الفهرس 
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Abstract
SUMMARY UMMARY UMMARY
It is relatively simple to identify the cause of infertility in women with ovulatory disorders or tubal disease, and in men with semen abnormalities. These categories account for the source of infertility in approximately 75 percent of couples. Infertility in the remaining 25 percent of couples is due to endometriosis (8 percent) or miscellaneous factors (eg, cervical factor, immunological factor, uterine synechiae) (2 percent) or is unexplained (15 percent).
Unexplained infertility refers to the absence of a definable cause for a couple’s failure to achieve pregnancy after 12 months of attempting conception despite a thorough evaluation, or after six months in women 35 and older.
Causes of female infertility:
The most common identifiable female factors, which accounted for 81 percent of female infertility, were:
Ovulatory disorders (25 percent).
Endometriosis (15 percent).
Pelvic adhesions (12 percent).
Tubal blockage (11 percent).
Other tubal abnormalities (11 percent).
Hyperprolactinemia (7 percent).
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The epidemiology of prevalence and causes of male infertility has never been accurately assessed for many reasons, including underreporting and lack of systematic data gathering.
Categories:
The causes of male infertility can be divided into four main areas:
1. Endocrine and systemic disorders: (usually with hypogonadotropic hypogonadism) – 2 to 5 percent.
2. Primary testicular defects in spermatogenesis:
65 to 80 percent, of which the majority have idiopathic dysspermatogenesis, an isolated defect in spermatogenesis without an identifiable cause.
3. Sperm transport disorders: 5 percent.
4. Idiopathic male infertility:
10 to 20 percent. Idiopathic male infertility should be distinguished from idiopathic dysspermatogenesis. Idiopathic male infertility describes an infertile man with a normal seminal fluid analysis and no apparent cause for infertility, whereas infertile men with idiopathic dysspermatogenesis have abnormal seminal fluid analyses.
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History: The most important points in the history are:
Duration of infertility.
Menstrual history.
Medical, surgical, and gynecological history.
Obstetrical history.
Sexual history.
Family history.
Personal and lifestyle history.
Diagnostic tests:
In addition to the history and physical examination, the initial diagnostic evaluation consists of:
Semen analysis to detect male factor infertility.
Documentation of normal ovulatory function. Women with regular menses approximately every four weeks with molimina symptoms are almost always ovulatory.
A test to rule out tubal occlusion and assess the uterine cavity. We usually perform a hysterosalpingogram (HSG), which evaluates both the uterus and tubes, but laparoscopy with chromotubation combined with hysteroscopy may be more appropriate in women suspected of having endometriosis. Dilute methylene blue can be used for the chromotubation dye.
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A test or tests of ovarian reserve such as cycle day 3 follicle-stimulating hormone (FSH) or estradiol, clomiphene citrate challenge test, anti-müllerian hormone (AMH), or antral follicle count.
Risk factors noted from the couple’s history may indicate the need for additional testing after the initial infertility evaluation.
Preconceptional laboratory screening may also be undertaken at this time so these results can be used for diagnostic and therapeutic counseling. Genetic screening should be offered in accordance with risk as defined by ethnicity.
Ovulatory disorders can be identified in 18 to 25 percent of couples presenting with infertility. Most of these women have oligomenorrhea, arbitrarily defined as menstruation that occurs at intervals of 35 days to six months. While ovulation may occasionally occur, spontaneous conception is unlikely.
Women with anovulatory infertility:
The clinical approach to ovulation induction requires an understanding of the causes of anovulation. The four most common ovulatory disorders include hypogonadotropic hypogonadism (HA), polycystic ovary syndrome (PCOS), primary ovarian insufficiency (POI), and hyperprolactinemia. Most experts have moved away from the World Health
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Organization (WHO) terminology which assign women to three categories of anovulation:
WHO class 1: Hypogonadotropic hypogonadal anovulation (hypothalamic amenorrhea [HA])
WHO class 2: Normogonadotropic normoestrogenic anovulation (almost all women in this category have polycystic ovary syndrome [PCOS]), when using the Rotterdam criteria for the diagnosis of PCOS. This is the most common cause of anovulation.
WHO class 3: Hypergonadotropic hypoestrogenic anovulation (primary ovarian insufficiency [POI; premature ovarian failure])
The management of couples with unexplained infertility should balance the efficacy, cost, safety, and risks of various treatment alternatives. A common approach is to start with treatments that consume few resources and are patient-directed (eg, lifestyle changes or timed intercourse), and then move sequentially to treatments requiring proportionately greater resources (clomiphene citrate [CC] plus intrauterine insemination [IUI]), and finally to high-resource interventions (gonadotropin injections plus IUI, in vitro fertilization [IVF]). The approach to treatment should be individualized for each couple. In general, if a specific fertility treatment does not result in pregnancy after three cycles, alternative treatments should be considered.
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The aim of the work is to assess the accuracy of serum anti-müllerian hormone levels and antral follicle count in prediction of clinical pregnancy in women with unexplained infertility and undergoing ICSI cycles.
This is a retrospectively study in assisted reproductive technology unit at Maternity Hospital – Ain Shams University from August 2018 to June 2019. This study included 71 women with unexplained primary infertility in ART unit undergoing ICSI cycles. Simple random sampling.
By the results in AMH > 1.5 ng/ml has high sensitivity and NPV in prediction at twin pregnancy.
No significant difference according to AMH and chemical pregnancy.
The predictive value of AFC and AMH were similar to both clinical pregnancy and live birth.
No significant difference according to clinical pregnancy regarding AMH, age, BMI, Duration, AFC, FSH, LH, E2 and Prolactin TSH.