quinta-feira, 2 de setembro de 2010

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Publicação no New England Journal of Medicine - 2 de setembro de 2010.


Teaching Topic
Clinical Problem-Solving
Hard to Conceive
J.H. Levison and Others

In the United States, approximately 10% of women of reproductive age have received infertility treatment. Among these cases of infertility, about 50% are attributed to female factors, and 25% to male factors; 25% are unexplained.
Clinical Pearls
How is infertility diagnosed?
Infertility is defined as the inability to conceive after 1 year of regular unprotected intercourse. Within the first year of attempted conception, 80 to 90% of couples conceive, and after 2 years 95% conceive.

What are the most common causes of infertility?
Three quarters of infertility cases have an identifiable cause; the rest are designated as “unexplained.” The majority of cases of female infertility result from disorders of ovulation or the fallopian tubes; other causes include endometriosis, cervical defects, and uterine abnormalities. The predominant cause of male infertility is a low number of functional sperm in the ejaculate.

Morning Report Questions
Q. What initial diagnostic evaluation is recommended for the infertile couple?
A. The initial diagnostic evaluation should include semen analysis, documentation of ovulation, and hysterosalpingography to evaluate the uterine cavity and tubal patency.

Q. What is the most common cause of fallopian tube blockage?
A. Distal tubal blockage most commonly results from pelvic inflammatory disease and salpingitis; the most common causes include infection with C. trachomatis or N. gonorrhea, but blockage can also result from mixed infection with mycoplasma, ureaplasma, and fecal coliform species and from mycobacterial infections — notably, Mycobacterium tuberculosis.