Abstract

PIP:

VArious indirect estimates indicate that involuntary infertility has an incidence of 10% in Great Britain. This incidence rises to 30% in parts of Africa where tubal diseases remain unchecked. This paper outlines the endocrine causes of infertility in females and treatment of this disorder. Diagnostic tests include estimation of prolactin, follicle stimulating hormone luteinizing hormone and thyroxine. Serial measurement of estradiol and progesterone are used to assess spontaneous ovarian activity. Withdrawal bleeding after withdrawal of exogenous progesterone also indicates estrogenic status. Pituitar X-rays of anovulating women reveal tumor-mediated infertility. Anovulatory infertility may be the result of ovarian failure; gonadotropin failure (resulting from hyperprolactinemia, normoprolactinemia cases with tumors, or low gonadotropin secretion); polycystic ovary syndrome; and thyroid disease. Inadequate ovulation may result because of defective luteal phase; prolonged follicular phase; or failure of positive feedback mechanisms. Dynamic tests of pituitary-ovarian function include gonadotropin-releasing hormone, clomiphene, and estrogen provocation tests. Tests for inadequate ovulation require a control of measurements of normal women throughout the menstrual cycle to compare hormone concentrations of women affected by ovulation insufficiency rather than relying on preconceived normal values. It is preferable to compare at least the follicular phase of the cycle of infertile women with the same phase of fertilized cycles which resulted in successful pregnancies.