Reproduction&ContraceptionNormalprocessofpregnancyAman

hasnormalspermproductionandfunction→Thespermcanbesentintovagina→Thespermswimthroughcervicalcanal

→Capacitationandacrosomereaction→Betransportedtotheampullaryportionofthe

fallopiantube→Penetrationandfertilizationoftheoocytetake

placeAwomanhasnormaloocyteproduction→Ovulationoccurs→Theoocytebecollectedintofallopiantubebyfimbria→Fertilization→Thezygotedevelopintoblastocyst→Theblastocystbesentintouterinecavity→ImplantationNormalprocessofpregnancyFecundabilityTheprobabilityofachievingpregnancywithinasinglemenstrualcycleThefecundabilityofanormalcouplehasbeenestimatedat20%to25%About90%ofcouplesshouldconceiveafter12monthsofunprotectedintercourseEpidemiologyofinfertility

Morerecentpopulation-basedstudiesfrom2009and2012reportedahigherprevalenceofinfertilitywithestimatesrangingfrom

12%to24%

1.BushnikT,CookJL,YuzpeAA,etal.EstimatingtheprevalenceofinfertilityinCanada.Hum

Reprod27:738–746,2012.2.SlamaR,HansenOKH,DucotB,etal.Estimationofthefrequencyofinvoluntaryinfertilityonanation-widebasis.Hum

Reprod1489–1498,2012.3.BhattacharyaS,PorterM,AmalrajE,etal.TheepidemiologyofinfertilityintheNorthEastofScotland.Hum

Reprod24:3096–3107,2009.GeneralprinciplesInfertility:pregnancydoesnotresultafter1

yearofnormalsexualactivitywithoutcontraceptives.Classification:

Primaryinfertility:nopreviouspregnanciesof

anykind.

Secondaryinfertility:previouspregnancy,but

currentdifficultinconceiving.CausesofInfertilityFromCollinsJA.Unexplainedinfertility.InKeyeWE,ChangRJ,RebarRW,etal[eds].Infertility:EvaluationandTreatment.Philadelphia:WBSaunders,1995,p250Abnormalsemen:asthenospermia,oligospermia/azoospermiateratospermia

lowspermmotilitylowspermconcentrationnospermabnormalmorphologyAssociatedfactors:undescendedtestes,parotitis,testitis,smoking,excessivealcoholconsumption,environmentaltoxins,drugs,etc.

Abnormal

sexualfunction:

Immunologicfactor:antispermantibody(AsAb)erectiledysfunction,premature

ejaculation,retrogradeejaculation

MalefactorsCommondisordersMalefactor

istheonlycauseofinfertilityin20%ofinfertilecouples,butitmaybeacontributingfactorinasmanyas30%ofcases.CausesofinfertilityRaredisordersObstructionofductusdeferensAzoospermiaTesticulartraumaDamageofblood-testisbarrierEndocrinediseasesChromosomalabnormalityDisordersofpituitary,thyroid

oradrenalgland

Notcurable！MalefactorsCausesofinfertilityMalefactorCausesofinfertilityFemaleinfertility——femaleinternalgenetaliaCausesofinfertilityFemaleinfertility——DefectiveovulationAssociatedclinicalmanifestationsinclude:

oligomenorrhoea（Oligo-ovulation）

amenorrhoea（anovulation）

thepolycysticovarysyndrome(pcos)

hypogonadotrophichypogonadism

hyperprolactinaemiaItusuallyresultsfromareversibledysfunctionofsomepartoftheHPOaxis.Prematureovarianfailure(POF)istheirreversiblefailureofHPOaxis：FSH>40mIU/mlCausesofinfertilityFemaleinfertility——Pelvicinflammatorydisease(PID)Tubaldisease

Thefimbrialendsoftubeadheretogetherandbecomesealed.

Thedelicateliningofthefallopiantubesbedamagedbysexually

transmitteddisease.(suchaschlamydiaandgonrrhoea)Previouspelvicsurgery：Followingpelvicsurgery,adhesionsdevelopinapproximately75%ofwomen.

Appendicitis：Ahistoryofappendicitisappearstoincreasetheriskoftubalfactorinfertiliy.

SepticabortionCausesofinfertilityFemaleinfertility——EndometriosisItcausesmechanicaldistortionofthefallopiantubes.Itcausedestructionoftheovaries.Itcanalsoresultininfertilitythroughtheunknownexactmechanism.EndometrialpolypsIntrauterineadhesionsEndometritisortuberculosisCongenitalmalformationsUterinetumorsFemaleinfertility——uterinefactorsCausesofinfertilityCausesofinfertilityFemaleinfertility——cervicalfactorsChroniccervicitis(mostcommon)：Hostilecervicalmucus

Atthetimeofovulation,cervicalmucusbecomethinandwatery,thefavourablecervicalmucusenablesspermatozoatopenetratereadilythroughit.ThehostilecervicalmucusisunreceptivetospermatozoaTumorPolypsCongenitalmalformationCausesofinfertilityOthercausesofinfertilityare:PsychosexualproblemsImmunologicfactorsSystemicdiseasesUnexplainedinfertility:Alltestsoffertilityarenormal,butthecouplearestillhavingdifficultyinachievingapregnancy.Familyplanning——

basicpolicyofchinaoverviewThedifferentmethodsofcontraception:Intra-uterinedevices(IUD)HormonalBarriermethodsNaturalmethodsSterilizationIUDIUDIUDIUDModeofactionAasepsisandmildinflammatoryreactionintheendometrium.Achangeofthebiochemicalcircumstancesinuterinecavity,theviabilityofgametesisreduced,andbothfertilizationandimplantationareimpeded.Functionsoftheadditionalmateriale.g.copper;Progestogen(causesendometrialatrophy).IUDIndicationtotheIUD:

Thewomenofchildbearingagehavenocontraindications.(butthosewhohavenobabyshouldbecautious)IUDContraindicationstotheIUD:PregnancyUndiagnosedirregulargenitaltractbleedingPelvicinflammatorydiseasePreviousectopicpregnancyUterinemalformationGenitaltumorSeriousdysmenorrheaHysteroptosiaCervicalstenosesorflabbinessSeriousbodydiseaseetc.IUDFittingofIUD:Time:The3rdto7thdayaftermenstruation3monthsafterlabor.Halfayearaftercesareandelivery.IftheIUDcontainsprogestogen,thetimeisthe3rddayinmenstralphaseIUDFittingofIUD:Type:

IUDwithcopperspiralsIUDwithprogestogenIUDSideeffectsofIUD1.PainThereisusuallytransientpainoninsertion.Persistentpainmaysignifyadevicewhichistoolarge.Painwithpyrexiasignifiespelvicinfection.IUDSideeffectsofIUD2.BleedingMenstruallossmaybeheavierorirregularinthefirstfewmonthsafterinsertion.PersistentsymptomsshouldbetreatedandtheIUDshouldberemovedifthetreatmentshavenoeffects.Thecopper-containingoneandtheprogestogen-containingonehavelessofaproblem.HormonalmethodsofcontraceptionThecombinedoralcontraceptivepill(COC)themostpopularcontraceptiveforwomenundertheageof30years.Extremelyeffectiveiftakenregularlyusuallysuppliedinapackof21.The1stpillistakenonday1ofthecycle.Pillswillbetakeneverydayfor21days,followedbya7-daybreakbeforestartingonthenextpacket.mostwomenhaveawithdrawalbleedduringthebreak.HormonalmethodsofcontraceptionCOCModeofaction:TheCOCinhibitsovulation.TheCOCrenderscervicalmucushostiletosperm.TheCOCrenderstheendometriumunfavourableforimplantation.HormonalmethodsofcontraceptionCOCContraindications:ThromboembolicpredispositionIschaemicheartdiseaseFocalmigraineTransientischaemicattacksorstrokeHyperlipidaemiaHypertensionArteritisHormonalmethodsofcontraceptionCOCContraindications:DiabeteswitharterialorrenalcomplicationsHeavysmoking(orwomenovertheageof35yearswhosmoke)GrossobesityLiverdiseaseorimpairedliverfunctionBreastcancerUndiagnosedabnormalgenitaltractbleedingPregnancyHormonalmethodsofcontraceptionCOCContraindications:HyperprolactinaemiaNephritishyperthyroidismCarcinomaNurserPsychosisAge>45HormonalmethodsofcontraceptionCOCAdvantages:Thewomanhascompletecontrolofherowncontraception.Themodeofactionisunrelatedtotheactofsexualintercourse.Bothmenstrualbloodlossanddysmenorrhoeareduce.HormonalmethodsofcontraceptionCOCAdvantages:Changesinthecervicalmucusconferincreasedprotectionagainstpelvicinflammatory.Suppressionofovulationconfersprotectionagainstbenignovariancysts,ectopicpregnancy,benignbreastdisease,ovarianandendometrialcancer.HormonalmethodsofcontraceptionCOCSideeffects:NauseaHeadacheBreakthroughbleedingBreasttendernessHirsutism/acneWeightgainVaginaldrynessFacialskinpigmentationThesideeffectswouldbereducediftheCOCistakenafteramealorbeforesleepBarriermethodsofcontraceptionTheypreventcontactbetweenspermandovum.

Thearethemostwidelyusedcontraceptivemethodworldwide.Theycomprise:diaphragmspermicidesmalecondomfemalcondomBarriermethodsofcontraceptionAdvantages:

SafetyLowfailurerateusedcorrectlyProtectionagainstsexuallytransmittedinfectionReducedriskofcervicalepithelialneoplasiaDisadvantages:HighusermotivationrequiredMessyInterferencewithsexualintercourseBarriermethodsofcontraceptionDiaphragm:

Itshouldalwaysbeusedinconjunctionwithaspermicidalcreamorjelly.Spermicides:

Itshouldbeusedasadjunctstootherbarriermethodscomeascreams,jellies,pessariesandfoams.Malecondoms:

Bemadefromthinlatexrubberandareprelubricatedwithaspermicide.Femalecondoms:

Fewcouplesusethismethodonaregularbasis.BarriermethodsofcontraceptionMalecondomNaturalmethod