Gynecological Surgery

Surgical treatments for female infertility

The female factors of infertility can best be discussed as they affect these various stages.

PHYSIOLOGICAL FACTORS ININFERTILITY:

(1) Reproductive power. Apparently healthy individuals differ widely in reproductive power.

(2) Age. Duncan in 1884 showed that the maximum fertility was between the ages of 20 and 24 years and that after 39 years fertility declined very rapidly.

(3) Stage of menstrual cycle-Fertility varies greatly according to the stage of the menstrual cycle, and there is evidence that the ovum after ovulation remains capable of fertilisation for a few hours only.

INTERFERENCE WITH UNION OF OVUM & SPERM.

(A) Vulva & Vagina.

(1) Thickened hymen.

(2) Congenitally small vaginal introit us and vaginal strictures.

(3) Other causes of Dyspareunia Vulvitis, vaginitis, veganism’s inflammation of Bartholin's glands. Urethral caruncle.

(B) Cervical barriers:-these are primarily Physiological.

(1) Abnormal cervical mucus. The character of the cervical mucus may be altered by an unhealthy

Cervix as evidenced by endocervicitis, erosion or polypi. The mucus becomes purulent and is inimical to the spermatozoa.

(C) Uterine conditions.

(1) Displacement-Mobile retroverted uteri are not a significa11t cause Of sterility. Fixed retroversions, however, which are associated with chronic salpingitis, pelvic peritonitis, or endometriosis, are a common cause of sterility.

(2) Uterine Fibromyomata are found in 3 to 50, 1" of women complaining of infertility.' According to Read, cornual or submucous tumours may cause infertility by occlusion of the tubes, distortion and enlargement of the uterine cavity and their association with chronic endometrial hyperplasia.

(3) Hypoplasia of the uterus associated with hypoplasia of the vagina, cervix and ovaries is an important cause of sterility, all the more so, because in some cases it may be prevented. The cause may be anything that retards the growth of the endocrine glands during embryonic life, infancy, childhood or puberty.

(4) Disordered uterine action. Attention was first drawn to the relation of this functional disturbance

To infertility by Stall worthy, who described the female genital tract as the most hysterical portion of a woman's anatomy. This is manifested in undue uterine and tubal irritability, as can be emonstrated by tubal insufflation of hysterosalpingography,

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