몇가지 정리.

1. Infertility의 요인 정리

• The physician's initial encounter with the infertile couple is the most important one because it sets the tone for subsequent evaluation and treatment. Factors from either or both partners may contribute to difficulties in conceiving; therefore, it is important to consider all possible diagnoses before pursuing invasive treatment..
• The main causes of infertility include male factor, decreased ovarian reserve, ovulatory disorders (ovulatory factor), tubal injury, blockage, or paratubal adhesions (including endometriosis with evidence of tubal or peritoneal adhesions), uterine factors, systemic conditions (including infections or chronic diseases such as autoimmune conditions or chronic renal failure), cervical and immunologic factors, and unexplained factors (including endometriosis with no evidence of tubal or peritoneal adhesions).
• The basic investigations that should be performed before starting any infertility treatment are semen analysis, confirmation of ovulation, and the documentation of tubal patency.
• Male factor is the only cause of infertility in 20% of infertile couples, but it may be a contributing factor in as many as 30% to 40% of cases. Treatment of reversible endocrine or infectious causes of subfertility, such as sexually transmitted diseases and thyroid disorders, tends to be efficacious. Intrauterine insemination (IUI) is the best studied and most widely practiced of all the insemination techniques. Intracytoplasmic sperm injection (ICSI) has allowed couples with male factor infertility to achieve assisted reproductive technologogy (ART) pregnancy outcomes that are comparable with those of couples with non-male factor infertility using conventional in vitro% fertilization (IVF) treatment..
• An association between the age of the woman and reduced fertility has been well documented. The decline in fecundability begins in the early 30s and accelerates during the late 30s and early 40s..
  
  
  
  
• Disorders of ovulation account for about 30% to 40% of all cases of female infertility. These disorders are generally among the most easily diagnosed and most treatable causes of infertility..
• The most common cause of oligo-ovulation and anovulation-both in the general population and among women presenting with infertility as polycystic ovarian syndrome (PCOS)..
• Tubal and peritoneal factors account for 30% to 40% of cases of female infertility. Cervical factor is estimated to be a cause of infertility in no more than 5% of infertile couples. Uterine pathologies constitute the etiologic factor in infertility in as many as 15% of couples seeking treatment and are diagnosed in as many as 50% of infertile patients. Leiomyomas have not been shown to be a direct cause of infertility..
• All methods of ART, by definition, involve interventions to retrieve oocytes. These techniques include IVF, ICSI, gamete intrafallopian transfer (GIFT), zygote intrafallopian transfer (ZIFT), cryopreserved embryo transfers, and the use of donor oocytes. Because of improved success rates associated with IVF embryo transfer, the performance of GIFT and ZIFT has declined..
• Multiple gestation, especially higher multiple gestation, is a serious complication of infertility treatment and has tremendous medical, psychological, social, and financial implications.
• Fortunately, recent studies have not shown an increased risk for breast, uterine, or ovarian cancer secondary to medications used for superovulation in the treatment of infertility..
• Information on the Society for Assisted Reproductive Technology (SART) and registered ART clinics are accessible by the public at http://www.sart.org..

• Male factor.
• Decreased ovarian reserve.
• Ovulatory disorders (ovulatory factor).
• Tubal injury, blockage, or paratubal adhesions (including endometriosis with evidence of tubal or peritoneal adhesions).
• Uterine factors.
• Systemic conditions (including infections or chronic diseases such as autoimmune conditions or chronic renal failure).
• Cervical and immunologic factors.
• Unexplained factors (including endometriosis with no evidence of tubal or peritoneal adhesions).

1. Male factor - 정액 이상, 정계정맥류, 무정자증- 

pretesticular : hypogonadotropic hypogonadism, coital dysfunction

testicular : gonadal failure(genetic, congenital, infective, antispermatogenic)

posttesticular : obstructive, vascular, immunologic

2. Female factor - 난소인자, 난관 및 복막 인자, 자궁경부 및 면역학적 인자, 자궁 인자

난소인자 : ovulatory dysfunction(PCOS)

난관 및 복막인자 : PID, Endometriosis

자궁경부 및 면역학적 인자 : 자궁경관 점액이상, 항정자 항체

자궁인자 : 자궁기형, 자궁근종, 자궁내막폴립, 자궁 내 유착증