take place. Dr. Misbah-ul-Qamar
Necessary factor for ovulation---a
surge of luteinizing hormone
• LH is necessary for final follicular growth &
• Without this hormone, even when large
quantities of FSH are available, the follicle will
not progress to the stage of ovulation.
• Mechanism responsible for LH surge:
• About 2 days before ovulation, rate of LH
secretion increases markedly (rising 6-10 fold
& peaking about 16 hours before ovulation)
Causes of LH surge
1. Positive feedback effect of estrogen on LH (&
to lesser extent FSH) secretion.
1. This effect is in sharp contrast to normal –ve
feedback effect of estrogen during remainder of
2. Increasing quantities of progesterone from
granulosa cells (a day or so before LH
surge) could possibly stimulates the excess
How to assess if ovulation has occured
• Urine analysis in latter half of cycle
– Measurement for a surge in pregnanediol (end
product of progesterone metabolism)
– Lack of this substance indicates ovulation failure
• Charting of body temperature throughout the
– Secretion of progesterone during latter half raises
body temperature about 0.5oF
LUTEAL PHASE OF OVARIAN CYCLE
• This phase of ovarian cycle dominated by the
presence of corpus luteum.
• The ruptured follicle left behind changes rapidly.
• The thecal and granulosa cells left behind
collapse into the emptied antrum that has been
partially filled up with blood vessels..
The luteal phase includes
1.Formation of corpus luteum and secretion of
progesterone and estrogen
2.Degeneration of corpus luteum
FORMATION OF CORPUS LUTEUM
• Corpus means body and luteum means yellow.
• It is an ovarian structure that develops from a
ruptured follicle following ovulation.
• The follicular cells are transformed into corpus
• The follicular turned luteal cells are converted
into very active steroidogenic tissue.
• The abundant presence of cholesterol, steroid
precursor molecule and lipid droplets within the
corpus luteum gives it a yellowish appearance.
• Progesterone secretion followed by secretion
of estrogen in follicular phase makes the
uterus a suitable site for implantation of
Results of female sexual cycle
1. Only a single ovum is normally released from
the ovaries each month only a single fetus
will begin to grow at a time.
2. The uterine endometrium is prepared in
advance for implantation of fertilized ovum
at the required time of month.
DEGENERATION OF CORPUS LUTEUM
• If the released ovum is not fertilized the corpus
luteum degenerates within 14 days after its
• The luteal cells degenerate and are phagocytized.
• The blood supply is withdrawn and connective
tissue fills in to form a fibrous tissue mass known
as corpus albicans, white mass.
• The luteal phase is now over and one ovarian
cycle is complete.
• If fertilization and implantation do occur, the
corpus luteum is not degenerated , but itDr. Misbah-ul-Qamar
Cause of corpus luteum involution
Loss of feedback inhibition of pituitary
• How anterior pituitary gland is uninhibited?
– Sudden cessation of secretion of estrogen &
– Inhibin by corpus luteum
• Pituitary inhibition causes it to begin secreting
increasing amounts of FSH & LH.
Effects of involution
• The final involution occurs at end of 12 days of
corpus luteum life (26th day of cycle, 2 days
1. Increasing FSH & LH initiate the growth of new
follicles beginning a new ovarian cycle.
2. Menstruation by uterus due to paucity of
progesterone, estrogen secretion.
Uterine CYCLE OR MENSTURAL CYCLE
• “The cyclical changes in the uterus that
accompany the hormonal changes in the
• The cyclical changes in the uterus results in
the menstrual bleeding once during each
menstrual cycle (once a month).
• Bleeding lasts for about five to seven days
after degeneration of corpus luteum.
• Menstrual cycle coincides in timing with the
early phase of ovarian follicular phase..
• It consists of the following phases:-
The menstrual phase
The proliferative phase
THE MENSTURAL PHASE
• It is characterized by discharge of blood and
endometrial debris form vagina.
• It is considered to be the start of a new
OVARIAN CYCLE, as it coincides with the end
of LUTEAL PHASE and onset of the
• Cause: involution of corpus luteum in ovary.
PROLIFERATIVE PHASE (estrogen phase)
• The proliferative phase is characterized by
repair and proliferation of endometrium.
• The endometrial surface is re-epitheliallized
within 4-7 days after beginning of
Why named estrogen phase
• Estrogen plays a key role by stimulating
endometrium to proliferate.
• Estrogen is secreted in increasing quantities by
ovary during 1st part of ovarian cycle
Effects of estrogen in proliferative
• Its stimulation causes the proliferation of
epithelial cells and blood vessels
• Stromal cells also proliferate rapidly
• during next week & a half (before ovulation),
endometrium increases greatly in thickness
resulting in a net thickness of 3 to 5mm of the
endometrium due to increase in:
– Stromal cells
– Growth of endometrial glands
– New endometrial BVs
• It occurs before ovulation, coincides with the
last part of follicular phase.
Importance of endometrial proliferation:
• At the beginning of each monthly cycle, most
of endometrium has been desquamated by
– Only a thin layer of endometrial stroma remains
– Only epithelial cells that are left are those located
in remaining deeper portions of glands/crypts
There is an additional advantage also
• Endometrial glands (especially those of
cervical region) secrete thin stringy mucus
mucus strings align themselves along the
length of cervical canal forming channels
that help guide sperm in proper direction
from vagina to uterus.
• That makes the latter half of monthly cycle
• This coincides with the luteal phase of ovarian
SECRETORY OR PROGESTational phase
• After ovulation, when corpus luteum is
formed the uterus enters secretory or
• Corpus luteum secretes progesterone (mainly)
• Progesterone converts the thickened estrogen
primed endometrium into glycogen filled
Peak of secretory phase
• The peak occurs about 1 week after ovulation
• During this part of cycle, endometrium has a
thickness of 5-6mm due to:
• Progesterone induced effects
• Estrogen induced effects (slight additional
Progesterone induced effects
• Marked swelling of endometrium
• Endometrial secretory development
• Glands increase in tortuosity
• Accumulation of an excess of secretory
substances in glandular epithelial cells
• Cytoplasmic increase in stromal cells (not only
glycogen but lipids also deposit)
• Proportional (secretory activity) increase in blood
• BVs become highly tortuous
• This phase is called the secretory phase
because the endometrial glands are
secreting glycogen or the progestational
(before pregnancy), referring to the
development of an endometrial lining
capable of supporting an early embryo.
Purpose of endometrial changes
• To produce a highly secretory endometrium
that contains large amounts of stored
• To provide appropriate conditions for
implantation of fertilized ovum (in blastocyst
• Availability of great quantities of nutrients to
early implanting embryo
• A name given to the uterine secretions.
• It provides nutrition for the early dividing
ovum until it implants.
• After implantation (7-9 days after ovulation),
trophoblastic cells absorb endometrial stored
• If fertilization and implantation do not occur
the corpus luteum degenerates and new
follicular phase and menstrual cycle starts
• It occurs if the ovum is not fertilized.
• Cause: low levels of ovarian hormones
(estrogen & progesterone)
Changes occuring in menstrual phase
• Reduction in estrogens & progesterone
Decreased stimulation of endometrial cells by
ovarian hormones involution of
endometrium (to about 65% of its previous
thickness) vasospasm in mucosal layers of
endometrium by vasoconstrictor
prostaglandins (involution induced release)
necrosis of endometrium & its BVs.
Causes of endometrial necrosis
– Decrease in nutrient supply
– Loss of hormonal stimulation
Outcome of endometrial necrosis
• Due to this necrosis, blood seeps into vascular
endometrial layerhemorrhagic areas grow
rapidly (over a period of 24-36 hours) necrotic
outer layers of endometrium separate from the
• The separation occurs at the sites of
• As a result, the superficial layers of endometrium
are desquamated (about 48 hours after the onset
How uterine contractions start during
• These contractions are responsible for the
expulsion of uterine contents which are:
• Mass of desquamated tissue
• Blood in uterine cavity
• These contents & certain contractile
substances cause the contraction
Degeneration of corpus luteum
Decreased level of estrogen and
Decreased level of ovarian hormone
stimulates release of prostaglandin
prostaglandin causes vasoconstriction of
endometrial vessels, disrupting the blood supply
reduced O2 supply to endometrium causes
its death including the blood vessels
This resulting bleeding alongwith
endometrial debris from the uterine cavity is
known as Menstrual flow.
• Approximately 40ml of blood & an additional
35ml of serous fluid are lost normally.
• Menstrual fluid is non-clotting.
• Within 4-7 days, loss of blood ceases.
• Reason: by this time, endometrium has
Leukorrhea During Menstruation
Regulation of females????
• Females have got a monthly rhythm which
causes certain cyclical variations
• The mechanism responsible for these
variations is the interplay b/w ovarian &
① the hypothalamus secretes GnRH, which
causes the anterior pituitary gland to secrete
LH & FSH.
②Negative feedback effects of estrogen &
progesterone to decrease LH & FSH secretion
③Positive feedback effect of estrogen before
ovulation the preovulatory luteinizing
• When does this occur?
– The 1st few cycles after the onset of puberty
– Cycles occuring several months to years before
• LH surge is not potent enough.
How does an anovulatory cycle
The phases of cycle continue but they are
altered in following ways:
1. Lack of ovulation causes failure of
development of corpus luteum
2. Cycle is shortened by several days, but the
Abnormalities of ovarian secretion
Hypersecretion by ovaries
Abnormal ovarian cycle
• The quantity of estrogens must rise above a
critical value to cause rhythmical cycles
• Irregularity occurs when the gonads are
secreting small quantities of estrogens.
• This could be a result of:
– Other factors causing hypogonadism, such as
Effects of irregular cycle
• Several months may elapse b/w menstrual
• Menstruation may cease altogether
• Failure of ovulation (insufficient LH for
MALE AND FEMALE INFERTILITY
• Infertility is “inability to conceive after one
year of conjugal life without use of
• The term "primary infertility" is applied to
“the couple who has never achieved a
• "secondary infertility" implies that “at least
one previous conception has taken place.”
origin of problem:
–20% both partners
• Rise in scrotal temperature
○Neurogenic: medications (α-blockers,
○Congenital: absence vas deferens (CF)
• Previous children
Infections: prostatitis, STD
Trauma to testicles
Surgery to testicles or hernia
Chemo or Radio therapy
Ethanol or Smoking
–Testes having normal head, neck and tail
–At least 2 samples over different period of
• Blood work: testosterone
• Testicular U/S
• Chromosomal analysis
SEMEN ANALYSIS (WHO)
• Volume > 2.0 mL
• Sperm > 20 million/mL
• Motility > 50% forward progression or
> 25% rapid progression within
• Morphology> 30% normal forms
About 5-10% of women are infertile!
Cause of female infertility
• Abnormality in genital tract
• Abnormal physiological function of genital
• Abnormal genetic development of ova
• Ovulation failure is the most common cause
Classification of causes of FEMALE INFERTILITY
–Pituitary (hyposecretion of gonadotropic
hormones failure to ovulate due to
insufficient hormonal stimuli)
Tumors: Pituitary adenoma, metastatic
Inappropriate gonadal feedback
○estrogen excess: obesity/ tumors
○Pituitary hyposecretion can be treated
by appropriately timed administration
–XRT / Chemo for childhood malignancies
–Premature ovarian failure
–Thick ovarian capsules occasionally exist on
the outside of ovaries, making ovulation
–Luteal phase deficiency
–Uterine abnormalities (most common is
–Tubal Disease (common cause is salpingitis)
• Endometrial tissue almost identical to that of
normal uterine endometrium grows (& even
menstruate) in the pelvic cavity.
• Common sites for the development of
endometriosis are surrounding the uterus,
fallopian tubes & ovaries.
Effects of endometriosis
• This situation causes fibrosis throughout the
pelvis which sometimes so enshrouds the
ovaries that an ovum cannot be released in
• Endometriosis also occludes the fallopian
tubes, either at fimbriated ends or elsewhere
along their extent.
How salpingitis could cause infertility
• It is inflammation of fallopian tubes which
causes fibrosis occlusion
• Gonococcal infection used to lead to
salpingitis in past but it has become less
prevelent due to modern therapy.
Mucus related infertility
• Still another cause of infertility is secretion of
abnormal mucus by uterine cervix
• In this case, failure of fertilization occurs due
to a viscous mucus plug
• Formation of such abnormal consistency of
mucous could result due to:
– Low grade infection /inflammation of cervix
– Abnormal hormonal stimulation of cervix
• Ordinarily, at the time of ovulation, the
hormonal environment of estrogen causes the
secretion of mucus with special characteristics
that allow rapid mobility of sperm into uterus.
• This environment actually guides the sperm
up along mucous threads
Regulatory of period
Medication, Smoking, Ethanol
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