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Pelvic Factor Tutorial Normal human reproduction requires a mature sperm to meet and fertilize a mature egg within the female reproductive tract (usually the fallopian tube). The fertilized egg (pre-implantation embryo) grows to become a multi-cellular "blastocyst," hatches from its "shell" (a soft gel like shell called the zona pellucida), adheres to the uterine lining (endometrium) and implants into the uterus. The implanted embryo then connects and communicates with the female host (pregnant woman) through blood vessels that are developed, from which it can then obtain nutrients and release metabolic waste products. Pelvic factor infertility refers to any structural (anatomic) abnormality that limits or prevents the mature sperm and mature egg from meeting and developing into a normal pregnancy. In this pelvic factor tutorial, the mechanical events that must occur for normal human reproduction are reviewed and discussed by Dr. Eric Daiter.
The normal events that allow fertilization (of the mature sperm and mature egg) and implantation (of the subsequent pre-implantation embryo) are active areas of medical research. Dr. Daiter reviews pelvic factor abnormalities that can reduce the chances for successful pregnancy, including mechanical barriers that limit the release of a mature egg (from the ovary and its subsequent entry into the fallopian tube) or the release of a mature sperm (from the testis and their subsequent entry into the female reproductive tract), cervical mucus abnormalities that reduce viability of sperm, and anatomic abnormalities of the pelvis (such as endometriosis symptoms or pelvic adhesions) or uterus that limit normal fertilization and implantation. Dr. Daiter discusses the available diagnostic tests to detect a pelvic factor problem, including the sensitivity and specificity of the screening semen analysis, sterile speculum exam, postcoital test, hysterosalpingogram, sonohysterogram, endometrial biopsy and pelvic evaluation (laparoscopy and hysteroscopy). There are a number of different locations where pelvic abnormalities may reduce fertility, each with their own treatment alternatives. Dr. Daiter describes the anatomic problems involving the male outflow tract, the vaginal vault, the cervix, the uterus, the fallopian tubes, pelvic endometriosis, and pelvic adhesions. The clinical evaluation for pelvic factor infertility that Dr. Daiter employs in his practice at The New Jersey Center for Fertility and Reproductive Medicine is presented. The questions asked to obtain a thorough history and a description of the procedures involved with the postcoital test, hysterosalpingogram, sonohysterogram, and pelvic evaluation (laparoscopy and hysteroscopy) are provided. The treatment options for pelvic factor abnormalities are based primarily on the type of problem identified. Dr. Daiter reviews these treatments, including intrauterine inseminations, controlled ovarian hyperstimulation, surgery, and In Vitro Fertilization (IVF). | |||||||||||||||||||||
